TY - JOUR AU - Badawi, Abeer AU - Elmoghazy, Somayya AU - Choudhury, Samira AU - Elgazzar, Sara AU - Elgazzar, Khalid AU - Burhan, M. Amer PY - 2025/7/15 TI - Multimodal Detection of Agitation in People With Dementia in Clinical Settings: Observational Pilot Study JO - JMIR Aging SP - e68156 VL - 8 KW - dementia KW - agitation KW - artificial intelligence KW - wearable sensors KW - video detection KW - multimodal sensing N2 - Background: Dementia is a progressive neurodegenerative condition that affects millions worldwide, often accompanied by agitation and aggression (AA), which contribute to patient distress and increased health care burden. Existing assessment methods for AA rely heavily on caregiver reporting, introducing subjectivity and inconsistency. Objective: This study proposes a novel, multimodal system for predicting AA episodes in individuals with severe dementia, integrating wearable sensor data and privacy-preserving video analytics. Methods: A pilot study involving 10 participants was conducted at Ontario Shores Mental Health Institute. The system combines digital biomarkers collected from the EmbracePlus (Empatica Inc) wristband with video-based behavioral monitoring. Facial features in video frames were anonymized using a masking tool, and a deep learning model was used for AA detection. To determine optimal performance, various machine learning and deep learning models were evaluated for both wearable and video data streams. Results: The Extra Trees model achieved up to 99% accuracy for personalized wristband data, while the multilayer perceptron model performed best in general models with 98% accuracy. For video analysis, the gated recurrent unit model achieved 95% accuracy and 99% area under the curve, and the long short-term memory model demonstrated superior response time for real-time use. Importantly, the system predicted AA episodes at least 6 minutes in advance in all participants based on wearable data. Conclusions: The findings demonstrate the system?s potential to autonomously and accurately detect and predict AA events in real-time. This approach represents a significant advancement in the proactive management of behavioral symptoms in dementia care. UR - https://aging.jmir.org/2025/1/e68156 UR - http://dx.doi.org/10.2196/68156 ID - info:doi/10.2196/68156 ER - TY - JOUR AU - Lau, Y. Cheryl W. AU - Kupiec, Klaudia AU - Livermore, Polly PY - 2025/7/1 TI - Exploring the Acceptance and Opportunities of Using a Specific Generative AI Chatbot to Assist Parents in Managing Pediatric Rheumatological Chronic Health Conditions: Mixed Methods Study JO - JMIR Pediatr Parent SP - e70409 VL - 8 KW - pediatric health care chatbot KW - technology acceptance KW - parental attitudes KW - children and young people's involvement KW - chronic disease management KW - AI hesitancy KW - chronic health condition KW - artificial intelligence N2 - Background: Health care chatbots can be used to support patients and their families with everyday decision-making. While there is some research on integrating artificial intelligence into pediatric care, no study has focused on the opportunity of implementing a generative artificial intelligence chatbot for pediatric rheumatology. Pediatric rheumatology conditions require intense family input, which can often leave families struggling to navigate disease flares, pain, fatigue, medication side effects and adherence, and support of their child, often when pediatric rheumatology departments are shut. Understanding how we can support families better, without the need for increased personnel, will have implications for the health care systems. Objective: The study aimed to explore parental and children and young people?s acceptance of chatbot use in a pediatric context, and understand how a chatbot could be specifically used for managing a child?s chronic health condition. Methods: This study was a mixed methods design, using both a family workshop and a subsequent questionnaire. Results: In total, 22 participants contributed to the qualitative design using the world café methodology at a workshop, and 47 participants (36 parents and 11 children and young people) completed quantitative data via a questionnaire. Participants expressed their likelihood of using chatbot technology, including ChatGPT, due to its accessibility. However, participants had significantly greater intention (parents: P<.001; children and young people: P=.006) to use a specific chatbot over ChatGPT, due to increased trust, credibility, and specificity in design. Children and young people and parents should be distinguished as 2 user groups in chatbot design, reflecting their specific needs in chatbot features and personalization. Conclusions: Overall, the study reinforced the need for a specialized and trusted chatbot designed with input from health professionals to assist families in managing complex chronic health conditions to support families in between appointments and complement existing face-to-face care. Future research should evaluate users? engagement with a functional prototype to investigate its usefulness and explore its implementation into families? everyday lives. Importantly, the current findings have broader implications for the field of pediatric health care, as similarly tailored chatbot interventions could benefit families who are managing other chronic health conditions. UR - https://pediatrics.jmir.org/2025/1/e70409 UR - http://dx.doi.org/10.2196/70409 ID - info:doi/10.2196/70409 ER - TY - JOUR AU - Choi, Seongmi AU - Kang, Hun AU - Shin, Jiyoung AU - Chu, Hui Sang AU - Choi, JiYeon PY - 2025/6/17 TI - Ecological Momentary Assessment to Measure Social Connectedness in Older Adults: Integrative Review JO - J Med Internet Res SP - e66324 VL - 27 KW - aged KW - social connectedness KW - ecological momentary assessment KW - review KW - mobile phone N2 - Background: The importance of social connectedness as a determinant of health and well-being in older adults is well-established. Ecological momentary assessment (EMA) shows promise for real-time measurement of social interactions, making it worthwhile to investigate its feasibility and the challenges of applying it to older adults. Objective: This integrative review aimed to (1) summarize and integrate the implementation of EMA in assessing older adults? social connectedness, and (2) discuss the EMA method and its use to assess the concept of social connectedness in order to guide future research. Methods: A total of 5 databases?PubMed, CINAHL, Embase, Web of Science, and PsycINFO?were searched for studies published up to March 2025. We included studies that (1) targeted adults aged 60 years or older, (2) used EMA to assess social connectedness, and (3) were published in a peer-reviewed journal. Studies using third-party reports to obtain EMA data and studies focusing on marital dyads were excluded. The analysis identified multifactorial constructs of social connectedness (structural, functional, and quality) and assessed EMA protocols and compliance or adherence to EMA. Results: Of the 18,886 studies identified, 43 were selected for final analysis. Social connectedness assessed via EMA mostly focused on the structural dimension, capturing whether an individual had social contact at a given moment (38/43, 88%). Among functional dimension (17/43, 40%), loneliness was the most measured construct, and the quality dimension (16/43, 37%) included quality of social interaction, pleasantness of encounters, and interpersonal tensions. In total, 2 studies addressed all 3 dimensions of social connectedness. In addition, to provide context for understanding social connectedness, assessments considered location at the time of assessment, type of activity, and physical (eg, pain and fatigue) and psychological states (eg, positive or negative mood). Data were mostly collected using an app on digital devices (eg, smartphone), and assessments were conducted 1-7 times per day for 5 to 25 days, achieving a compliance rate of over 70%. Conclusions: The findings of this study highlight the current state of science in measuring social connectedness in older adults through EMA and demonstrate its feasibility in real-world settings. Further research is suggested to address the conceptual and methodological challenges of EMA, as measurement of multifactorial constructs of social connectedness and standardization of EMA protocols may increase the likelihood of capturing useful information about older adults? real-time social connectedness. Trial Registration: PROSPERO CRD42024499050; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024499050 UR - https://www.jmir.org/2025/1/e66324 UR - http://dx.doi.org/10.2196/66324 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/66324 ER - TY - JOUR AU - Cuppen, Sharon AU - van Leunen, Mayke AU - Henken, Tamara AU - Goevaerts, Mayra AU - Scherrenberg, Martijn AU - Falter, Maarten AU - Dendale, Paul AU - Kemps, Hareld AU - Kop, J. Willem PY - 2025/6/12 TI - Association of Technology-Related Skills and Self-Efficacy With Willingness to Participate in Heart Failure Telemonitoring: Cross-Sectional Observational Study JO - JMIR Form Res SP - e68992 VL - 9 KW - heart failure KW - telemonitoring KW - participating in telemonitoring KW - technological skills KW - technological self-efficacy KW - technological learnability N2 - Background: The adoption of telemonitoring in patients with heart failure (HF) is influenced by technology-related skills and self-efficacy, as well as psychological, clinical, and demographic factors. However, the relative importance of these factors with regard to willingness to use telemonitoring is insufficiently understood. Objectives: This cross-sectional observational study examines the extent to which technology-related skills and self-efficacy are related to willingness to participate in telemonitoring in patients with HF. Methods: Patients completed questionnaires during hospitalization. Associations of technological skills and self-efficacy with willingness to participate in telemonitoring (dichotomous and continuous scale) were examined using regression models. Mediation-moderation analyses were used to investigate the role of self-efficacy in the association of technological skills with willingness to participate. Results: This study recruited 61 patients admitted for decompensated HF (mean age 79.9, SD 9.5 years; 24 women). Higher levels of technological skills were associated with higher willingness to participate in telemonitoring (odds ratio [OR] 1.073 per scale unit, 95% CI 1.031-1.117). Technological self-efficacy and learnability were also related to willingness to participate (OR 1.141, 95% CI 1.039-1.252; OR 1.029, 95% CI 1.006-1.052) but did not mediate the association of technological skills with willingness to participate in telemonitoring. Psychological factors (anxiety, depressive symptoms, and perceived social support), age, and cognitive and physical functioning did not moderate the association of technological skills with willingness to participate in telemonitoring. Conclusions: Technological skills, self-efficacy, and learnability are interrelated factors that need to be considered in patients with HF who are eligible for telemonitoring. Future intervention studies that target these factors could increase patients? willingness and competence in using telemonitoring after admission for HF. UR - https://formative.jmir.org/2025/1/e68992 UR - http://dx.doi.org/10.2196/68992 ID - info:doi/10.2196/68992 ER - TY - JOUR AU - Mariscal, Angel Miguel AU - Garcia, Celeste AU - Zavala, Lily AU - Ramirez, Magaly PY - 2025/6/10 TI - Culturally Adapted STAR-Caregivers Virtual Training and Follow-Up for Latino Caregivers of People Living With Dementia: Single-Arm Pre-Post Mixed Methods Study JO - JMIR Aging SP - e66053 VL - 8 KW - dementia KW - gerontology KW - geriatric KW - older person KW - aging KW - Latina KW - Latino KW - caregiver KW - symptom management KW - digital technology KW - digital intervention KW - digital health application KW - pilot study N2 - Background: Latino caregivers are at an increased risk of negative health outcomes due to the responsibilities of caring for someone with dementia. Although interventions exist to address caregiver burden, they often do not meet the cultural needs of Latino caregivers. Objective: This study aimed to pilot test the cultural adaptation of the STAR-Caregivers Virtual Training and Follow-Up (STAR-VTF) intervention. The intervention is an evidence-based training program designed to teach family caregivers strategies to manage behavioral and psychological symptoms of dementia (BPSD). Our research team has conducted past studies to identify and perform culturally relevant adaptations to the training modules of STAR-VTF, and this study aimed to pilot these culturally adapted modules with a sample of Latino caregivers. Methods: Data on feasibility, usability, and acceptability were collected from a pilot test in which Latino caregivers (n=16) used the training modules of the STAR-VTF intervention over a 7-week period. Participants completed usability surveys following the completion of each module, and acceptability was assessed through semistructured interviews (n=14) postintervention. Preliminary outcome measures were also collected, and a descriptive analysis was conducted. The primary outcomes were the Revised Memory and Behavior Problem Checklist (RMBPC) and the Preparedness for Caregiving Scale. Results: The pilot study results suggest that it is feasible to deliver the culturally adapted STAR-VTF intervention to Latino caregivers, with 94% (15/16) of participants maintaining enrollment through intervention completion. The intervention?s usability was found to be ?good? based on an average System Usability Score of 76.7 out of 100 across all training modules. Caregivers were generally satisfied with the training modules. In addition, preliminary outcome results demonstrated a trend of decreased BPSD pre- versus postintervention (RMBPC subscale score: 28.24 to 21.34). Findings also demonstrated decreased caregiver reaction to BPSD pre- versus postintervention (RMBPC subscale score: 40.40 to 37.21) and increased caregiver preparedness based on pre- and postintervention (Preparedness Caregiving Scale score: 1.98 to 2.43). Conclusions: The pilot study demonstrated that the culturally adapted STAR-VTF intervention is feasible and perceived as easy to use by a small sample of Latino caregivers. We aim to refine the cultural adaptations of the STAR-VTF intervention further based on feedback from study participants. Future studies are necessary to test the efficacy of the intervention and support the broad dissemination of the culturally adapted intervention. UR - https://aging.jmir.org/2025/1/e66053 UR - http://dx.doi.org/10.2196/66053 ID - info:doi/10.2196/66053 ER - TY - JOUR AU - Gabb, Grace Victoria AU - Blackman, Jonathan AU - Morrison, Hamish AU - Li, Haoxuan AU - Kendrick, Adrian AU - Turner, Nicholas AU - Greenwood, Rosemary AU - Biswas, Bijetri AU - Heslegrave, Amanda AU - Coulthard, Elizabeth PY - 2025/5/28 TI - Longitudinal Remote Sleep and Cognitive Research in Older Adults With Mild Cognitive Impairment and Dementia: Prospective Feasibility Cohort Study JO - JMIR Aging SP - e72824 VL - 8 KW - feasibility KW - sleep KW - remote study design KW - mild cognitive impairment KW - dementia KW - electroencephalography KW - actigraphy KW - saliva KW - digital biomarkers N2 - Background: Sleep holds promise as a modifiable risk factor for neurodegenerative diseases and dementia. Clinical trials to modify sleep in people at risk of or in the early stages of dementia are needed. Monitoring natural sleep from home could support pragmatic and decentralized large-scale clinical trials. However, whether longitudinal sleep research can be successfully delivered remotely in this population has not been established yet. Objective: We investigated the feasibility of remote longitudinal research using wearable devices, web-based cognitive tasks, and a smartphone app to record sleep and cognition in older adults with mild cognitive impairment (MCI) or dementia. Methods: Older adults with MCI or dementia due to Alzheimer disease or Lewy body disease and cognitively healthy participants completed at-home sleep and circadian monitoring (digital sleep diaries, actigraphy, wearable sleep electroencephalography, and saliva samples) and digital cognitive assessments for 8 weeks. Feasibility outcomes included recruitment, retention, and data completeness. Results: In total, 41 participants consented (n=10, 24% participants with Alzheimer disease; n=11, 27% participants with Lewy body disease; and n=20, 49% controls). There were predominantly male and White British participants, with a mean age of 70.9 (SD 5.9) years. Retention was very high, with 40 (98%) participants completing 8 weeks of remote monitoring. Data completeness for sleep electroencephalography was 91% and ranged from 79% to 97% for all remote tasks and was overall high across all participant subgroups. In total, 30% (12/40) of participants reported receiving external support with completing study tasks. Conclusions: High rates of retention, data completeness, and data quality suggested that longitudinal multimodal sleep and cognitive profiling using novel and remote monitoring technology is feasible in older adults with MCI and dementia and healthy older adults, even without study partner support. Remote monitoring should be considered for mechanistic and interventional trials. Careful consideration should be given to how to ensure remote monitoring technologies reduce burden and enhance inclusivity, particularly in communities traditionally underserved by research and those with lower digital literacy. International Registered Report Identifier (IRRID): RR2-10.2196/52652 UR - https://aging.jmir.org/2025/1/e72824 UR - http://dx.doi.org/10.2196/72824 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/72824 ER - TY - JOUR AU - Kokorelias, M. Kristina AU - Wasilewski, B. Marina AU - Valentine, Dean AU - Eaton, D. Andrew AU - Dove, Erica AU - Brown, Paige AU - McKinlay, Stuart AU - Sheppard, L. Christine AU - Su, Esther AU - Singh, K. Hardeep AU - Flanagan, Ashley AU - Zhabokritsky, Alice AU - Abdelhalim, Reham AU - Parpia, Rabea AU - Zewude, Rahel AU - Jamieson, Laura AU - Walmsley, Sharon AU - Sirisegaram, Luxey PY - 2025/5/27 TI - Socioculturally Appropriate Internet-Based Geriatric Care Model for Older Adults Living With HIV: Experience-Based Co-Design Approach JO - JMIR Aging SP - e67122 VL - 8 KW - older adults KW - HIV KW - virtual care KW - co-design KW - qualitative research N2 - Background: Older adults living with HIV face challenges accessing regular geriatric care, and while virtual care services could offer a solution, they may come with limitations. Objective: This study aimed to co-design a culturally appropriate virtual care model tailored to older adults? needs using the experience-based co-design methodology. Methods: We used a qualitative, experience-based co-design approach with 19 older adults living with HIV. The process involved 3 phases: identifying needs through interviews and questionnaires, codeveloping a care model prototype through focus groups and a workshop, and refining the model using feedback from a world café format. Data were analyzed using thematic content analysis. Results: The co-design process led to a virtual care model prototype that directly addressed participants? key needs. These included personalized communication methods, simplified technology interfaces for easier access, and culturally responsive care practices. Participants emphasized the importance of privacy in virtual consultations, flexible scheduling to accommodate health fluctuations, and ongoing support for managing both HIV and aging-related conditions. Their feedback shaped a model designed to bridge service gaps, offering a more inclusive, accessible, and patient-centered approach to virtual geriatric care. Conclusions: This study co-designed a potential virtual geriatric care model grounded in the experiences of older adults living with HIV. By integrating participants? insights throughout the design process, the model offers a promising approach to improving care for this vulnerable population. Future directions for research to test this model are proposed. UR - https://aging.jmir.org/2025/1/e67122 UR - http://dx.doi.org/10.2196/67122 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/67122 ER - TY - JOUR AU - Neumann, Ariana AU - König, Hans-Helmut AU - Hajek, André PY - 2025/5/26 TI - Determinants of Having Online Health Consultations During the COVID-19 Pandemic Among Middle-Aged and Older Adults in Germany: Representative Longitudinal Survey Study JO - JMIR Aging SP - e60311 VL - 8 KW - telemedicine KW - digital health KW - remote consultation KW - health services for the aged KW - patient acceptance of health care KW - COVID-19 N2 - Background: During the COVID-19 pandemic, telemedicine services represented a widely implemented alternative to in-person doctor and therapist appointments. Consequently, rates of telemedicine use rapidly increased worldwide, also in Germany. Research regarding longitudinal determinants of telemedicine use is needed, particularly from nationally representative German samples, to improve understanding of the use behavior of major target groups such as middle-aged and older adults. Objective: This study aimed to longitudinally investigate determinants of online health consultation use among middle-aged and older individuals during the COVID-19 pandemic in Germany. Methods: Nationally representative longitudinal data of German middle-aged and older adults (?46 years old) were taken from the German Ageing Survey (DEAS). Data from the Compact Survey (conducted between June and July 2020) and wave 7 (conducted between November 2020 and March 2021) of the DEAS were observed (pooled analytic sample N=5456). Having experienced consultations with doctors or therapists on online platforms served as the outcome measure. Associations with socioeconomic, health- and health behavior?related, psychological, and COVID-19?related determinants were tested using random effects logistic regressions. Results: In our sample, 49% (2673/5456) of participants were female and the mean age of the participants was 67.8 (SD 9.4) years. Past experience with online health consultations was reported by 10.3% (561/5456) of the sample. Online health consultation use was associated with high education (OR 1.43, 95% CI 1.06?1.93; P=.02), poor self-rated health (OR 0.60, 95% CI 0.49?0.75; P<.001), and higher frequency of physical activity (reference: low frequency; medium frequency: OR 1.58, 95% CI 1.15?2.17; P=.005; high frequency: OR 1.73, 95% CI 1.09?2.76; P=.02). Moreover, greater levels of loneliness (OR 1.43, 95% CI 1.06?1.93; P=.04) and life satisfaction (OR 1.33, 95% CI 1.02?1.73; P=.04) as well as perceiving the COVID-19 crisis as a greater personal threat (OR 1.08, 95% CI 1.01?1.15; P=.02) were associated with having online health consultations during the COVID-19 pandemic. Conclusions: Online health consultation use does not seem to be exclusively associated with the health of middle-aged and older patients. Study findings emphasize the longitudinal association of education and psychosocial factors as well as health factors with telemedicine use during the COVID-19 pandemic in Germany. This knowledge may help to improve and adapt services to this patient group, which could contribute to higher utilization rates in the future. Future studies are needed to verify these initial findings under postpandemic circumstances and across different countries. UR - https://aging.jmir.org/2025/1/e60311 UR - http://dx.doi.org/10.2196/60311 ID - info:doi/10.2196/60311 ER - TY - JOUR AU - Chau, Hing Pui AU - Cheung, Ting Denise Shuk AU - Kwok, Yan Jojo Yan AU - Chan, Chi Wai AU - Yu, Fung Doris Sau PY - 2025/5/16 TI - Online Group?Based Dual-Task Training to Improve Cognitive Function of Community-Dwelling Older Adults: Randomized Controlled Feasibility Study JO - JMIR Aging SP - e67267 VL - 8 KW - cognitive training KW - dual-task KW - co-design KW - online KW - older adults KW - Hong Kong N2 - Background: Cognitive training for older adults is crucial before cognitive impairment emerges. During periods of social distancing like the COVID-19 pandemic, cognitive stimuli are lacking. Online dual-task training is proposed as a solution to address these needs. Objective: We aimed to explore the feasibility, acceptance, and potential effects of online group-based dual-task training as an intervention for enhancing cognitive function among community-dwelling older adults. Methods: A randomized controlled feasibility study was conducted with 76 participants in Hong Kong, randomly assigned to the intervention and attention control groups in a ratio of 2:1 (n=50, 66% and n=26, 34%, respectively). The intervention group underwent 60-minute online dual-task training sessions twice a week for 12 weeks, incorporating cognitive components (upper limb and finger movement, arithmetic operation, and verbal fluency) and physical components (chair-based exercises) developed through a co-design approach. The attention control group received online health talks. Outcomes related to feasibility and acceptance included class attendance and self-reported satisfaction. Main outcomes related to potential effects included the Memory Inventory in Chinese and the Montreal Cognitive Assessment 5 Minutes (Hong Kong Version) at baseline, 6 weeks (midintervention), 12 weeks (postintervention) and 18 weeks (follow-up). Descriptive statistics and linear mixed effects models were used. Effect size was described with Cohen d. Qualitative feedback was collected from 12 informants and analyzed by thematic analysis. Results: About 72% (36/50) of the participants in the intervention group and 62% (16/26) in the control group attended over 75% of the classes. In total, 44 (88%) participants from the intervention group provided acceptance feedback; 82% (36/44) were satisfied and 84% (37/44) would recommend the training to others. Improvement in the Memory Inventory in Chinese score in the intervention group was observed at midintervention, postintervention, and follow-up, with a medium-to-large effect size (d=0.65, 0.43 and 0.85, respectively). Adjusting for baseline values, the between-group differences in the Montreal Cognitive Assessment 5 Minutes (Hong Kong Version) score attained a small-to-medium effect size at midintervention (d=0.34) and postintervention (d=0.23). Qualitative feedback highlighted the timesaving and convenient aspects of online dual-task training, with participants finding the sessions challenging and enjoyable, and reporting benefits across cognitive, physical, and psychosocial domains. However, a preference for traditional in-person training was noted among the older adults despite the advantages of online training. Conclusions: Online dual-task training is a feasible intervention accepted by the older adults, with potential benefits in cognitive abilities. Online training may complement in-person sessions. Further investigation in a full-scale randomized controlled trial is warranted to comprehensively explore its effects and address areas for improvement. Trial Registration: ClinicalTrials.gov NCT05573646; https://clinicaltrials.gov/study/NCT05573646 UR - https://aging.jmir.org/2025/1/e67267 UR - http://dx.doi.org/10.2196/67267 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/67267 ER - TY - JOUR AU - Post, Dannielle AU - Whitson, Kathleen AU - Parfitt, Gaynor PY - 2025/5/12 TI - Implementation of New Technologies in an Aged Care Social Day Program: Mixed Methods Evaluation JO - JMIR Aging SP - e60297 VL - 8 KW - aged care KW - older adults KW - interactive robots KW - social engagement KW - evaluation KW - geriatric KW - robot KW - day program KW - perception N2 - Background: Australia?s aging population is looking to age in place, accessing care alternatives external to the traditional model of residential aged care facilities. This evaluation is situated in a Social Day Program, delivered by an aged care organization. It is designed to cater for people living with dementia, located in an environment equipped with new technologies including age-specific interactive computer gaming, social robots, sensory stimulation, and virtual reality. The technologies are designed to support older adults, enabling them to stay connected and maintain physical and cognitive functioning, independence, and quality of life. Objective: This project aimed to undertake a multifaceted evaluation of the implementation of the new technologies, including an exploration of the barriers and enablers to uptake. The key issue is how to enhance the potential for optimizing the use of these technologies in the Social Day Program environment, to help inform decision-making regarding the implementation of these technologies at the organization?s other sites, and future investment in such technologies by aged care organizations generally. Methods: Observation of technology use within the organization was conducted over a 16-week period. Surveys and semistructured interviews were used to collect information from staff related to their experiences with the technology. Thematic analysis was used to analyze the interviews. Data were triangulated across the sample. Results: Forty-eight observation periods were completed, totaling 126.5 observation hours. Technology use by clients was observed on 24 occasions, for 22 (17.4% of the observation time) hours. Nineteen staff completed surveys. Nearly three-quarters (n=14) of the staff perceived there to be barriers to the clients? use of technology, and 18 (95%) staff reported that they assisted clients to use the technology. Ten (53%) staff reported receiving training to use the technology and feeling confident in their knowledge of the technology to assist clients in using it. Twelve staff members participated in an interview. Key themes identified from the interview data were: technology has potential but is not for everyone, incorporating the subtheme technology as a placation tool, staff knowledge and confidence, and technology functionality and support. Conclusions: This evaluation identified that technology was not being used for the purposes of enrichment or experience enhancement, nor extensively. Multiple barriers to the implementation and sustained use of the technology items were identified. Recommendations to improve implementation and promote sustained use of technology, based on the findings of this evaluation and evidence from the literature, may apply to other organizations seeking to implement these technologies in similar programs. UR - https://aging.jmir.org/2025/1/e60297 UR - http://dx.doi.org/10.2196/60297 ID - info:doi/10.2196/60297 ER - TY - JOUR AU - Lam, Aaron AU - Simonetti, Simone AU - D'Rozario, Angela AU - Ireland, David AU - Bradford, DanaKai AU - Fripp, Jurgen AU - Naismith, L. Sharon PY - 2025/4/28 TI - Perceptions of the Use of Mobile Apps to Assess Sleep-Dependent Memory in Older Adults With Subjective and Objective Cognitive Impairment: Focus Group Approach JO - JMIR Aging SP - e68147 VL - 8 KW - aging KW - mild cognitive impairment KW - subjective cognitive impairment KW - digital health KW - cognition KW - neuropsychology KW - sleep N2 - Background: Sleep-dependent memory (SDM) is the phenomenon where newly obtained memory traces are consolidated from short-term memory stores to long-term memory, underpinning memory for daily life. Administering SDM tasks presents considerable challenges, particularly for older adults with memory concerns, due to the need for sleep laboratories and research staff being present to administer the task. In response, we have developed a prototype mobile app aimed at automating the data collection process. Objective: This study investigates the perspectives of older adults, with subjective or objective cognitive impairment, regarding barriers and facilitators to using a new mobile app for at-home assessment of SDM. Methods: In total, 11 participants aged 50 years and older were recruited from the Healthy Brain Ageing memory clinic, a specialized research memory clinic that focuses on the assessment and early intervention of cognitive decline. Two focus groups were conducted and thematically analyzed using NVivo (version 13; Lumivero). Results: On average, participants were aged 68.5 (SD 5.1) years, and 4/11 were male. Eight participants had subjective cognitive impairment, and 3 participants had mild cognitive (objective) impairment. Two main themes emerged from the focus groups, shedding light on participants? use of mobile phones and the challenges and facilitators associated with transitioning from traditional laboratory-based assessments to home assessments. These challenges include maintaining accurate data, engaging with humans versus robots, and ensuring accessibility and task compliance. Additionally, potential solutions to these challenges were identified. Conclusions: Our findings underscore the importance of app flexibility in accommodating diverse user needs and preferences as well as in overcoming barriers. While some individuals required high-level assistance, others expressed the ability to navigate the app independently or with minimal support. In conclusion, older adults provided valuable insights into the app modifications, user needs, and accessibility requirements enabling home-based SDM assessment. UR - https://aging.jmir.org/2025/1/e68147 UR - http://dx.doi.org/10.2196/68147 ID - info:doi/10.2196/68147 ER - TY - JOUR AU - Mhatre, Anand AU - Dumm, Abigail AU - Zhao, Muyun AU - Parra Rodriguez, Lorena PY - 2025/4/28 TI - Wheelchair Servicing for Older Adults: Cross-Sectional Study JO - JMIR Rehabil Assist Technol SP - e66472 VL - 12 KW - maintenance KW - mobile app KW - mobility KW - older adults KW - repair KW - seating KW - telemonitoring KW - wheelchair KW - wheelchair breakdown KW - wheelchair failure N2 - Background: Wheelchairs are assistive mobility devices known to experience frequent part failures and breakdowns within 6 months of regular use. No tools or technologies exist to monitor the wheelchairs? condition or usage and inform stakeholders and users regarding when or how often they need to undergo servicing to avoid critical part failure. Objective: We aimed to test the association between wheelchair usage and manual wheelchair damage, part failures, and consequences for older wheelchair users and evaluate their preferences for a new wheelchair servicing technology. Methods: A cross-sectional study was performed with older manual wheelchair users atInstituto Nacional de Geriatría in Mexico. Demographic data, wheelchair information, failure counts, and preferences for new technology (sensor and smartphone app for servicing) were collected using surveys. Road shocks experienced by the wheelchair were collected for a week using a sensor. Results: Ten participants (mean [SD] age, 78.8 [11.8] y; 8 female and 2 male) participated. Seven experienced an average (SD) of 2.86 (1.36) self-reported part failures. Road shocks correlated with self-reported loose brake failures (r(8)=0.58, P=.09), the damaged condition of tires (r(8)=0.61, P=.1), and the damaged condition of brakes (r(8)=0.58, P=.099). No consequences were reported. Part failures increased as self-maintenance occurrences increased (r(9)=0.67, P=.04). More than 8 participants responded that they would like to monitor the wheelchair?s condition using the new technology and purchase it at an average (SD) price of US $28.95 (18.13). Conclusions: In this study, the association between wheelchair usage and failures showed that data-driven wheelchair inspection schedules should be determined through a collaborative approach involving researchers and stakeholders in wheelchair repair provision and older adult users. Older adults are interested in using new technology to engage in wheelchair servicing. UR - https://rehab.jmir.org/2025/1/e66472 UR - http://dx.doi.org/10.2196/66472 ID - info:doi/10.2196/66472 ER - TY - JOUR AU - Ormazábal, Yony AU - Arauna, Diego AU - Cantillana, Carlos Juan AU - Palomo, Iván AU - Fuentes, Eduardo AU - Mena, Carlos PY - 2025/4/17 TI - Unveiling the Frailty Spatial Patterns Among Chilean Older Persons by Exploring Sociodemographic and Urbanistic Influences Based on Geographic Information Systems: Cross-Sectional Study JO - JMIR Aging SP - e64254 VL - 8 KW - aging KW - frailty KW - geospatial clustering KW - urban factors KW - neighborhood conditions. N2 - Background: Frailty syndrome increases the vulnerability of older adults. The growing proportion of older adults highlights the need to better understand the factors contributing to the prevalence of frailty. Current evidence suggests that geomatic tools integrating geolocation can provide valuable information for implementing preventive measures by enhancing the urban physical environment. Objective: The aim of this study was to analyze the relationship between various elements of the urban physical environment and the level of frailty syndrome in older Chilean people. Methods: A cohort of 251 adults aged 65 years or older from Talca City, Chile, underwent comprehensive medical assessments and were geographically mapped within a Geographic Information Systems database. Frailty was determined using the Fried frailty criteria. The spatial analysis of the frailty was conducted in conjunction with layers depicting urban physical facilities within the city, including vegetables and fruit shops, senior centers or communities, pharmacies, emergency health centers, main squares and parks, family or community health centers, and sports facilities such as stadiums. Results: The studied cohort was composed of 187 women and 64 men, with no significant differences in age and BMI between genders. Frailty prevalence varied significantly across clusters, with Cluster 3 showing the highest prevalence (14/47, P=.01). Frail individuals resided significantly closer to emergency health centers (960 [SE 904] m vs 1352 [SE 936] m, P=.04), main squares/parks (1550 [SE 130] m vs. 2048 [SE 105] m, P=.03), and sports fields (3040 [SE 236] m vs 4457 [SE 322]m, P=.04) compared with nonfrail individuals. There were no significant differences in urban quality index across frailty groups, but frail individuals lived in areas with higher population density (0.013 [SE 0.001] vs 0.01 [SE 0.0007], P=.03). Conclusions: Frail individuals exhibit geospatial patterns suggesting intentional proximity to health facilities, sports venues, and urban facilities, revealing associations with adaptive responses to frailty and socioeconomic factors. This highlights the crucial intersection of urban environments and frailty, which is important for geriatric medicine and public health initiatives. UR - https://aging.jmir.org/2025/1/e64254 UR - http://dx.doi.org/10.2196/64254 ID - info:doi/10.2196/64254 ER - TY - JOUR AU - Li, Xiaoli AU - Liu, Xiaoyu AU - Yin, Cheng AU - Collins, Sandra AU - Alanazi, Eman PY - 2025/4/16 TI - Impact of a Virtual Reality Video ("A Walk-Through Dementia") on YouTube Users: Topic Modeling Analysis JO - JMIR Form Res SP - e67755 VL - 9 KW - Alzheimer disease KW - Alzheimer disease and related dementias KW - ADRD KW - dementia KW - public awareness KW - text mining KW - older adult KW - health care student KW - training KW - health care professional KW - simulation KW - digital world KW - virtual environment KW - virtual tour KW - walk-through dementia KW - virtual reality KW - VR KW - VR video KW - VR application KW - topic modeling KW - YouTube KW - Bidirectional Encoder Representations from Transformers KW - BERT KW - social media comments KW - experiential learning tool N2 - Background: Emerging research has highlighted the potential of virtual reality (VR) as a tool for training health care students and professionals in care skills for individuals with Alzheimer disease and related dementias (ADRD). However, there is limited research on the use of VR to engage the general public in raising awareness about ADRD. Objective: This research aimed to examine the impact of the VR video ?A Walk-Through Dementia? on YouTube users by analyzing their posts. Methods: We collected 12,754 comments from the VR video series ?A Walk-Through Dementia,? which simulates the everyday challenges faced by individuals with ADRD, providing viewers with an immersive experience of the condition. Topic modeling was conducted to gauge viewer opinions and reactions to the videos. A pretrained Bidirectional Encoder Representations from Transformers (BERT) model was used to transform the YouTube comments into high-dimensional vector embeddings, allowing for systematic identification and detailed analysis of the principal topics and their thematic structures within the dataset. Results: We identified the top 300 most frequent words in the dataset and categorized them into nouns, verbs, and adjectives or adverbs using a part-of-speech tagging model, fine-tuned for accurate tagging tasks. The topic modeling process identified eight8 initial topics based on the most frequent words. After manually reviewing the 8 topics and the content of the comments, we synthesized them into 5 themes. The predominant theme, represented in 2917 comments, centered on users? personal experiences with the impact of ADRD on patients and caregivers. The remaining themes were categorized into 4 main areas: positive reactions to the VR videos, challenges faced by individuals with ADRD, the role of caregivers, and learning from the VR videos. Conclusions: Using topic modeling, this study demonstrated that VR applications serve as engaging and experiential learning tools, offering the public a deeper understanding of life with ADRD. Future research should explore additional VR applications on social media, as they hold the potential to reach wider audiences and effectively disseminate knowledge about ADRD. UR - https://formative.jmir.org/2025/1/e67755 UR - http://dx.doi.org/10.2196/67755 ID - info:doi/10.2196/67755 ER - TY - JOUR AU - Tan, Siow-Hooi AU - Yap, Yee-Yann AU - Tan, Siow-Kian AU - Wong, Chee-Kuan PY - 2025/3/24 TI - Determinants of Telehealth Adoption Among Older Adults: Cross-Sectional Survey Study JO - JMIR Aging SP - e60936 VL - 8 KW - telehealth services adoption KW - survey KW - questionnaire KW - telehealth KW - older adult population KW - subjective well-being KW - transition cost KW - technology acceptance model KW - importance-performance map analysis KW - IPMA N2 - Background: The aging population and the accompanying rise in chronic diseases have intensified the need to study the adoption of telehealth services. However, the success of telehealth services depends not only on their ease and usefulness but also on addressing broader concerns. Despite being a substantial user group in traditional health services, older adults may encounter barriers to adopting telehealth services. Increasing the adoption of telehealth among the older adult population is crucial for enhancing their access to care and managing the challenges of aging effectively. Objective: We aimed to explore factors influencing the adoption of telehealth services among older adults in Malaysia, going beyond the conventional framework by incorporating transition cost and subjective well-being as additional constructs. Methods: A cross-sectional survey was conducted among 119 adults aged ?60 years in Malaysia, using 39 survey items adapted from existing studies. Data analysis was performed using partial least squares structural equation modeling, with both the measurement model and structural model being evaluated. To determine the predictive relevance of the model, PLSpredict was applied. In addition, importance-performance map analysis was conducted to further expand on the structural model results by assessing the performance of each variable. Results: Of the 119 participants, 52 (43.7%) were women and 67 (56.3%) were men. The study found that subjective well-being (?=0.448; P<.001) was the most significant factor, followed by attitude (?=0.242; P<.001), transition cost (?=?0.163; P<.001), and perceived usefulness (?=0.100, P=.02) in influencing telehealth service intention. Furthermore, perceived ease of use (?=0.271; P<.001), availability (?=0.323; P<.001), subjective well-being (?=0.261; P<.001), and trust (?=0.156, P=.004) positively influenced perceived usefulness, while inertia (?=0.024, P=.22) did not. In addition, availability (?=0.420; P<.001) and subjective well-being (?=0.260; P<.001) were positively related to perceived ease of use, with inertia (?=?0.246; P<.001) having a negative impact. The importance-performance map analysis results showed that subjective well-being (importance=0.532) was the most crucial factor for older adult users, while availability (importance=70.735) had the highest performance in telehealth services. Conclusions: This research underscores the importance of catering to the subjective well-being of older adults and optimizing the availability of telehealth services to encourage adoption, ultimately advancing health care accessibility and quality for this vulnerable demographic. UR - https://aging.jmir.org/2025/1/e60936 UR - http://dx.doi.org/10.2196/60936 UR - http://www.ncbi.nlm.nih.gov/pubmed/40126531 ID - info:doi/10.2196/60936 ER - TY - JOUR AU - Böttinger, Johanna Melissa AU - Mellone, Sabato AU - Klenk, Jochen AU - Jansen, Carl-Philipp AU - Stefanakis, Marios AU - Litz, Elena AU - Bredenbrock, Anastasia AU - Fischer, Jan-Philipp AU - Bauer, M. Jürgen AU - Becker, Clemens AU - Gordt-Oesterwind, Katharina PY - 2025/3/21 TI - A Smartphone-Based Timed Up and Go Test Self-Assessment for Older Adults: Validity and Reliability Study JO - JMIR Aging SP - e67322 VL - 8 KW - timed up and go test KW - self-assessment KW - instrumented assessment KW - technology-based assess-ment KW - physical capacity KW - mobility KW - aged KW - mobile applications KW - smartphone KW - diagnostic self evaluation N2 - Background: The Timed Up and Go test (TUG) is recommended as an evidence-based tool for measuring physical capacity. Instrumented TUG (iTUG) approaches expand classical supervised clinical applications offering the potential of self-assessment for older adults. Objective: This study aimed to evaluate the concurrent validity and test-retest reliability of a smartphone-based TUG self-assessment ?up&go app.? Methods: A total of 52 community-dwelling older adults (>67 years old) were recruited. A validated and medically certified system attached with a belt at the lower back was used as a reference system to validate the ?up&go app? algorithm. The participants repeated the TUG 5 times wearing, a smartphone with the ?up&go app? in their front trouser pocket and an inertial sensor to test the concurrent validity. A subsample of 37 participants repeated the ?up&go app? measurement 2 weeks later to examine the test-retest reliability. Results: The correlation between the ?up&go app? and the reference measurement was r=0.99 for the total test duration and r=0.97 for the 5 single repetitions. Agreement between the 5 repetitions was intraclass correlation coefficient (ICC)=0.9 (0.84?0.94). Leaving out the first repetition, the agreement was ICC=0.95 (0.92?0.97). Test-retest agreement had an ICC=0.79 (0.53?0.9). Conclusions: The duration of 5 repetitions of the TUG test, measured with the pocket-worn ?up&go app,? was very consistent with the results of a lower-back sensor system, indicating excellent concurrent validity. Participants walked slower in the first round than in the other 4 repetitions within a test run. Test-retest reliability was also excellent. The ?up&go app? provides a useful smartphone-based approach to measure 5 repetitions of the TUG. The app could be used by older adults as a self-screening and monitoring tool of physical capacity at home and thereby help to early identify functional limitations and take interventions when necessary. UR - https://aging.jmir.org/2025/1/e67322 UR - http://dx.doi.org/10.2196/67322 ID - info:doi/10.2196/67322 ER - TY - JOUR AU - Kang, Hyunjin AU - Yang, Tingting AU - Banu, Nazira AU - Ng, Ting Sheryl Wei AU - Lee, Kyu Jeong PY - 2025/3/19 TI - Exploring Smart Health Wearable Adoption Among Singaporean Older Adults Based on Self-Determination Theory: Web-Based Survey Study JO - JMIR Aging SP - e69008 VL - 8 KW - smart health wearables KW - self-determination theory KW - AI anxiety KW - perceived privacy risk KW - health consciousness N2 - Background: Smart health wearables offer significant benefits for older adults, enabling seamless health monitoring and personalized suggestions based on real-time data. Promoting adoption and sustained use among older adults is essential to empower autonomous health management, leading to better health outcomes, improved quality of life, and reduced strain on health care systems. Objective: This study investigates how autonomy-related contextual factors, including artificial intelligence (AI) anxiety, perceived privacy risks, and health consciousness, are related to older adults? psychological needs of competence, autonomy, and relatedness (RQ1). We then examined whether the fulfillment of these needs positively predicts older adults? intentions to adopt these devices (H1), and how they mediate the relationship between these factors and older adults? intentions to use smart health wearables (RQ2). Additionally, it compares experienced and nonexperienced older adult users regarding the influence of these psychological needs on use intentions (RQ3). Methods: A web-based survey was conducted with individuals aged 60 years and above in Singapore, using a Qualtrics survey panel. A total of 306 participants (177 male; mean age of 65.47 years, age range 60?85 years) completed the survey. A structural equation model was used to analyze associations among AI anxiety, perceived privacy risks, and health consciousness, and the mediating factors of competence, autonomy, and relatedness, as well as their relationship to smart health wearable use intention. Results: Health consciousness positively influenced all intrinsic motivation factors?competence, autonomy, and relatedness?while perceived privacy risks negatively affected all three. AI anxiety was negatively associated with competence only. Both privacy risk perceptions and health consciousness were indirectly linked to older adults? intentions to use smart health wearables through competence and relatedness. No significant differences were found in motivational structures between older adults with prior experience and those without. Conclusions: This study contributes to the application of self-determination theory in promoting the use of smart technology for health management among older adults. The results highlight the critical role of intrinsic motivation?particularly competence?in older adults? adoption of smart health wearables. While privacy concerns diminish motivation, health consciousness fosters it. The study results offer valuable implications for designing technologies that align with older adults? motivations, potentially benefiting aging populations in other technologically advanced societies. Developers should focus on intuitive design, transparent privacy practices, and social features to encourage adoption, empowering older adults to use smart wearables for proactive health management. UR - https://aging.jmir.org/2025/1/e69008 UR - http://dx.doi.org/10.2196/69008 ID - info:doi/10.2196/69008 ER - TY - JOUR AU - Wolfe, H. Brooke AU - Oh, Jung Yoo AU - Choung, Hyesun AU - Cui, Xiaoran AU - Weinzapfel, Joshua AU - Cooper, Amanda R. AU - Lee, Hae-Na AU - Lehto, Rebecca PY - 2025/3/13 TI - Caregiving Artificial Intelligence Chatbot for Older Adults and Their Preferences, Well-Being, and Social Connectivity: Mixed-Method Study JO - J Med Internet Res SP - e65776 VL - 27 KW - older adults KW - technology use KW - AI chatbots KW - artificial intelligence KW - well-being KW - social connectedness KW - mobile phone N2 - Background: The increasing number of older adults who are living alone poses challenges for maintaining their well-being, as they often need support with daily tasks, health care services, and social connections. However, advancements in artificial intelligence (AI) technologies have revolutionized health care and caregiving through their capacity to monitor health, provide medication and appointment reminders, and provide companionship to older adults. Nevertheless, the adaptability of these technologies for older adults is stymied by usability issues. This study explores how older adults use and adapt to AI technologies, highlighting both the persistent barriers and opportunities for potential enhancements. Objective: This study aimed to provide deeper insights into older adults? engagement with technology and AI. The technologies currently used, potential technologies desired for daily life integration, personal technology concerns faced, and overall attitudes toward technology and AI are explored. Methods: Using mixed methods, participants (N=28) completed both a semistructured interview and surveys consisting of health and well-being measures. Participants then participated in a research team?facilitated interaction with an AI chatbot, Amazon Alexa. Interview transcripts were analyzed using thematic analysis, and surveys were evaluated using descriptive statistics. Results: Participants? average age was 71 years (ranged from 65 years to 84 years). Most participants were familiar with technology use, especially using smartphones (26/28, 93%) and desktops and laptops (21/28, 75%). Participants rated appointment reminders (25/28, 89%), emergency assistance (22/28, 79%), and health monitoring (21/28, 75%). Participants rated appointment reminders (25/28, 89.3%), emergency assistance (22/28, 78.6%), and health monitoring (21/28, 75%) as the most desirable features of AI chatbots for adoption. Digital devices were commonly used for entertainment, health management, professional productivity, and social connectivity. Participants were most interested in integrating technology into their personal lives for scheduling reminders, chore assistance, and providing care to others. Challenges in using new technology included a commitment to learning new technologies, concerns about lack of privacy, and worries about future technology dependence. Overall, older adults? attitudes coalesced into 3 orientations, which we label as technology adapters, technologically wary, and technology resisters. These results illustrate that not all older adults were resistant to technology and AI. Instead, older adults are aligned with categories on a spectrum between willing, hesitant but willing, and unwilling to use technology and AI. Researchers can use these findings by asking older adults about their orientation toward technology to facilitate the integration of new technologies with each person?s comfortability and preferences. Conclusions: To ensure that AI technologies effectively support older adults, it is essential to foster an ongoing dialogue among developers, older adults, families, and their caregivers, focusing on inclusive designs to meet older adults? needs. UR - https://www.jmir.org/2025/1/e65776 UR - http://dx.doi.org/10.2196/65776 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/65776 ER - TY - JOUR AU - Buawangpong, Nida AU - Siviroj, Penprapa AU - Pinyopornpanish, Kanokporn AU - Sirikul, Wachiranun PY - 2025/3/11 TI - Transcultural Adaptation, Validation, Psychometric Analysis, and Interpretation of the 22-Item Thai Senior Technology Acceptance Model for Mobile Health Apps: Cross-Sectional Study JO - JMIR Aging SP - e60156 VL - 8 KW - STAM KW - senior technology acceptance model KW - validity KW - reliability KW - mHealth KW - older adult KW - technology acceptance KW - mobile health KW - app KW - transcultural adaptation KW - psychometric analysis KW - geriatrics KW - cross-sectional study KW - Thai KW - theory analysis KW - Cronbach ? KW - McDonald ? KW - quality of life KW - well-being KW - social media KW - telehealth KW - health informatics KW - eHealth KW - mobile phone N2 - Background: The rapid advancement of technology has made mobile health (mHealth) a promising tool to mitigate health problems, particularly among older adults. Despite the numerous benefits of mHealth, assessing individual acceptance is required to address the specific needs of older people and promote their intention to use mHealth. Objective: This study aims to adapt and validate the senior technology acceptance model (STAM) questionnaire for assessing mHealth acceptance in the Thai context. Methods: In this cross-sectional study, we adapted the original, 38-item, English version of the STAM using a 10-point Likert scale for mHealth acceptability among the Thai population. We translated the mHealth STAM into Thai using forward and backward translation. A total of 15 older adults and experts completed the pilot questionnaire and were interviewed to assess its validity. The pilot items of the Thai mHealth STAM were then reworded and revised for better comprehension and cross-cultural compatibility. The construct validity of the Thai mHealth STAM was evaluated by a multidimensional approach, including exploratory and confirmatory factor analysis and nonparametric item response theory analysis. Discriminative indices consisting of sensitivity, specificity, and area under the receiver operating characteristic (AUROC) were used to determine appropriate banding and discriminant validity for the intention to use mHealth. Internal consistency was assessed using Cronbach ? and McDonald ? coefficients. Results: Out of the 1100 participants with a mean age of 62.3 (SD 8.8) years, 360 (32.7%) were adults aged 45-59 years, and 740 (67.3%) were older adults aged 60 years and older. Of the 40-item pilot questionnaire, exploratory factor analysis identified 22 items with factor loadings >0.4 across 7 principal components, explaining 91.45% of the variance. Confirmatory factor analysis confirmed that 9-dimensional sets of 22 items had satisfactory fit indices (comparative fit index=0.976, Tucker-Lewis index=0.968, root mean square error of approximation=0.043, standardized root mean squared residual=0.044, and R2 for each item>0.30). The score banding D (low?151, moderate 152-180, and high?181) was preferred as the optimal 22-item Thai mHealth STAM cutoff score based on the highest sensitivity of 89% (95% CI 86.1%-91.5%) and AUROC of 72.4% (95% CI 70%-74.8%) for predicting the intention to use mHealth. The final Thai mHealth STAM, consisting of 22 items, exhibited remarkable internal consistency, as evidenced by a Cronbach ? of 0.88 (95% CI 0.87-0.89) and a McDonald ? of 0.85 (95% CI 0.83-0.87). For all 22 items, the corrected item-total correlations ranged between 0.26 and 0.71. Conclusions: The 22-item Thai mHealth STAM demonstrated satisfactory psychometric properties in both validity and reliability. The questionnaire has the potential to serve as a practical questionnaire in assessing the acceptance and intention to use mHealth among pre-older and older adults. UR - https://aging.jmir.org/2025/1/e60156 UR - http://dx.doi.org/10.2196/60156 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60156 ER - TY - JOUR AU - Buawangpong, Nida AU - Sirikul, Wachiranun AU - Siviroj, Penprapa PY - 2025/3/7 TI - Factors Associated With the Intention to Use mHealth Among Thai Middle-Aged Adults and Older Adults: Cross-Sectional Study JO - JMIR Hum Factors SP - e63607 VL - 12 KW - mHealth KW - mobile healthcare KW - older adults KW - elderly KW - aging KW - questionnaire KW - smartphone KW - mHealth usage KW - intention to use N2 - Background: Mobile health care (mHealth) apps are emerging worldwide as a vital component of internet health care, but there are issues, especially among older adults. Objective: We aim to investigate the factors influencing the intention to use (ITU) mHealth apps, focusing on those with and without prior mHealth experience. Methods: A cross-sectional study conducted from August 2022 to July 2023 included Thai citizens aged 45 years or older. Self-reported questionnaires collected data on sociodemographic information, health conditions, smartphone or tablet ownership, and mHealth usage experience. The Thai mHealth Senior Technology Acceptance Model questionnaires with a 10-point Likert scale evaluated mHealth acceptance. A multivariable logistic regression analysis, adjusted for age, gender, education, income, and living area, was performed for 2 subgroups: those who used ITU mHealth apps and those who did not. Results: Of 1100 participants, 537 (48.8%) intended to use mHealth apps, while 563 (51.2%) did not. The ITU group had a younger average age, higher education levels, higher income, and fewer underlying diseases compared to those who did not intend to use mHealth apps. For those who had never used mHealth apps, having a smartphone was strongly associated with higher odds of ITU (adjusted odds ratio 2.81, 95% CI 1.6 to 4.93; P<.001), while having any underlying disease was associated with lower odds of ITU (adjusted odds ratio 0.63, 95% CI 0.42 to 0.97; P=.034). Higher acceptance levels, characterized by a positive attitude toward mHealth and lower fear of making mistakes, were also associated with higher ITU. For those with prior mHealth experience, acceptance in areas such as perceived ease of use, gerontechnology anxiety, and facilitating conditions was significantly associated with ITU. Conclusions: Among inexperienced users, a positive attitude toward mHealth significantly enhanced ITU. Conversely, having an underlying disease decreased ITU, indicating a need for tailored mHealth apps. For experienced users, acceptance levels in areas such as ease of use and gerontechnology anxiety were crucial. Future research should explore specific mHealth apps for more targeted insights. UR - https://humanfactors.jmir.org/2025/1/e63607 UR - http://dx.doi.org/10.2196/63607 ID - info:doi/10.2196/63607 ER - TY - JOUR AU - Yan, Mengyao AU - Sun, Wendi AU - Tan, Cheng AU - Wu, Yibo AU - Liu, Yuanli PY - 2025/3/4 TI - Analysis of Factors Influencing the Willingness of Chinese Older Adults to Use mHealth Devices: Nationwide Cross-Sectional Survey Study JO - J Med Internet Res SP - e66804 VL - 27 KW - older adults KW - mobile health devices KW - health management KW - medical services KW - mobile phone N2 - Background: In addition to standard older adult care services, mobile medical devices have proved to be an effective tool for controlling the health of older adults. However, little is known about the variables driving the acceptance of these gadgets and the willingness of older adults in China to use them. Objective: This study aims to explore the factors that affect the use of mobile health (mHealth) devices by older adults in China, focusing on individual, social, and family influences. Methods: The Psychology and Behavior Investigation of Chinese Residents survey database provided the data for this study. The survey was conducted in 148 Chinese cities between June 20 and August 31, 2022. The parameters linked to older persons? desire to use mobile medical devices were determined by this study using a combination model of multiple stepwise linear regression and a classification and regression tree decision tree. Results: In total, 4085 older adults took part in the poll. On a scale of 0 to 100, the average score for willingness to adopt mHealth devices was 63.70 (SD 25.11). The results of the multiple stepwise linear regression showed that having a postgraduate degree and higher (?=.040; P=.007), being unemployed (?=.037; P=.02), having a high social status (?=.085; P<.001), possessing high health literacy (?=.089; P<.001), demonstrating high self-efficacy (?=.043; P=.02), not living with children (?=.0340; P=.02), having a household per capita monthly income of >Y4000 (US $550) (?=.048; P=.002), experiencing high perceived social support (?=.096; P<.001), reporting a high quality of life (?=.149; P<.001), having higher levels of family communication (?=?.071; P<.001), having an identity bubble (?=.085; P<.001), not having chronic diseases (?=.049; P=.001), and experiencing mild depression (?=?.035; P=.02) were associated with older adults? willingness to use mHealth devices. The classification and regression tree decision tree model?s findings demonstrated that the primary determinants of older adults? desire to use mHealth devices are quality of life, identity bubble, social status, health literacy, family health, and perceived social support. Conclusions: This study uses the Andersen Healthcare Utilization Model to investigate the effects of demand variables, enabling resources, and predisposing traits on older persons? propensity to use mHealth devices. These results offer reference data for the marketing and use of mHealth devices for older individuals in the future. The ultimate goal of this strategy is to create a balanced and harmonious integration of technology and humanistic care. UR - https://www.jmir.org/2025/1/e66804 UR - http://dx.doi.org/10.2196/66804 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053781 ID - info:doi/10.2196/66804 ER - TY - JOUR AU - Everard, Gauthier AU - Declerck, Louise AU - Lejeune, Thierry AU - Edwards, Gareth Martin AU - Bogacki, Justine AU - Reiprich, Cléo AU - Delvigne, Kelly AU - Legrain, Nicolas AU - Batcho, Sebiyo Charles PY - 2025/3/3 TI - A Self-Adaptive Serious Game to Improve Motor Learning Among Older Adults in Immersive Virtual Reality: Short-Term Longitudinal Pre-Post Study on Retention and Transfer JO - JMIR Aging SP - e64004 VL - 8 KW - virtual reality KW - aged KW - learning KW - upper extremity KW - video games KW - kinematics N2 - Background: Despite their potential, the use of serious games within immersive virtual reality (iVR) for enhancing motor skills in older adults remains relatively unexplored. In this study, we developed a self-adaptive serious game in iVR called REAsmash-iVR. This game involves swiftly locating and striking a digital mole presented with various distractors. Objective: This short-term longitudinal pre-post study aims to evaluate REAsmash-iVR?s efficacy in promoting motor learning in older adults. Specifically, we seek to determine the transfer and retention of motor learning achieved through REAsmash-iVR to other iVR tasks. Methods: A total of 20 older adults participated in the study, engaging with REAsmash-iVR over 7 consecutive days. The evaluation included iVR tests such as KinematicsVR and a VR adaptation of the Box and Block Test (BBT-VR). KinematicsVR tasks included drawing straight lines and circles as fast and as accurately as possible, while BBT-VR required participants to move digital cubes as quickly as possible within 60 seconds. Assessments were conducted before and after the intervention, with a follow-up at 1 week post intervention. The primary outcome focused on evaluating the impact of REAsmash-iVR on speed-accuracy trade-off during KinematicsVR tasks. Secondary outcomes included analyzing movement smoothness, measured by spectral arc length, and BBT-VR scores. Results: Results revealed significant improvements in speed-accuracy trade-off post intervention compared to that before the intervention, with notable retention of skills for straight lines (t19=5.46; P<.001; Cohen d=1.13) and circle drawing (t19=3.84; P=.001; Cohen d=0.787). Likewise, there was a significant enhancement in spectral arc length, particularly for circle drawing (?˛2=11.2; P=.004; ?2=0.23), but not for straight-line drawing (?˛2=2.1; P=.35; ?2=0.003). Additionally, participants demonstrated transfer with significant improvement (q=5.26; P<.001; Cohen r=0.678) and retention (q=6.82; P<.001; Cohen r=0.880) in BBT-VR skills. Conclusions: These findings provide perspectives for the use of iVR to improve motor learning in older adults through delivering self-adaptive serious games targeting motor and cognitive functions. Trial Registration: ClinicalTrials.gov NCT04694833; https://clinicaltrials.gov/study/NCT04694833 UR - https://aging.jmir.org/2025/1/e64004 UR - http://dx.doi.org/10.2196/64004 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053708 ID - info:doi/10.2196/64004 ER - TY - JOUR AU - Min, Deborah AU - Yun, Ji-Young AU - Parslow, Chad AU - Jajodia, Anushka AU - Han, Hae-Ra PY - 2025/2/25 TI - Online-Based Recruitment Methods for Community-Dwelling Older Adults: Scoping Review and Lessons Learned From the PLAN Trial JO - J Med Internet Res SP - e55082 VL - 27 KW - older adults KW - online KW - online recruitment KW - community-dwelling KW - strategies KW - America KW - Americans KW - technology adoption KW - digital technologies KW - COVID-19 KW - pandemic KW - digital health KW - dementia KW - caregivers KW - healthcare system KW - community health workers KW - consultants KW - mobile phone N2 - Background: Despite rapid technological advancement and a considerably aging US population, there remains a gap in the literature pertaining to online-based recruitment strategies for older adults. Objective: This study aimed to describe the lessons learned from the authors? experience of recruiting a sample for PLAN (Preparing successful aging through dementia Literacy education And Navigation), an ongoing, community-based randomized controlled trial designed to promote the transition of community-dwelling Korean American older adults with probable dementia and their caregivers into the health care system. The authors also present online-based recruitment strategies focused on older adults reported in relevant published studies to compare with their experiences. Methods: Data sources included PLAN recruitment tracking files, study team meeting minutes, and interviews with community consultants. We also conducted a scoping review of published studies, searching PubMed in July 2021, and updated our search in September 2023. Eligibility criteria included (1) focus on older adults aged more than 65 years, (2) sample recruited from a community setting, and (3) inclusion and description of online-based recruitment strategies. Exclusion criteria (1) did not focus on adults older than 65 years in a community setting, (2) did not include or describe online-based recruitment strategies, or (3) used online-based methods but not for the purpose of recruitment. The review followed the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews). Information was extracted using a data charting table and synthesized by conducting a thematic analysis. Results: In total, 8 articles were included in the scoping review and primarily addressed health promotion and recruitment strategy evaluation. When compared with PLAN data sources, five key themes emerged as relevant to the online-based recruitment of community-dwelling older adults: (1) unfamiliarity with technology?limited digital literacy, (2) differences in internet access and use across older age groups, (3) providing technological support to promote recruitment, (4) successful and unsuccessful recruitment using social media, and (5) other diverse online-based methods of recruitment. In particular, direct quotes from multiple sources for the PLAN trial revealed technological challenges that were common among immigrant older adults as the study team used various online-based recruitment activities. Conclusions: The literature was limited in the discussion of online-based recruitment among older participants. Data sources revealed the digital divide and limited digital literacy, particularly among non?English-speaking immigrant older adults and their caregivers. The usefulness of online-based recruitment of older adults is uncertain due, in large part, to limited sociodemographic diversity noted in the samples recruited in the included studies. Future research should explore the role of race and ethnicity and other characteristics, such as socioeconomic status, sex, education, access to technology, and digital literacy, in relation to online-based recruitment for adequate representation of diverse older adults in research. Trial Registration: ClinicalTrials.gov NCT03909347; https://clinicaltrials.gov/study/NCT03909347 UR - https://www.jmir.org/2025/1/e55082 UR - http://dx.doi.org/10.2196/55082 UR - http://www.ncbi.nlm.nih.gov/pubmed/39998873 ID - info:doi/10.2196/55082 ER - TY - JOUR AU - Vordenberg, E. Sarah AU - Nichols, Julianna AU - Marshall, D. Vincent AU - Weir, Rebecca Kristie AU - Dorsch, P. Michael PY - 2025/2/18 TI - Authors? Reply: Enhancing the Clinical Relevance of Al Research for Medication Decision-Making JO - J Med Internet Res SP - e72007 VL - 27 KW - older adults KW - artificial intelligence KW - vignette KW - pharmacology KW - medication KW - decision-making KW - aging KW - attitude KW - perception KW - perspective KW - electronic heath record UR - https://www.jmir.org/2025/1/e72007 UR - http://dx.doi.org/10.2196/72007 UR - http://www.ncbi.nlm.nih.gov/pubmed/39964740 ID - info:doi/10.2196/72007 ER - TY - JOUR AU - Wang, Qi AU - Chen, Mingxian PY - 2025/2/18 TI - Enhancing the Clinical Relevance of Al Research for Medication Decision-Making JO - J Med Internet Res SP - e70657 VL - 27 KW - older adults KW - artificial intelligence KW - medication KW - decision-making KW - data security KW - patient trust UR - https://www.jmir.org/2025/1/e70657 UR - http://dx.doi.org/10.2196/70657 UR - http://www.ncbi.nlm.nih.gov/pubmed/39964744 ID - info:doi/10.2196/70657 ER - TY - JOUR AU - Wong, Ching Arkers Kwan AU - Lee, Toon Jessica Hiu AU - Zhao, Yue AU - Lu, Qi AU - Yang, Shulan AU - Hui, Ching Vivian Chi PY - 2025/2/12 TI - Exploring Older Adults? Perspectives and Acceptance of AI-Driven Health Technologies: Qualitative Study JO - JMIR Aging SP - e66778 VL - 8 KW - artificial intelligence?based health technologies KW - health technology KW - AI-based health technology KW - machine learning KW - ML KW - artificial intelligence KW - AI KW - algorithm KW - model KW - analytics KW - perceptions KW - acceptability KW - gerontology KW - geriatrics KW - older adult KW - elderly KW - older person KW - older people KW - aging KW - mobile phone N2 - Background: Artificial intelligence (AI) is increasingly being applied in various health care services due to its enhanced efficiency and accuracy. As the population ages, AI-based health technologies could be a potent tool in older adults? health care to address growing, complex, and challenging health needs. This study aimed to investigate perspectives on and acceptability of the use of AI-led health technologies among older adults and the potential challenges that they face in adopting them. The findings from this inquiry could inform the designing of more acceptable and user-friendly AI-based health technologies. Objective: The objectives of the study were (1) to investigate the attitudes and perceptions of older adults toward the use of AI-based health technologies; (2) to identify potential facilitators, barriers, and challenges influencing older adults? preferences toward AI-based health technologies; and (3) to inform strategies that can promote and facilitate the use of AI-based health technologies among older adults. Methods: This study adopted a qualitative descriptive design. A total of 27 community-dwelling older adults were recruited from a local community center. Three sessions of semistructured interviews were conducted, each lasting 1 hour. The sessions covered five key areas: (1) general impressions of AI-based health technologies; (2) previous experiences with AI-based health technologies; (3) perceptions and attitudes toward AI-based health technologies; (4) anticipated difficulties in using AI-based health technologies and underlying reasons; and (5) willingness, preferences, and motivations for accepting AI-based health technologies. Thematic analysis was applied for data analysis. The Theoretical Domains Framework and the Capability, Opportunity, Motivation, and Behavior (COM-B) model behavior change wheel were integrated into the analysis. Identified theoretical domains were mapped directly to the COM-B model to determine corresponding strategies for enhancing the acceptability of AI-based health technologies among older adults. Results: The analysis identified 9 of the 14 Theoretical Domains Framework domains?knowledge, skills, social influences, environmental context and resources, beliefs about capabilities, beliefs about consequences, intentions, goals, and emotion. These domains were mapped to 6 components of the COM-B model. While most participants acknowledged the potential benefits of AI-based health technologies, they emphasized the irreplaceable role of human expertise and interaction. Participants expressed concerns about the usability of AI technologies, highlighting the need for user-friendly and tailored AI solutions. Privacy concerns and the importance of robust security measures were also emphasized as critical factors affecting their willingness to adopt AI-based health technologies. Conclusions: Integrating AI as a supportive tool alongside health care providers, rather than regarding it as a replacement, was highlighted as a key strategy for promoting acceptance. Government support and clear guidelines are needed to promote ethical AI implementation in health care. These measures can improve health outcomes in the older adult population by encouraging the adoption of AI-driven health technologies. UR - https://aging.jmir.org/2025/1/e66778 UR - http://dx.doi.org/10.2196/66778 ID - info:doi/10.2196/66778 ER - TY - JOUR AU - Wong, Po Ka AU - Teh, Pei-Lee AU - Lim, Marc Weng AU - Lee, Huey Shaun Wen PY - 2025/2/5 TI - Enhancing Older Adults? Lives Through Positive Aging Perception, Quality-of-Life Enhancement, and Social Support to Drive Acceptance and Readiness Toward Indoor Assistive Technology: Cross-Sectional Study JO - JMIR Aging SP - e59665 VL - 8 KW - indoor assistive technology KW - positive aging perceptions KW - quality of life KW - social support KW - technology acceptance KW - technology readiness N2 - Background: The growing aging population faces increasing mobility limitations, highlighting the need for assistive technologies as potential solutions. These technologies support the independence and well-being of older adults and individuals with mobility challenges. Indoor mobility is essential for daily activities and significantly impacts their lives. Limited indoor mobility can reduce quality of life and heighten the risk of falls. Objective: This study explores how positive aging perceptions, quality-of-life enhancements, and social support influence the acceptance and readiness of indoor assistive technologies among older adults. Methods: A cross-sectional study was conducted at a gerontechnology laboratory, requiring participants to visit the facility in person. Each 60-minute session included demonstrations of various indoor assistive technologies and the completion of a questionnaire. The assistive technologies showcased encompassed a wide range of devices. Participants? positive aging perceptions, quality-of-life enhancements, social support, technology acceptance, and readiness were measured using validated scales. Data were analyzed with AMOS (version 28; IBM Corp) and SPSS (version 28; IBM Corp), using structural equation modeling and multivariate analysis of covariance to assess the effects of predictors while controlling for demographic factors. Results: A total of 104 older adults aged 60 years and older participated, with a mean age of 67.92 (SD 5.68) years. Structural equation modeling indicated that positive aging perception has a significant influence on older adults? control beliefs (P=.095), comfort (P=.047), and confidence (P<.001) in gerontechnology. Multivariate analysis revealed significant combined effects of quality-of-life enhancement (P=.01) and social support (P=.03) on technology acceptance and readiness, wherein quality-of-life enhancement (P=.001) and social support (P=.008) negatively impacted security perception. Among demographic variables, educational level significantly impacted gerontechnology confidence (P=.004) while ethnicity influenced optimism (P=.003). Conclusions: This study sheds light on key factors affecting older adults? acceptance and readiness to adopt indoor assistive technologies. Findings highlight the importance of fostering positive aging perceptions through these technologies. Addressing issues related to control beliefs, comfort, and confidence in gerontechnology is essential to enhance technology acceptance and readiness among older adults. Future research should investigate the underlying mechanisms and create targeted interventions to support successful technology adoption in this population. UR - https://aging.jmir.org/2025/1/e59665 UR - http://dx.doi.org/10.2196/59665 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59665 ER - TY - JOUR AU - Kor, Kin Patrick Pui AU - Liu, Wa Justina Yat AU - Wong, Ching Arkers Kwan AU - Tsang, Lik Alex Pak AU - Tan, Zhi Han AU - Cheung, Ki Daphne Sze AU - Leung, Wai Humphrey Kwong AU - Wong, Yuet Frances Kam PY - 2025/2/5 TI - Effectiveness of a Dyadic Technology?Enhanced Home-Based Horticultural Therapy on Psychosocial Well-Being Among People With Dementia and Their Family Caregivers: Multimethods Pilot Study JO - JMIR Aging SP - e66017 VL - 8 KW - horticultural activity KW - dementia KW - caregivers KW - dyadic intervention KW - technology?enhanced intervention N2 - Background: Horticultural therapy (HT) has been proposed to be an effective intervention for improving the psychosocial well-being of people with dementia and their caregivers. However, constraints such as limited land space in high-density cities, unstable weather, and lack of gardening experience may hamper the delivery of HT to people with dementia and their caregivers. Objective: This pilot study aimed to examine the feasibility and preliminary effects of a technology-enhanced home-based HT for people with dementia and their caregivers using a hydroponic indoor growing system. Methods: A single-group pre-post design was adopted. A total of 37 dyads of people with dementia and their caregivers participated in 3 weekly face-to-face sessions, followed by 8 weeks of home-based horticultural activities. Outcomes were measured at baseline and postintervention (at week 11), including feasibility outcomes, cognitive function, neuropsychiatric symptoms, and happiness levels of people with dementia. Caregivers? outcomes included positive aspects of caregiving, perceived stress levels, depressive symptoms, caregiver distress, and happiness levels. Semistructured focus group interviews were conducted with the caregivers to further explore their horticultural experience. Results: Intervention feasibility was established with a completion rate of 83.78% and an attrition rate of 2.63% (n=1). Significant improvements were detected in caregiver distress (P<.05) and the happiness level of people with dementia (P<.01). The qualitative findings indicated that HT improved the psychological well-being of both people with dementia and caregivers, enhanced the relationships between caregivers and people with dementia, expanded the caregivers? social networks, and enhanced the autobiographical memory of people with dementia. Conclusions: This pilot study provides evidence on the feasibility of using a hydroponic indoor grower to conduct home-based HT for people with dementia and their caregivers. The findings suggest positive effects on the psychological well-being of both people with dementia and their caregivers. Caregivers reported potential positive effects of HT on the autobiographical memory retrieval of people with dementia. Due to the pilot nature of this study, a control group was not employed. Therefore, large-scale randomized controlled trials are encouraged to further confirm the effectiveness of the intervention. Trial Registration: ClinicalTrials.gov NCT05577975; https://clinicaltrials.gov/study/NCT05577975 UR - https://aging.jmir.org/2025/1/e66017 UR - http://dx.doi.org/10.2196/66017 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/66017 ER - TY - JOUR AU - Nester, O. Caroline AU - De Vito, N. Alyssa AU - Prieto, Sarah AU - Kunicki, J. Zachary AU - Strenger, Jennifer AU - Harrington, D. Karra AU - Roque, Nelson AU - Sliwinski, J. Martin AU - Rabin, A. Laura AU - Thompson, I. Louisa PY - 2025/2/4 TI - Association of Subjective Cognitive Concerns With Performance on Mobile App?Based Cognitive Assessment in Cognitively Normal Older Adults: Observational Study JO - JMIR Aging SP - e64033 VL - 8 KW - subjective cognitive concerns KW - subjective cognitive decline KW - digital cognitive assessment KW - mobile app KW - app-based KW - preclinical Alzheimer disease KW - mild cognitive impairment KW - MCI KW - preclinical dementia KW - mobile monitoring of cognitive change KW - Cognitive Function Instrument KW - mHealth KW - mobile health KW - applications KW - cognition KW - assessment KW - remote KW - geriatrics KW - gerontology KW - aging KW - memory KW - older adult KW - elderly KW - digital health KW - mobile phone N2 - Background: Subjective cognitive concerns (SCCs) may be among the earliest clinical symptoms of dementia. There is growing interest in applying a mobile app?based cognitive assessment to remotely screen for cognitive status in preclinical dementia, but the relationship between SCC and relevant mobile assessment metrics is uncertain. Objective: This study aimed to characterize the relationship between SCC and adherence, satisfaction, and performance on mobile app assessments in cognitively unimpaired older adults. Methods: Participants (N=122; Meanage=68.85 [SD 4.93] years; Meaneducation=16.85 [SD 2.39] years; female: n=82, 66.7%; White:n=106, 86.2%) completed 8 assessment days using Mobile Monitoring of Cognitive Change (M2C2), an app-based testing platform, with brief daily sessions within morning, afternoon, and evening time windows (24 total testing sessions). M2C2 includes digital working memory, processing speed, and episodic memory tasks. Participants provided feedback about their satisfaction and motivation related to M2C2 upon study completion. SCC was assessed using the Cognitive Function Instrument. Regression analyses evaluated the association between SCC and adherence, satisfaction, and performance on M2C2, controlling for age, sex, depression, and loneliness. Linear-mixed effects models evaluated whether SCC predicted M2C2 subtest performance over the 8-day testing period, controlling for covariates. Results: SCC was not associated with app satisfaction or protocol motivation, but it was significantly associated with lower rates of protocol adherence (ß=?.20, P=.37, 95% CI ?.65 to ?.02). Higher SCC endorsement significantly predicted worse overall episodic memory performance (ß=?.20, P=.02, 95% CI ?.02 to ?.01), but not working memory or processing speed. There was a main effect of SCC on working memory performance at day 1 (estimate=?1.05, SE=0.47, P=.03) and a significant interaction between SCC and working memory over the 8-day period (estimate=0.05, SE=0.02, P=.03), such that SCC was associated with initially worse, then progressively better working memory performance. Conclusions: SCCs are associated with worse overall memory performance on mobile app assessments, patterns of cognitive inefficiency (variable working memory), and mildly diminished adherence across an 8-day assessment period. Findings suggest that mobile app assessments may be sensitive to subtle cognitive changes, with important implications for early detection and treatment for individuals at risk for dementia. UR - https://aging.jmir.org/2025/1/e64033 UR - http://dx.doi.org/10.2196/64033 ID - info:doi/10.2196/64033 ER - TY - JOUR AU - Guo, Lin AU - Li, Yunwei AU - Cheng, Kai AU - Zhao, Ying AU - Yin, Wenqiang AU - Liu, Ying PY - 2025/1/31 TI - Impact of Internet Usage on Depression Among Older Adults: Comprehensive Study JO - J Med Internet Res SP - e65399 VL - 27 KW - internet usage KW - depression KW - older people KW - mechanism KW - heterogeneity KW - mobile phone N2 - Background: Depression is a widespread mental health issue affecting older adults globally, with substantial implications for their well-being. Although digital interventions have proven effective in high-income countries, research on the potential of internet usage to alleviate depression among older adults in high-income countries remains limited. Objective: This study aimed to examine the impact of internet usage on depression among older adults in high-income countries by developing a comprehensive theoretical framework and testing key hypotheses. Methods: Using data from the China Health and Retirement Longitudinal Study (CHARLS), a 2-stage instrumental variable approach was applied to address endogeneity and estimate causal relationships between internet usage and depression. Results: The findings indicate that internet usage results in a 1.41% reduction in depression levels among older adults. This effect is mediated by four primary mechanisms: (1) enhanced social interaction, (2) increased physical activity, (3) improved intergenerational contact, and (4) expanded access to educational opportunities. A heterogeneity analysis revealed that these effects are more pronounced in urban areas, eastern regions, and regions with superior internet infrastructure. Conclusions: Internet usage plays a crucial role in alleviating depression among older adults in high-income countries, with regional variations. The findings highlight the need for targeted policy interventions to improve internet access and digital literacy, which can mitigate depression and enhance the mental health of older adults. UR - https://www.jmir.org/2025/1/e65399 UR - http://dx.doi.org/10.2196/65399 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/65399 ER - TY - JOUR AU - Wang, Yingxuan Dorothy AU - Wong, Lai-Yi Eliza AU - Cheung, Wai-Ling Annie AU - Tang, Kam-Shing AU - Yeoh, Eng-Kiong PY - 2025/1/29 TI - A Comparison of Patient and Provider Perspectives on an Electronic Health Record?Based Discharge Communication Tool: Survey Study JO - JMIR Aging SP - e60506 VL - 8 KW - older adult KW - gerontology KW - geriatric KW - old KW - older KW - elderly KW - aging KW - aged KW - post-acute care KW - communication KW - satisfaction KW - medication information KW - patient-provider comparison KW - technology-based intervention KW - technology acceptance model KW - discharge KW - EHR KW - record KW - portal KW - cross-sectional KW - survey KW - questionnaire KW - experience KW - attitude KW - opinion KW - perception KW - perspective KW - acceptance KW - adoption KW - design KW - user experience N2 - Background: Hospital discharge for older adult patients carries risks. Effective patient-provider communication is crucial for postacute care. Technology-based communication tools are promising in improving patient experience and outcomes. However, there is limited evidence comparing patient and provider user experiences on a large-scale basis, hindering the exploration of true patient-provider shared understanding. Objective: This study aimed to evaluate an electronic health record?based discharge communication tool by examining and comparing patient and provider perspectives. Methods: This study comprised a cross-sectional self-administered staff survey and a pre-post cross-sectional patient survey. Physicians, nurses, and older adult patients aged 65 years and older discharged from 4 public hospitals were included. Patient-provider comparison items focused on 3 aspects of the design quality of the tool (information clarity, adequacy, and usefulness) and overall satisfaction with the tool. In addition, patients? experience of discharge information and their medication-taking behaviors before and after the program implementation were compared based on a validated local patient experience survey instrument. Providers? perceived usefulness of this tool to their work and implementation intentions were measured based on the technology acceptance model to enhance understanding of their experiences by conducting structural equation modeling analysis. Results: A total of 1375 and 2353 valid responses were received from providers and patients, respectively. Patients? overall satisfaction with this communication tool is significantly higher than providers?, and patients rated the information clarity and usefulness presented by this tool higher as well (P<.001). However, patients rated information adequacy significantly lower than providers (P<.001). Meanwhile, patients reported a significant improvement in their experience of discharge medication information, and fewer patients reported side effects encounters after the program implementation (126/1083, 11.6% vs 111/1235, 9%; P=.04). However, providers showed inconsistent implementation fidelity. Providers? perceived quality of the tool design (? coefficient=0.24, 95% CI 0.08-0.40) and perceived usefulness to their work (? coefficient=0.57, 95% CI 0.43-0.71) significantly impacted their satisfaction. Satisfaction can significantly impact implementation intentions (? coefficient=0.40, 95% CI 0.17-0.64), which further impacts implementation behaviors (? coefficient=0.16, 95% CI 0.10-0.23). Conclusions: A notable disparity exists between patients and health care providers. This may hinder the achievement of the tool?s benefits. Future research should aim for a comprehensive overview of implementation barriers and corresponding strategies to enhance staff performance and facilitate patient-provider shared understanding. UR - https://aging.jmir.org/2025/1/e60506 UR - http://dx.doi.org/10.2196/60506 ID - info:doi/10.2196/60506 ER - TY - JOUR AU - Shade, Marcia AU - Yan, Changmin AU - Jones, K. Valerie AU - Boron, Julie PY - 2025/1/24 TI - Evaluating Older Adults? Engagement and Usability With AI-Driven Interventions: Randomized Pilot Study JO - JMIR Form Res SP - e64763 VL - 9 KW - voice assistant KW - interventions KW - usability KW - engagement KW - personality KW - older adults KW - aging KW - technology KW - artificial intelligence KW - AI KW - self-management KW - pilot trial KW - chronic KW - musculoskeletal pain KW - AI assistant KW - Alexa KW - user experience KW - digital health KW - digital intervention KW - mobile phone N2 - Background: Technologies that serve as assistants are growing more popular for entertainment and aiding in daily tasks. Artificial intelligence (AI) in these technologies could also be helpful to deliver interventions that assist older adults with symptoms or self-management. Personality traits may play a role in how older adults engage with AI technologies. To ensure the best intervention delivery, we must understand older adults? engagement with and usability of AI-driven technologies. Objective: This study aimed to describe how older adults engaged with routines facilitated by a conversational AI assistant. Methods: A randomized pilot trial was conducted for 12-weeks in adults aged 60 years or older, self-reported living alone, and having chronic musculoskeletal pain. Participants (N=50) were randomly assigned to 1 of 2 intervention groups (standard vs enhanced) to engage with routines delivered by the AI assistant Alexa (Amazon). Participants were encouraged to interact with prescribed routines twice daily (morning and evening) and as needed. Data were collected and analyzed on routine engagement characteristics and perceived usability of the AI assistant. An analysis of the participants? personality traits was conducted to describe how personality may impact engagement and usability of AI technologies as interventions. Results: The participants had a mean age of 79 years, with moderate to high levels of comfort and trust in technology, and were predominately White (48/50, 96%) and women (44/50, 88%). In both intervention groups, morning routines (n=62, 74%) were initiated more frequently than evening routines (n=52, 62%; z=?2.81, P=.005). Older adult participants in the enhanced group self-reported routine usability as good (mean 74.50, SD 11.90), and those in the standard group reported lower but acceptable usability scores (mean 66.29, SD 6.94). Higher extraversion personality trait scores predicted higher rates of routine initiation throughout the whole day and morning in both groups (standard day: B=0.47, P=.004; enhanced day: B=0.44, P=.045; standard morning: B=0.50, P=.03; enhanced morning: B=0.53, P=.02). Higher agreeableness (standard: B=0.50, P=.02; enhanced B=0.46, P=.002) and higher conscientiousness (standard: B=0.33, P=.04; enhanced: B=0.38, P=.006) personality trait scores predicted better usability scores in both groups. Conclusions: he prescribed interactive routines delivered by an AI assistant were feasible to use as interventions with older adults. Engagement and usability by older adults may be influenced by personality traits such as extraversion, agreeableness, and conscientiousness. While integrating AI-driven interventions into health care, it is important to consider these factors to promote positive outcomes. Trial Registration: ClinicalTrials.gov NCT05387447; https://clinicaltrials.gov/study/NCT05387447 UR - https://formative.jmir.org/2025/1/e64763 UR - http://dx.doi.org/10.2196/64763 ID - info:doi/10.2196/64763 ER - TY - JOUR AU - Chang, Chien-Hsiang AU - Wei, Chun-Chun AU - Lien, Wei-Chih AU - Yang, Tai-Hua AU - Liu, Bo AU - Lin, Yimo AU - Tan, Thong Poh AU - Lin, Yang-Cheng PY - 2025/1/21 TI - The Usability and Effect of a Novel Intelligent Rehabilitation Exergame System on Quality of Life in Frail Older Adults: Prospective Cohort Study JO - JMIR Serious Games SP - e50669 VL - 13 KW - frailty KW - exergame KW - older adults KW - intelligent rehabilitation KW - reminiscence therapy KW - eHealth care N2 - Background: Aging in older adults results in a decline in physical function and quality of daily life. Due to the COVID-19 pandemic, the exercise frequency among older adults decreased, further contributing to frailty. Traditional rehabilitation using repetitive movements tends not to attract older adults to perform independently. Objective: Intelligent Rehabilitation Exergame System (IRES), a novel retro interactive exergame that incorporates real-time surface electromyography, was developed and evaluated. Methods: Frail older adults were invited to use the IRES for rehabilitation using lower limb training twice per week for 4 weeks. Participants were required to have no mobility or communication difficulties and be willing to complete the 4-week study. The enrolled cohort had baseline scores ranging from 1 to 5 on the Clinical Frailty Scale, as described by Rockwood et al. Three major lower limb movements (knee extension, plantar flexion, and dorsiflexion) were performed 20 times for each leg within 30 minutes. The surface electromyography collected and analyzed muscle potential signals for review by health care professionals to customize the protocol for the next training. The System Usability Scale (SUS) and Taiwanese version of the EuroQol-5 Dimensions (EQ-5D) were administered after completing the first (week 1, baseline) and last training (week 4, one-month follow-up) to evaluate the usability of the IRES and its effects on the quality of life of participants. Results: A total of 49 frail older adults (mean age 74.6 years) were included in the analysis. The usability of the IRES improved according to the mean SUS score, from 82.09 (good) at baseline to 87.14 (good+) at 1-month follow-up. The willingness to use (t96=?4.51; P<.001), learnability (t96=?4.83; P<.001), and confidence (t96=?2.27; P=.02) in working with the IRES increased. After using the IRES for 1 month, significant improvements were observed in the ease of use (t47=2.05; P=.04) and confidence (t47=2.68; P<.001) among participants without previous rehabilitation experience. No sex-based differences in the SUS scores were found at baseline or 1-month follow-up. The quality of life, as assessed by the EQ-5D, improved significantly after 1 month of IRES training compared to that at baseline (t96=6.03; P<.001). Conclusions: The novel IRES proposed in this study received positive feedback from frail older adults. Integrating retro-style exergame training into rehabilitation not only improved their rehabilitation motivation but also increased their learning, system operability, and willingness to continue rehabilitation. The IRES provides an essential tool for the new eHealth care service in the post?COVID-19 era. UR - https://games.jmir.org/2025/1/e50669 UR - http://dx.doi.org/10.2196/50669 ID - info:doi/10.2196/50669 ER - TY - JOUR AU - Kwek, Peng Siong AU - Leong, Ying Qiao AU - Lee, Vien V. AU - Lau, Yin Ni AU - Vijayakumar, Smrithi AU - Ng, Ying Wei AU - Rai, Bina AU - Raczkowska, Natalia Marlena AU - Asplund, L. Christopher AU - Remus, Alexandria AU - Ho, Dean PY - 2025/1/13 TI - Exploring the General Acceptability and User Experience of a Digital Therapeutic for Cognitive Training in a Singaporean Older Adult Population: Qualitative Study JO - JMIR Form Res SP - e63568 VL - 9 KW - older adults KW - cognitive training KW - digital therapeutic KW - DTx KW - remote KW - usability KW - acceptance KW - interviews KW - gerontology KW - geriatric KW - elderly KW - experiences KW - attitudes KW - opinions KW - perceptions KW - perspectives KW - interview KW - cognition KW - digital health KW - qualitative KW - thematic N2 - Background: Singapore?s large aging population poses significant challenges for the health care system in managing cognitive decline, underscoring the importance of identifying and implementing effective interventions. Cognitive training delivered remotely as a digital therapeutic (DTx) may serve as a scalable and accessible approach to overcoming these challenges. While previous studies indicate the potential of cognitive training as a promising solution for managing cognitive decline, understanding the attitudes and experiences of older adults toward using such DTx platforms remains relatively unexplored. Objective: This study aimed to characterize the general acceptability and user experience of CURATE.DTx, a multitasking-based DTx platform that challenges the cognitive domains of attention, problem-solving, and executive function in the Singaporean older adult population. Methods: A total of 15 older adult participants (mean age 66.1, SD 3.5 years) were recruited for a 90-minute in-person session. This session included a 30-minute playtest of CURATE.DTx, followed by a 60-minute semistructured interview to understand their overall attitudes, experience, motivation, and views of the intervention. Interviews were audio-recorded and transcribed verbatim, then analyzed using an inductive approach. Thematic analysis was used to identify emerging patterns and insights. Results: A total of 3 main themes, and their respective subthemes, emerged from the interviews: comprehension, with subthemes of instruction and task comprehension; acceptability, with subthemes of tablet usability, engagement and enjoyment, and attitude and perceived benefits; and facilitators to adoption, with subthemes of framing and aesthetics, motivation recommendations and the role of medical professionals. Our findings revealed that participants encountered some challenges with understanding certain elements of CURATE.DTx. Nevertheless, they were still highly engaged with it, finding the challenge to be enjoyable. Participants also showed a strong awareness of the importance of cognitive training and expressed a keen interest in using CURATE.DTx for this purpose, especially if recommended by medical professionals. Conclusions: Given the positive engagement and feedback obtained from Singaporean older adults on CURATE.DTx, this study can serve as a basis for future platform iterations and strategies that should be considered during implementation. Future studies should continue implementing an iterative codesign approach to ensure the broader applicability and effectiveness of interventions tailored to this demographic. UR - https://formative.jmir.org/2025/1/e63568 UR - http://dx.doi.org/10.2196/63568 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63568 ER - TY - JOUR AU - Su, Kuan-Chu AU - Wu, Ko-Chiu AU - Chou, Kuei-Ru AU - Huang, Chia-Hsu PY - 2025/1/9 TI - Tongue Muscle Training App for Middle-Aged and Older Adults Incorporating Flow-Based Gameplay: Design and Feasibility Pilot Study JO - JMIR Serious Games SP - e53045 VL - 13 KW - exergame KW - mobile app KW - flow KW - self-care KW - feasibility KW - older adults KW - dysphagia KW - tongue exercises N2 - Background: Complications due to dysphagia are increasingly prevalent among older adults; however, the tediousness and complexity of conventional tongue rehabilitation treatments affect their willingness to rehabilitate. It is unclear whether integrating gameplay into a tongue training app is a feasible approach to rehabilitation. Objective: Tongue training has been proven helpful for dysphagia treatment. Following the development of a tongue training app, a feasibility trial aimed to identify physiological and psychological factors that affect user and flow experience and explored whether training specialized muscles could produce a flow experience for optimal immersion. We aimed to provide a useful tool for medical rehabilitation so that older adults could retain tongue muscle flexibility. Methods: After consulting professional nurses, we developed a mobile gaming app for middle-aged and older adults to train their tongue muscles. This pilot study used an image recognition system to detect the tongue movements of 32 healthy middle-aged and older adults (7 males, 21.9%; 25 females, 78.1%) during 3 game training tasks, each requiring different reaction speeds. Their physiological and psychological signals, as well as the results of the Flow State Scale 2 (FSS2) questionnaire, were used for correlation analysis regarding relevant flow experiences to establish and evaluate the feasibility of our method. Results: Through exploratory factor analyses, a 2-factor (operation and immersion) structure was confirmed to have an adequate model fit (?˛36=448.478; P<.001; Kaiser-Meyer-Olkin=0.757) and internal consistency reliability (Cronbach ?=0.802). The slow, medium, and fast levels all significantly affected the FSS2 score for operation (P=.001), the National Aeronautics and Space Administration Task Load Index (P<.001), and flow distance (P<.001). K-means clustering revealed that participants could be further categorized into 3 groups. Through the analysis of changes in the participants? physiological and psychological signals for each given task, Pearson correlation indicated that changes were primarily related to flow distance. For the 12 indicators measured in this study, the low, medium, and high operation groups showed significance in 58% (7/12), 50% (6/12), and 25% (3/12) of the indicators, respectively. Similarly, the low, medium, and high immersion groups had changes in 50% (6/12), 33% (4/12), and 17% (2/12) of indicators, respectively. Conclusions: Our research supports the further development of a gaming app to aid older adults with tongue muscle training and measure flow using physiological and psychological signals to enhance training accuracy and feasibility. Next, we aim to conduct a randomized pilot trial, improve app functions, offer alternative rehabilitation options, and encourage long-term participation. Future goals include enhancing long-term efficacy, diversifying training modes, and adding a multiuser interactive option for an added challenge. UR - https://games.jmir.org/2025/1/e53045 UR - http://dx.doi.org/10.2196/53045 ID - info:doi/10.2196/53045 ER - TY - JOUR AU - Martins, Isabel Ana AU - Ribeiro, Óscar AU - Santinha, Gonçalo AU - Silva, Telmo AU - Rocha, P. Nelson AU - Silva, G. Anabela PY - 2025/1/9 TI - Effectiveness of Integrated Digital Solutions to Empower Older Adults in Aspects Related to Their Health: Systematic Review and Meta-Analysis JO - J Med Internet Res SP - e54466 VL - 27 KW - empowerment KW - older adults KW - digital health KW - digital solutions KW - effectiveness KW - health related KW - outcomes KW - systematic review KW - meta-analysis KW - synthesize KW - evaluate KW - apps KW - mHealth KW - mobile health N2 - Background: Digital solutions, such as mobile apps or telemonitoring devices, are frequently considered facilitators in the process of empowering older adults, but they can also act as a source of digital exclusion or disempowerment if they are not adequate for older adults? needs and characteristics. Objective: This study aimed to synthesize and critically evaluate existing evidence on the effectiveness of integrated digital solutions that enable interaction for empowering older adults in aspects related to their health and to explore potential factors (eg, type of technology, participants? characteristics) impacting effectiveness. Methods: A systematic search was carried out in PubMed, ScienceDirect, SCOPUS, EBSCO, and SciELO using a combination of terms informed by previous reviews on empowerment. Screening of references was performed against predefined inclusion criteria. Data extraction and the methodological quality of included studies using the PEDro (Physiotherapy Evidence Database) scale were performed by 2 authors. The certainty of evidence was graded for the main comparisons and outcomes of the review using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) framework. When at least 3 studies were available within the same domain of empowerment (knowledge, support by others, capacities, and behaviors) and comparison group, a meta-analysis was performed. Results: A total of 30 manuscripts were included in the review. Regarding knowledge, there was very low certainty of evidence of a medium effect size (ES) favoring the digital intervention group (k=5, ES=0.40, 95% CI 0.07-0.73, I2=79%). Regarding capacities, there was low certainty of evidence of no between-group differences (k=5, d=0.13, 95% CI ?0.02 to 0.29, I2=0%) when comparing digital solutions against no intervention, low certainty of evidence of a medium ES favoring the digital intervention group (k=13, d=0.29, 95% CI 0.07-0.52, I2=79%) when comparing digital solutions against usual care, and very low certainty of evidence of no between-group differences (k=4, d=0.97, 95% CI ?0.62 to 2.56, I2=97%) when comparing digital interventions to face-to-face interventions. Regarding social support and behaviors, no meta-analysis was possible, and existing evidence is conflicting. Conclusions: There is very-low-to-low certainty of evidence that using integrated digital solutions results in increased knowledge and increased capacities (mainly self-efficacy) when compared to usual care and impacts capacities to an extent similar to face-to-face interventions at postintervention. Interestingly, results also suggest, with low certainty of evidence, that there are no differences between using digital solutions and no intervention for improving capacities. Included studies and technologies were diverse, and meta-analysis showed high heterogeneity, which limits the confidence in the results and suggests that further research might affect the conclusions of this review. Trial Registration: PROSPERO CRD42022346823; https://tinyurl.com/39k29pzc UR - https://www.jmir.org/2025/1/e54466 UR - http://dx.doi.org/10.2196/54466 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54466 ER - TY - JOUR AU - Valkonen, Paula AU - Kujala, Sari AU - Savolainen, Kaisa AU - Helminen, Riina-Riitta PY - 2025/1/8 TI - Exploring Older Adults? Needs for a Healthy Life and eHealth: Qualitative Interview Study JO - JMIR Hum Factors SP - e50329 VL - 12 KW - older adults KW - eHealth KW - needs KW - retirement KW - well-being KW - cultural probes KW - sentence completion KW - human-computer interaction N2 - Background: Aging brings physical and life changes that could benefit from eHealth services. eHealth holistically combines technology, tasks, individuals, and contexts, and all these intertwined elements should be considered in eHealth development. As users? needs change with life situations, including aging and retirement, it is important to identify these needs at different life stages to develop eHealth services for well-being and active, healthy lives. Objective: This study aimed to (1) understand older adults? everyday lives in terms of well-being and health, (2) investigate older adults? needs for eHealth services, and (3) create design recommendations based on the findings. Methods: A total of 20 older adults from 2 age groups (55 to 74 years: n=12, 60%; >75 years: n=8, 40%) participated in this qualitative interview study. The data were collected remotely using a cultural probes package that included diary-based tasks, sentence completion tasks, and 4 background questionnaires; we also performed remote, semistructured interviews. The data were gathered between the fall of 2020 and the spring of 2021 in Finland as a part of the Toward a Socially Inclusive Digital Society: Transforming Service Culture (DigiIN) project (2019 to 2025). Results: In the daily lives of older adults, home-based activities, such as exercising (72/622, 11.6% of mentions), sleeping (51/622, 8.2% of mentions), and dining and cooking (96/622, 15.4% of mentions), promoted well-being and health. When discussing their needs for eHealth services, participants highlighted a preference for a chat function. However, they frequently mentioned barriers and concerns such as the lack of human contact, inefficiency, and difficulties using eHealth systems. Older adults value flexibility; testing possibilities (eg, trial versions); support for digital services; and relevant, empathetically offered content with eHealth services on short-term and long-term bases in their changing life situations. Conclusions: Many older adults value healthy routines and time spent at home. The diversity of older adults? needs should be considered by making it possible for them to manage their health safely and flexibly on different devices and channels. eHealth services should adapt to older adults? life changes through motivation, personalized content, and appropriate functions. Importantly, older adults should still have the option to not use eHealth services. UR - https://humanfactors.jmir.org/2025/1/e50329 UR - http://dx.doi.org/10.2196/50329 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/50329 ER - TY - JOUR AU - DeLange Martinez, Pauline AU - Tancredi, Daniel AU - Pavel, Misha AU - Garcia, Lorena AU - Young, M. Heather PY - 2025/1/8 TI - Adapting the Technology Acceptance Model to Examine the Use of Information Communication Technologies and Loneliness Among Low-Income, Older Asian Americans: Cross-Sectional Survey Analysis JO - JMIR Aging SP - e63856 VL - 8 KW - social isolation KW - loneliness KW - aged KW - older adults KW - Asian American KW - immigrant KW - vulnerable populations KW - internet KW - information and communication technologies KW - ICTs KW - digital divide KW - technology acceptance model KW - mobile phone N2 - Background: Loneliness is a significant issue among older Asian Americans, exacerbated by the COVID-19 pandemic. Older age, lower income, limited education, and immigrant status heighten loneliness risk. Information communication technologies (ICTs) have been associated with decreased loneliness among older adults. However, older Asian Americans are less likely to use ICTs, particularly if they are immigrants, have limited English proficiency, or are low income. The Technology Acceptance Model posits that perceived usefulness (PU), and perceived ease of use (PEOU) are key factors in predicting technology use. Objective: This study aimed to examine associations between PU, PEOU, ICT use, and loneliness among low-income, older Asian Americans. Methods: Cross-sectional survey data were gathered from predominately older Asian Americans in affordable senior housing (N=401). Using exploratory factor analysis and Horn parallel analysis, we examined 12 survey items to identify factors accounting for variance in ICT use. We deployed structural equation modeling to explore relationships among the latent factors and loneliness, adjusting for demographic and cognitive factors. Results: Exploratory factor analysis and Horn parallel analysis revealed 3 factors that accounted for 56.48% (6.78/12) total variance. PEOU combined items from validated subscales of tech anxiety and comfort, accounting for a 28.44% (3.41/12) variance. ICT use combined years of technological experience, computer, tablet, and smartphone use frequency, accounting for 15.59% (1.87/12) variance. PU combined 2 items assessing the usefulness of technology for social connection and learning and accounted for a 12.44% (1.49/12) variance. The 3-factor structural equation modeling revealed reasonable fit indexes (?2133=345.132; P<.001, chi-square minimum (CMIN)/df = 2595, comparative fit index (CFI)=0.93, Tucker-Lewis Index (TLI)=0.88). PEOU was positively associated with PU (?=.15; P=.01); PEOU and PU were positive predictors of ICT use (PEOU ?=.26, P<.001; PU ?=.18, P=.01); and ICT use was negatively associated with loneliness (?=?.28, P<.001). Demographic and health covariates also significantly influenced PU, PEOU, ICT use, and loneliness. English proficiency and education positively predicted PEOU (r=0.25, P<.001; r=0.26, P<.001) and ICT use (?=1.66, P=.03; ?=.21, P<.001), while subjective cognitive decline and Asian ethnicity were positively associated with loneliness (?=.31, P<.001; ?=.25, P<.001). Conclusions: This study suggests that targeted interventions enhancing PU or PEOU could increase ICT acceptance and reduce loneliness among low-income Asian Americans. Findings also underscore the importance of considering limited English proficiency and subjective cognitive decline when designing interventions and in future research. UR - https://aging.jmir.org/2025/1/e63856 UR - http://dx.doi.org/10.2196/63856 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63856 ER - TY - JOUR AU - Jin, Hengjiang AU - Qu, Ying PY - 2025/1/6 TI - Association Between Intergenerational Support, Technology Perception and Trust, and Intention to Seek Medical Care on the Internet Among Chinese Older Adults: Cross-Sectional Questionnaire Study JO - J Med Internet Res SP - e65065 VL - 27 KW - intergenerational support KW - older adults KW - internet medical intentions KW - perceived technology KW - trust N2 - Background: Avoiding technological innovation does not simplify life. In fact, using internet-based medical services can enhance the quality of life for older adults. In the context of an aging population and the growing integration of information technology, the demand for internet-based medical services among older adults is gaining increased attention. While scholars have highlighted the important role of intergenerational support in promoting digital inclusion for older adults, research on the relationship between intergenerational support and older adults? intentions to seek online care remains limited. Objective: This study aims (1) to explore the association between intergenerational support, online medical information, and older adults? intention to seek medical care online, and (2) to examine the mediating role of technology perception and trust, as well as the moderating role of eHealth literacy. Methods: A cross-sectional survey was conducted in China, collecting 958 valid responses from older adults aged 60 years and above. A vast majority of participants were between the ages of 60 and 75 years (771/958, 80.5%). Of the 958 participants, 559 (58.4%) resided in rural areas, while 399 (41.6%) lived in urban areas. The survey included questions on intergenerational support, perceived usefulness, perceived ease of use, trust, online medical information, eHealth literacy, and the intention to seek medical care online. Structural equation modeling and linear regression analysis were applied to explore the relationship between intergenerational support and the intention to seek medical care on the internet. Results: Intergenerational support was positively associated with perceived ease of use (?=.292, P<.001), perceived usefulness (?=.437, P<.001), trust (?=.322, P<.001), and the intention to seek medical care online (?=.354, P<.001). Online medical information also positively affected the intention to seek medical care online among older adults (?=.109, P<.001). Perceived ease of use (?=.029, 95% CI 0.009-0.054), perceived usefulness (?=.089, 95% CI 0.050-0.130), and trust (?=.063, 95% CI 0.036-0.099) partially mediated the association between intergenerational support and the intention to seek medical care online. Further analysis found that perceived ease of use, perceived usefulness, and trust played a chain mediating role between intergenerational support and the intention to seek medical care online (?=.015, 95% CI 0.008-0.027; ?=.022, 95% CI 0.012-0.036). Additionally, eHealth literacy played a moderating role in the relationship between intergenerational support and perceived ease of use (?=.177, P<.001), perceived usefulness (?=.073, P<.05), trust (?=.090, P<.01), and the intention to seek medical care online (?=.124, P<.001). Conclusions: An integrated model of health communication effects was constructed and validated, providing empirical support for the intention to seek medical care online and for the impact of health communication. This model also helps promote the role of technology in empowering the lives of seniors. UR - https://www.jmir.org/2025/1/e65065 UR - http://dx.doi.org/10.2196/65065 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/65065 ER - TY - JOUR AU - Rong, Jian AU - Pathiravasan, H. Chathurangi AU - Zhang, Yuankai AU - Faro, M. Jamie AU - Wang, Xuzhi AU - Schramm, Eric AU - Borrelli, Belinda AU - Benjamin, J. Emelia AU - Liu, Chunyu AU - Murabito, M. Joanne PY - 2024/12/31 TI - Baseline Smartphone App Survey Return in the Electronic Framingham Heart Study Offspring and Omni 1 Study: eCohort Study JO - JMIR Aging SP - e64636 VL - 7 KW - mHealth KW - mobile health KW - mobile application KW - smartphone KW - digital health KW - digital technology KW - digital intervention KW - gerontology KW - geriatric KW - older adult KW - aging KW - eFHS KW - eCohort KW - smartphone app KW - baseline app surveys KW - Framingham Heart Study KW - health information KW - information collection KW - mobile phone N2 - Background: Smartphone apps can be used to monitor chronic conditions and offer opportunities for self-assessment conveniently at home. However, few digital studies include older adults. Objective: We aim to describe a new electronic cohort of older adults embedded in the Framingham Heart Study including baseline smartphone survey return rates and survey completion rates by smartphone type (iPhone [Apple Inc] and Android [Google LLC] users). We also aim to report survey results for selected baseline surveys and participant experience with this study?s app. Methods: Framingham Heart Study Offspring and Omni (multiethnic cohort) participants who owned a smartphone were invited to download this study?s app that contained a range of survey types to report on different aspects of health including self-reported measures from the Patient-Reported Outcomes Measurement Information System (PROMIS). iPhone users also completed 4 tasks including 2 cognitive and 2 physical function testing tasks. Baseline survey return and completion rates were calculated for 12 surveys and compared between iPhone and Android users. We calculated standardized scores for the PROMIS surveys. The Mobile App Rating Scale (MARS) was deployed 30 days after enrollment to obtain participant feedback on app functionality and aesthetics. Results: We enrolled 611 smartphone users (average age 73.6, SD 6.3 y; n=346, 56.6% women; n=88, 14.4% Omni participants; 478, 78.2% iPhone users) and 596 (97.5%) returned at least 1 baseline survey. iPhone users had higher app survey return rates than Android users for each survey (range 85.5% to 98.3% vs 73.8% to 95.2%, respectively), but survey completion rates did not differ in the 2 smartphone groups. The return rate for the 4 iPhone tasks ranged from 80.9% (380/470) for the gait task to 88.9% (418/470) for the Trail Making Test task. The Electronic Framingham Heart Study participants had better standardized t scores in 6 of 7 PROMIS surveys compared to the general population mean (t score=50) including higher cognitive function (n=55.6) and lower fatigue (n=45.5). Among 469 participants who returned the MARS survey, app functionality and aesthetics was rated high (total MARS score=8.6 on a 1?10 scale). Conclusions: We effectively engaged community-dwelling older adults to use a smartphone app designed to collect health information relevant to older adults. High app survey return rates and very high app survey completion rates were observed along with high participant rating of this study?s app. UR - https://aging.jmir.org/2024/1/e64636 UR - http://dx.doi.org/10.2196/64636 ID - info:doi/10.2196/64636 ER - TY - JOUR AU - Ruggiano, Nicole AU - Brown, Leslie Ellen AU - Clarke, J. Peter AU - Hristidis, Vagelis AU - Roberts, Lisa AU - Framil Suarez, Victoria Carmen AU - Allala, Chaithra Sai AU - Hurley, Shannon AU - Kopcsik, Chrystine AU - Daquin, Jane AU - Chevez, Hamilton AU - Chang-Lau, Raymond AU - Agronin, Marc AU - Geldmacher, S. David PY - 2024/12/23 TI - An Evidence-Based IT Program With Chatbot to Support Caregiving and Clinical Care for People With Dementia: The CareHeroes Development and Usability Pilot JO - JMIR Aging SP - e57308 VL - 7 KW - Alzheimer disease KW - artificial intelligence KW - caregivers KW - chatbot KW - dementia KW - mobile applications KW - conversational agent KW - design KW - apps N2 - Background: There are numerous communication barriers between family caregivers and providers of people living with dementia, which can pose challenges to caregiving and clinical decision-making. To address these barriers, a new web and mobile-enabled app, called CareHeroes, was developed, which promotes the collection and secured sharing of clinical information between caregivers and providers. It also provides caregiver support and education. Objective: The primary study objective was to examine whether dementia caregivers would use CareHeroes as an adjunct to care and gather psychosocial data from those who used the app. Methods: This paper presents the implementation process used to integrate CareHeroes into clinical care at 2 memory clinics and preliminary outcome evaluation. Family caregivers receiving services at clinics were asked to use the app for a 12-month period to collect, track, and share clinical information with the care recipient?s provider. They also used it to assess their own mental health symptoms. Psychosocial outcomes were assessed through telephone interviews and user data were collected by the app. Results: A total of 21 caregivers enrolled in the pilot study across the 2 memory clinics. Usage data indicated that caregivers used many of the features in the CareHeroes app, though the chatbot was the most frequently used feature. Outcome data indicated that caregivers? depression was lower at 3-month follow-up (t11=2.03, P=.03). Conclusions: Recruitment and retention of the pilot study were impacted by COVID-19 restrictions, and therefore more testing is needed with a larger sample to determine the potential impact of CareHeroes on caregivers? mental health. Despite this limitation, the pilot study demonstrated that integrating a new supportive app for caregivers as an adjunct to clinical dementia care is feasible. Implications for future technology intervention development, implementation planning, and testing for caregivers of people living with dementia are discussed. UR - https://aging.jmir.org/2024/1/e57308 UR - http://dx.doi.org/10.2196/57308 ID - info:doi/10.2196/57308 ER - TY - JOUR AU - Supplieth, Juliana AU - Lech, Sonia AU - O?Sullivan, Lorraine Julie AU - Spang, Robert AU - Voigt-Antons, Jan?Niklas AU - Schuster, Johanna PY - 2024/12/19 TI - Development of a Tablet-Based Outpatient Care Application for People With Dementia: Interview and Workshop Study JO - JMIR Hum Factors SP - e59865 VL - 11 KW - dementia KW - tablet application development KW - multidisciplinary health care KW - feasibility study KW - general practitioners KW - digital health care N2 - Background: Dementia management presents a significant challenge for individuals affected by dementia, as well as their families, caregivers, and health care providers. Digital applications may support those living with dementia; however only a few dementia-friendly applications exist. Objective: This paper emphasizes the necessity of considering multiple perspectives to ensure the high-quality development of supportive health care applications. The findings underscore the importance of incorporating input from stakeholders and the needs of affected families into application development. Method: A qualitative approach was chosen, consisting of three interviews and an expert workshop. The interviews and the workshop were recorded and transcribed, and qualitative content analysis was carried out according to the methodology described by Kuckartz with the support of MAXQDA. Results: During the development phases of the application, team meetings and discussions took place. We found that general practitioners and family caregivers play pivotal roles in the treatment and care of people with dementia, often expressing specific preferences and suggestions regarding supportive and assistive technologies. Moreover, the successful development of a useful tablet application requires robust scientific and multidisciplinary discussions and teamwork within the health care community. Conclusion: This paper underscores the necessity of including multiple scientific, clinical, and technical perspectives to ensure the high-quality development of supportive health care applications. Furthermore, adopting a spiral development approach inclusive of feedback loops is imperative for iterative refinement and enhancement of the application. International Registered Report Identifier (IRRID): RR2-10.1024/1662-9647/a000210 UR - https://humanfactors.jmir.org/2024/1/e59865 UR - http://dx.doi.org/10.2196/59865 ID - info:doi/10.2196/59865 ER - TY - JOUR AU - Malhotra, Chetna AU - Yee, Alethea AU - Ramakrishnan, Chandrika AU - Kaurani, Naraindas Sanam AU - Chua, Ivy AU - Lakin, R. Joshua AU - Sim, David AU - Balakrishnan, Iswaree AU - Ling, Jin Vera Goh AU - Weiliang, Huang AU - Ling, Fong Lee AU - Pollak, I. Kathryn PY - 2024/12/18 TI - Development and Usability of an Advance Care Planning Website (My Voice) to Empower Patients With Heart Failure and Their Caregivers: Mixed Methods Study JO - JMIR Aging SP - e60117 VL - 7 KW - advance care planning KW - decision aid KW - heart KW - website KW - heart failure KW - care plan KW - caregiver KW - usability KW - acceptability N2 - Background: Web-based advance care planning (ACP) interventions offer a promising solution to improve ACP engagement, but none are specifically designed to meet the needs of patients with heart failure and their caregivers. Objective: We aimed to develop and assess the usability and acceptability of a web-based ACP decision aid called ?My Voice,? which is tailored for patients with heart failure and their caregivers. Methods: This study?s team and advisory board codeveloped the content for both patient and caregiver modules in ?My Voice.? Using a mixed methods approach, we iteratively tested usability and acceptability, incorporating feedback from patients, caregivers, and health care professionals (HCPs). Results: We interviewed 30 participants (11 patients, 9 caregivers, and 10 HCPs). Participants found the website easy to navigate, with simple and clear content facilitating communication of patients? values and goals. They also appreciated that it allowed them to revisit their care goals periodically. The average System Usability Scale score was 74 (SD 14.8; range: 42.5-95), indicating good usability. Over 80% (8/11) of patients and 87% (7/8) of caregivers rated the website?s acceptability as good or excellent. Additionally, 70% (7/10) of HCPs strongly agreed or agreed with 11 of the 15 items testing the website?s acceptability. Conclusions: ?My Voice? shows promise as a tool for patients with heart failure to initiate and revisit ACP conversations with HCPs and caregivers. We will evaluate its efficacy in improving patient and caregiver outcomes in a randomized controlled trial. Trial Registration: ClinicalTrials.gov NCT06090734; https://clinicaltrials.gov/study/NCT06090734 UR - https://aging.jmir.org/2024/1/e60117 UR - http://dx.doi.org/10.2196/60117 ID - info:doi/10.2196/60117 ER - TY - JOUR AU - Ahmed, Nisar AU - Hall, Alex AU - Poku, Brenda AU - McDermott, Jane AU - Astbury, Jayne AU - Todd, Chris PY - 2024/12/18 TI - Experiences and Views of Older Adults of South Asian, Black African, and Caribbean Backgrounds About the Digitalization of Primary Care Services Since the COVID-19 Pandemic: Qualitative Focus Group Study JO - JMIR Form Res SP - e57580 VL - 8 KW - digital health and primary care services KW - digital exclusion KW - digital divide KW - health inequalities KW - older adults KW - South Asian KW - Black African KW - Caribbean KW - COVID-19 pandemic KW - qualitative focus group study N2 - Background: The COVID-19 pandemic from 2020 to 2022 prompted governments worldwide to enforce lockdowns and social restrictions, alongside the rapid adoption of digital health and care services. However, there are concerns about the potential exclusion of older adults, who face barriers to digital inclusion, such as age, socioeconomic status, literacy level, and ethnicity. Objective: This study aims to explore the experiences of older adults from the 3 largest minoritized ethnic groups in England and Wales?people of South Asian, Black African, and Caribbean backgrounds?in the use of digitalized primary care services since the beginning of the COVID-19 pandemic. Methods: In total, 27 individuals participated in 4 focus groups (April and May 2023) either in person or via online videoconferencing. Patient and public involvement and engagement were sought through collaboration with community organizations for focus group recruitment and feedback on the topic guide. Data were analyzed using framework analysis. Results: This paper summarizes the perspectives of 27 older adults from these 3 minoritized ethnic groups and identifies four key themes: (1) service accessibility through digital health (participants faced difficulties accessing digital health care services through online platforms, primarily due to language barriers and limited digital skills, with reliance on younger family members or community organizations for assistance; the lack of digital literacy among older community members was a prominent concern, and digital health care services were felt to be tailored for English speakers, with minimal consultation during the development phase), (2) importance of face-to-face (in-person) appointments for patient-clinician interactions (in-person appointments were strongly preferred, emphasizing the value of physical interaction and connection with health care professionals; video consultations were seen as an acceptable alternative), (3) stressors caused by the shift to remote access (the transition to remote digital access caused stress, fear, and anxiety; participants felt that digital health solutions were imposed without sufficient explanation or consent; and Black African and Caribbean participants reported experiences of racial discrimination within the health care system), and (4) digital solutions (evaluating technology acceptance; participants acknowledged the importance of digitalization but cautioned against viewing it as a one-size-fits-all solution; they advocated for offline alternatives and a hybrid approach, emphasizing the need for choice and a well-staffed clinical workforce). Conclusions: Digital health initiatives should address the digital divide, health inequalities, and the specific challenges faced by older adults, particularly those from minoritized ethnic backgrounds, ensuring accessibility, choice, and privacy. Overcoming language barriers involves more than mere translation. Maintaining in-person options for consultations, addressing sensitive issues, and implementing support systems at the practice level to support those struggling to access services are vital. This study recommends that policy makers ensure the inclusivity of older adults from diverse backgrounds in the design and implementation of digital health and social care services. UR - https://formative.jmir.org/2024/1/e57580 UR - http://dx.doi.org/10.2196/57580 UR - http://www.ncbi.nlm.nih.gov/pubmed/39693146 ID - info:doi/10.2196/57580 ER - TY - JOUR AU - Vordenberg, E. Sarah AU - Nichols, Julianna AU - Marshall, D. Vincent AU - Weir, Rebecca Kristie AU - Dorsch, P. Michael PY - 2024/12/16 TI - Investigating Older Adults? Perceptions of AI Tools for Medication Decisions: Vignette-Based Experimental Survey JO - J Med Internet Res SP - e60794 VL - 26 KW - older adults KW - survey KW - decisions KW - artificial intelligence KW - vignette KW - drug KW - pharmacology KW - pharmaceutic KW - medication KW - decision-making KW - geriatric KW - aging KW - surveys KW - attitude KW - perception KW - perspective KW - recommendation KW - electronic heath record N2 - Background: Given the public release of large language models, research is needed to explore whether older adults would be receptive to personalized medication advice given by artificial intelligence (AI) tools. Objective: This study aims to identify predictors of the likelihood of older adults stopping a medication and the influence of the source of the information. Methods: We conducted a web-based experimental survey in which US participants aged ?65 years were asked to report their likelihood of stopping a medication based on the source of information using a 6-point Likert scale (scale anchors: 1=not at all likely; 6=extremely likely). In total, 3 medications were presented in a randomized order: aspirin (risk of bleeding), ranitidine (cancer-causing chemical), or simvastatin (lack of benefit with age). In total, 5 sources of information were presented: primary care provider (PCP), pharmacist, AI that connects with the electronic health record (EHR) and provides advice to the PCP (?EHR-PCP?), AI with EHR access that directly provides advice (?EHR-Direct?), and AI that asks questions to provide advice (?Questions-Direct?) directly. We calculated descriptive statistics to identify participants who were extremely likely (score 6) to stop the medication and used logistic regression to identify demographic predictors of being likely (scores 4-6) as opposed to unlikely (scores 1-3) to stop a medication. Results: Older adults (n=1245) reported being extremely likely to stop a medication based on a PCP?s recommendation (n=748, 60.1% [aspirin] to n=858, 68.9% [ranitidine]) compared to a pharmacist (n=227, 18.2% [simvastatin] to n=361, 29% [ranitidine]). They were infrequently extremely likely to stop a medication when recommended by AI (EHR-PCP: n=182, 14.6% [aspirin] to n=289, 23.2% [ranitidine]; EHR-Direct: n=118, 9.5% [simvastatin] to n=212, 17% [ranitidine]; Questions-Direct: n=121, 9.7% [aspirin] to n=204, 16.4% [ranitidine]). In adjusted analyses, characteristics that increased the likelihood of following an AI recommendation included being Black or African American as compared to White (Questions-Direct: odds ratio [OR] 1.28, 95% CI 1.06-1.54 to EHR-PCP: OR 1.42, 95% CI 1.17-1.73), having higher self-reported health (EHR-PCP: OR 1.09, 95% CI 1.01-1.18 to EHR-Direct: OR 1.13 95%, CI 1.05-1.23), having higher confidence in using an EHR (Questions-Direct: OR 1.36, 95% CI 1.16-1.58 to EHR-PCP: OR 1.55, 95% CI 1.33-1.80), and having higher confidence using apps (EHR-Direct: OR 1.38, 95% CI 1.18-1.62 to EHR-PCP: OR 1.49, 95% CI 1.27-1.74). Older adults with higher health literacy were less likely to stop a medication when recommended by AI (EHR-PCP: OR 0.81, 95% CI 0.75-0.88 to EHR-Direct: OR 0.85, 95% CI 0.78-0.92). Conclusions: Older adults have reservations about following an AI recommendation to stop a medication. However, individuals who are Black or African American, have higher self-reported health, or have higher confidence in using an EHR or apps may be receptive to AI-based medication recommendations. UR - https://www.jmir.org/2024/1/e60794 UR - http://dx.doi.org/10.2196/60794 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60794 ER - TY - JOUR AU - Chen, Jiaren AU - Park, Jong-Hwan AU - Lin, Chien-Yu AU - Lai, Ting-Fu AU - Kim, Du-Ri AU - Shin, Myung-Jun AU - Moon, Eunsoo AU - Kang, Mo Jung AU - Lee, Won Jong AU - Cho, Jae Yoon AU - Liao, Yung AU - Goh, Sik Tae AU - Lee, Sub Jung PY - 2024/12/16 TI - Whole-Body and Segmental Phase Angles and Cognitive Function in the Older Korean Population: Cross-Sectional Analysis JO - JMIR Public Health Surveill SP - e63457 VL - 10 KW - bioelectrical impedance analysis KW - oxidative stress KW - cellular health KW - cognitive function KW - older adults KW - BIA KW - phase angle KW - PhA N2 - Background: Recently, the phase angle (PhA) has emerged as an essential indicator of cellular health. Most studies have examined its association with physiological conditions, such as sarcopenia, frailty, and physical function, in older populations. Simultaneously, growing attention is being paid to the clinical relevance of segmental PhAs for future applications. However, few studies have explored the relationship between PhAs, especially segmental PhAs, and the psychological aspects of health, particularly cognitive function. Objective: We aimed to investigate the association between whole-body and segmental PhAs and cognitive function in older adults. Methods: Individuals aged 65 years and above were recruited from adult community groups residing in Busan, South Korea, through the 2022 Bus-based Screening and Assessment Network (BUSAN) study of Pusan National University Hospital. Participants? whole-body and segmental PhAs were measured using a bioelectrical impedance analyzer (BWA 2.0 Body Water Analyzer, InBody), and cognitive functions (overall and subdomains, including memory, orientation, attention and calculation, and language) were self-reported using the Korean version of the Mini-Mental State Examination. Multiple linear regression analyses were performed to examine these associations. Results: This study included 625 older adults aged 65?96 years (women: n=444, 71%; men: n=191, 29%). A positive association was observed between whole-body PhA and cognitive function (b=0.62, 95% CI 0.16?1.08; P<.01). We observed significant positive associations between the PhA of the lower limbs (b=0.72, 95% CI 0.38?1.06; P<.001) and cognitive function. Analysis of the Mini-Mental State Examination subdomains revealed that whole-body PhA was significantly related to memory (b=0.11, 95% CI 0.00?0.22; P=.04); the PhA of the upper limbs was significantly related to orientation (b=0.29, 95% CI 0.09?0.49; P=.01); and the PhA of the lower limbs was significantly related to orientation (b=0.24, 95% CI 0.10?0.38; P<.001), attention and calculation (b=0.21, 95% CI 0.06?0.37; P=.01), memory (b=0.14, 95% CI 0.05?0.22; P=.001), and language functions (b=0.07, 95% CI 0.01?0.12; P=.01). However, trunk PhA showed no significant association. Conclusions: Our findings bolster the emerging evidence of a significant positive correlation between whole-body PhA and cognitive function in our sample, with nuanced relationships observed across different segmental PhAs and cognitive subdomains. Therefore, this study revealed that PhAs could be a useful tool for screening or preventing cognitive decline in the general older population, offering substantial evidence for future interventional studies. Further research should delve into the mechanisms and assess targeted interventions that enhance regional physical function to support cognitive health in older adults. Further long-term investigation on these associations is warranted. UR - https://publichealth.jmir.org/2024/1/e63457 UR - http://dx.doi.org/10.2196/63457 ID - info:doi/10.2196/63457 ER - TY - JOUR AU - Klein, Melina AU - von Bosse, Alexa AU - Kunze, Christophe PY - 2024/12/10 TI - The Needs and Experiences of People With Early-Stage Dementia Using an Application for Cognitive and Physical Activation in Germany: Qualitative Study JO - JMIR Aging SP - e62689 VL - 7 KW - touch-based digital technology KW - gerontology KW - geriatric KW - older KW - elderly KW - aging KW - aged KW - tablet-based technology KW - tablet KW - digital care application KW - mHealth KW - mobile health KW - app KW - health app KW - home care setting KW - caring relatives KW - dementia KW - MCI KW - Alzheimer KW - mild cognitive impairment KW - cognition KW - prototype KW - digital health KW - telehealth KW - memory loss KW - patient care KW - patient health KW - patient support N2 - Background: The demand for support among people with dementia is increasing, while caregiving capacity is declining. As the trend of aging at home continues, technologies can help maintain the autonomy of people with dementia, enabling them to live independently for as long as possible. Furthermore, digital applications can have numerous positive biopsychosocial effects on the health of people with dementia, enhancing their physical, cognitive, and social functioning. Objective: This study aims to investigate the needs and experiences of people with dementia regarding a prototype tablet-based application designed to promote cognitive and physical activity. Methods: We conducted a methodical triangulation by combining semistructured interviews with people with dementia and external overt participant observation while testing a tablet-based application. A qualitative content analysis, as outlined by Kuckartz, was used to analyze the data. Results: Participants demonstrated varying levels of ability and prior experience with technology. While most were initially hesitant to use the tablet independently, they were more willing to try it after receiving encouragement. Some individuals required more assistance than others, indicating the need for individualized adjustments. Personal relevance to the content appeared to be crucial for cognitive tasks, as it helped to minimize overload for people with dementia. The participants appreciated social interaction with researchers and direct communication. Therefore, it is important to consider the role of personal support when developing and implementing technology. Conclusions: The successful implementation and use of technology requires acceptance and an effective interaction between people with dementia, technology, and caregivers or caring relatives providing personal support. The acceptance of the application was found to be less influenced by the types and presentation of tasks and more by content relevance and social interaction. Ideally, one-on-one support will be provided during use, though this requires additional time and financial resources, which are often limited in caregiving settings. UR - https://aging.jmir.org/2024/1/e62689 UR - http://dx.doi.org/10.2196/62689 ID - info:doi/10.2196/62689 ER - TY - JOUR AU - Jeon, Sangha AU - Charles, Turk Susan PY - 2024/12/10 TI - Internet-Based Social Activities and Cognitive Functioning 2 Years Later Among Middle-Aged and Older Adults: Prospective Cohort Study JO - JMIR Aging SP - e63907 VL - 7 KW - online social interaction KW - cognitive health KW - age differences KW - Health and Retirement Study KW - social activity KW - internet use KW - isolation N2 - Background: A number of studies document the benefits of face-to-face social interactions for cognitive functioning among middle-aged and older adults. Social activities in virtual worlds may confer similar if not enhanced cognitive benefits as face-to-face social activities, given that virtual interactions require the additional cognitive tasks of learning and navigating communicative tools and technology platforms. Yet, few studies have examined whether social activities in internet-based settings may have synergistic effects on cognitive functioning beyond those of face-to-face interactions. Objective: This study examined whether internet-based social activity participation is associated with concurrent and later cognitive functioning, after adjusting for face-to-face social activity participation and sociodemographic covariates. Methods: For cross-sectional analyses, we included 3650 adults aged 50 years and older who completed questions in the 2020 Health and Retirement Study about social activity participation, including specific internet-based social activities such as emailing or accessing social networks. Cognitive functioning was measured using the standardized cognitive tasks assessing working memory, episodic memory, and attention and processing speed. The longitudinal analyses included the 2034 participants who also completed follow-up cognitive assessments in 2022. Results: Our results revealed that those with higher levels of internet-based social activity participation had higher levels of concurrent cognitive functioning than those with low levels of internet-based social activity participation, after adjusting for demographic and health-related factors and face-to-face social activity participation (b=0.44, SE 0.07; P<.001). More internet-based social activity participation also predicted better cognitive functioning 2 years later, even when adjusting for baseline cognitive functioning and other covariates (b=0.35, SE 0.09; P<.001). Conclusions: Our findings suggest that greater engagement in internet-based social activities is associated with higher levels of concurrent cognitive functioning and slower cognitive decline in middle-aged and older adults. UR - https://aging.jmir.org/2024/1/e63907 UR - http://dx.doi.org/10.2196/63907 ID - info:doi/10.2196/63907 ER - TY - JOUR AU - Lad, Meher AU - Taylor, John-Paul AU - Griffiths, David Timothy PY - 2024/12/9 TI - Reliable Web-Based Auditory Cognitive Testing: Observational Study JO - J Med Internet Res SP - e58444 VL - 26 KW - auditory testing KW - hearing loss KW - cognitive testing KW - auditory KW - observational study KW - older adult KW - hearing KW - questionnaire KW - auditory cognitive testing KW - in person KW - web-based setting KW - auditory memory KW - Pearson KW - female KW - women KW - audiology N2 - Background: Web-based experimentation, accelerated by the COVID-19 pandemic, has enabled large-scale participant recruitment and data collection. Auditory testing on the web has shown promise but faces challenges such as uncontrolled environments and verifying headphone use. Prior studies have successfully replicated auditory experiments but often involved younger participants, limiting the generalizability to older adults with varying hearing abilities. This study explores the feasibility of conducting reliable auditory cognitive testing using a web-based platform, especially among older adults. Objective: This study aims to determine whether demographic factors such as age and hearing status influence participation in web-based auditory cognitive experiments and to assess the reproducibility of auditory cognitive measures?specifically speech-in-noise perception and auditory memory (AuM)?between in-person and web-based settings. Additionally, this study aims to examine the relationship between musical sophistication, measured by the Goldsmiths Musical Sophistication Index (GMSI), and auditory cognitive measures across different testing environments. Methods: A total of 153 participants aged 50 to 86 years were recruited from local registries and memory clinics; 58 of these returned for web-based, follow-up assessments. An additional 89 participants from the PREVENT cohort were included in the web-based study, forming a combined sample. Participants completed speech-in-noise perception tasks (Digits-in-Noise and Speech-in-Babble), AuM tests for frequency and amplitude modulation rate, and the GMSI questionnaire. In-person testing was conducted in a soundproof room with standardized equipment, while web-based tests required participants to use headphones in a quiet room via a web-based app. The reproducibility of auditory measures was evaluated using Pearson and intraclass correlation coefficients, and statistical analyses assessed relationships between variables across settings. Results: Older participants and those with severe hearing loss were underrepresented in the web-based follow-up. The GMSI questionnaire demonstrated the highest reproducibility (r=0.82), while auditory cognitive tasks showed moderate reproducibility (Digits-in-Noise and Speech-in-Babble r=0.55 AuM tests for frequency r=0.75 and amplitude modulation rate r=0.44). There were no significant differences in the correlation between age and auditory measures across in-person and web-based settings (all P>.05). The study replicated previously reported associations between AuM and GMSI scores, as well as sentence-in-noise perception, indicating consistency across testing environments. Conclusions: Web-based auditory cognitive testing is feasible and yields results comparable to in-person testing, especially for questionnaire-based measures like the GMSI. While auditory tasks demonstrated moderate reproducibility, the consistent replication of key associations suggests that web-based testing is a viable alternative for auditory cognition research. However, the underrepresentation of older adults and those with severe hearing loss highlights a need to address barriers to web-based participation. Future work should explore methods to enhance inclusivity, such as remote guided testing, and address factors like digital literacy and equipment standards to improve the representativeness and quality of web-based auditory research. UR - https://www.jmir.org/2024/1/e58444 UR - http://dx.doi.org/10.2196/58444 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58444 ER - TY - JOUR AU - Bruni, Francesca AU - Mancuso, Valentina AU - Panigada, Jonathan AU - Stramba-Badiale, Marco AU - Cipresso, Pietro AU - Pedroli, Elisa PY - 2024/12/5 TI - Exploring How Older Adults Experience semAPP, a 360° Media?Based Tool for Memory Assessment: Qualitative Study JO - JMIR Aging SP - e56796 VL - 7 KW - assessment KW - virtual reality KW - 360-degree videos KW - user experience KW - memory KW - aging KW - psycho gerontology N2 - Background: Technology is already a part of our daily lives, and its influence is growing rapidly. This evolution has not spared the health care field. Nowadays, a crucial challenge is considering aspects such as design, development, and implementation, highlighting their functionality, ease of use, compatibility, performance, and safety when a new technological tool is developed. As noted in many works, the abandonment rate is usually higher when a user has a terrible experience with these instruments. It would be appropriate to incorporate the final users?whether they are patients, health care professionals, or both?in the stages of instrument design to understand their needs and preferences. Since most apps that fail did not include end users and health care professionals in the development phase, their involvement at all stages of app development may increase their commitment and improve integration, self-management, and health outcomes. Objective: This study aims (1) to develop semAPP (spatial and episodic memory assessment application), a 360° media?based tool, to assess memory in aging by simulating a real-life situation and (2) to test the usability of the app and the connected experience in an end-user population. Methods: A total of 34 older adults participated in the study: 16 (47%) healthy individuals and 18 (53%) patients with mild cognitive impairment. They used semAPP and completed qualitative and quantitative measures. The app includes 2 parts: object recognition and spatial memory tasks. During the first task, users have to navigate in an apartment freely and visit rooms, and then they must recognize the right map of the house. In the second task, users are immersed in a living room, and they have to encode and then recall some target objects, simulating a relocation. We deployed this app on an 11.2-inch iPad, and we tested its usability and the experience of users interacting with the app. We conducted descriptive analyses for both the entire sample and each subgroup; we also conducted parametric and correlation analyses to compare groups and to examine the relationship between task execution and the virtual experience, as well as the acceptance of technology. Results: Both groups judged the app as an easy-to-use tool, and they were willing to use it. Moreover, the results match the idea that usability might be influenced by different factors depending on instrument and personal features, such as presentation, functionality, system performance, interactive behavior, attitudes, skills, and personality. Conclusions: The findings support the possibility of using semAPP in older patients, as well as the importance of designing and evaluating new technological tools, considering not only the general population but also the specific target ones. UR - https://aging.jmir.org/2024/1/e56796 UR - http://dx.doi.org/10.2196/56796 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56796 ER - TY - JOUR AU - Dermody, Gordana AU - Wadsworth, Daniel AU - Dunham, Melissa AU - Glass, Courtney AU - Fritz, Roschelle PY - 2024/12/5 TI - Factors Affecting Clinician Readiness to Adopt Smart Home Technology for Remote Health Monitoring: Systematic Review JO - JMIR Aging SP - e64367 VL - 7 KW - clinician KW - provider KW - health professional KW - smart home KW - remote monitoring KW - technology KW - readiness KW - adoption KW - preparedness N2 - Background: The population of older adults worldwide continues to increase, placing higher demands on primary health care and long-term care. The costs of housing older people in care facilities have economic and societal impacts that are unsustainable without innovative solutions. Many older people wish to remain independent in their homes and age in place. Assistive technology such as health-assistive smart homes with clinician monitoring could be a widely adopted alternative to aged-care facilities in the future. While studies have found that older persons have demonstrated a readiness to adopt health-assistive smart homes, little is known about clinician readiness to adopt this technology to support older adults to age as independently as possible. Objective: The purpose of this systematic review was to identify the factors that affect clinician readiness to adopt smart home technology for remote health monitoring. Methods: This review was conducted in accordance with the Joanna Briggs Institute methodology for systematic Reviews and followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for reporting. Results: Several factors affected clinicians? perspectives on their readiness to adopt smart home technology for remote health monitoring, including challenges such as patient privacy and dignity, data security, and ethical use of ?invasive? technologies. Perceived benefits included enhancing the quality of care and outcomes. Conclusions: Clinicians, including nurses, reported both challenges and benefits of adopting smart home technology for remote health monitoring. Clear strategies and frameworks to allay fears and overcome professional concerns and misconceptions form key parts of the Readiness for Adoption Pathway proposed. The use of more rigorous scientific methods and reporting is needed to advance the state of the science. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020195989; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=195989 UR - https://aging.jmir.org/2024/1/e64367 UR - http://dx.doi.org/10.2196/64367 UR - http://www.ncbi.nlm.nih.gov/pubmed/39012852 ID - info:doi/10.2196/64367 ER - TY - JOUR AU - Kokorelias, M. Kristina AU - Valentine, Dean AU - Dove, M. Erica AU - Brown, Paige AU - McKinlay, Stuart AU - Sheppard, L. Christine AU - Singh, Hardeep AU - Eaton, D. Andrew AU - Jamieson, Laura AU - Wasilewski, B. Marina AU - Zhabokritsky, Alice AU - Flanagan, Ashley AU - Abdelhalim, Reham AU - Zewude, Rahel AU - Parpia, Rabea AU - Walmsley, Sharon AU - Sirisegaram, Luxey PY - 2024/12/4 TI - Exploring the Perspectives of Older Adults Living With HIV on Virtual Care: Qualitative Study JO - JMIR Aging SP - e65730 VL - 7 KW - HIV KW - human immunodeficiency virus KW - perspective KW - telemedicine KW - telehealth KW - virtual care KW - virtual health KW - virtual medicine KW - qualitative KW - gerontology KW - geriatrics KW - older adult KW - older people KW - aging N2 - Background: As the population of individuals with HIV ages rapidly due to advancements in antiretroviral therapy, virtual care has become an increasingly vital component in managing their complex health needs. However, little is known about perceptions of virtual care among older adults living with HIV. Objective: This study aimed to understand the perceptions of older adults living with HIV regarding virtual care. Methods: Using an interpretive, qualitative, descriptive methodology, semistructured interviews were conducted with 14 diverse older adults living with HIV. The participants lived in Ontario, Canada, self-identified as HIV-positive, and were aged 50 years or older. Efforts were made to recruit individuals with varying experience with virtual health care. Reflexive thematic analysis was conducted with the interview transcripts to identify prevalent themes. Results: The identified themes included (1) the importance of relationships in virtual care for older adults living with HIV; (2) privacy and confidentiality in virtual care; and (3) challenges and solutions related to access and technological barriers in virtual care. These themes highlight the perceptions of diverse older adults living with HIV concerning virtual care, emphasizing the fundamental role of trust, privacy, and technology access. Conclusions: By embracing the unique perspectives and experiences of this population, we can work toward building more inclusive and responsive health care systems that meet the needs of all individuals, regardless of age, HIV status, or other intersecting identities. UR - https://aging.jmir.org/2024/1/e65730 UR - http://dx.doi.org/10.2196/65730 ID - info:doi/10.2196/65730 ER - TY - JOUR AU - Naudé, Bérangčre AU - Rigaud, Anne-Sophie AU - Pino, Maribel PY - 2024/12/2 TI - Investigating the Acceptability of an Interactive Television Intervention Promoting Social Links Among Older Adults Living at Home and in Care Institutions: Qualitative Interview and Questionnaire Study JO - JMIR Hum Factors SP - e58051 VL - 11 KW - interactive television KW - iTV KW - acceptance KW - older adults KW - nursing home KW - residential facility KW - technology acceptance model KW - TAM KW - mobile phone N2 - Background: When older adults (OAs) can no longer live independently at home, they have the option to choose from various types of geriatric care institutions, such as residential facilities or nursing homes. For several years now, thanks to the development of interactive television (iTV), social link functions have been accessible directly on televisions, tools that are already integrated into residents? rooms. The acceptance of technologies specifically targeting older users, as well as iTV, has been widely documented in the literature, incorporating factors from the innovation resistance model. Objective: This research aims to enrich the acceptance of existing models of innovation by OAs living in different settings. Methods: User tests were carried out to evaluate OAs? experiences with iTV and identify the factors involved in its acceptance. A total of 32 OAs living at home, in nursing homes, or in residential facilities in France were interviewed between November 2022 and June 2023. iTV acceptance was examined using an interview grid based on the technology acceptance model and included the following factors: intention to use, perceived usefulness, perceived ease of use, user resistance, anxiety, facilitating conditions, and user characteristics. Results: The deductive qualitative analysis based on the technology acceptance model helped to identify 33 concepts. Conclusions: This study has contributed to the literature on the acceptance of iTV by OAs living at home and in geriatric institutions, particularly by enriching existing models and proposing new avenues for reflection. UR - https://humanfactors.jmir.org/2024/1/e58051 UR - http://dx.doi.org/10.2196/58051 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58051 ER - TY - JOUR AU - Chan, Andrew AU - Cai, Joanne AU - Qian, Linna AU - Coutts, Brendan AU - Phan, Steven AU - Gregson, Geoff AU - Lipsett, Michael AU - Ríos Rincón, M. Adriana PY - 2024/12/2 TI - In-Home Positioning for Remote Home Health Monitoring in Older Adults: Systematic Review JO - JMIR Aging SP - e57320 VL - 7 KW - gerontology KW - geriatrics KW - older adult KW - elderly KW - aging KW - aging-in-place KW - localization KW - ambient sensor KW - wearable sensor KW - acceptability KW - home monitor KW - health monitor KW - technology KW - digital health KW - e-health KW - telehealth KW - clinical studies KW - cognitive impairment KW - neuro KW - cognition N2 - Background: With the growing proportion of Canadians aged >65 years, smart home and health monitoring technologies may help older adults manage chronic disease and support aging in place. Localization technologies have been used to support the management of frailty and dementia by detecting activities in the home. Objective: This systematic review aims to summarize the clinical evidence for in-home localization technologies, review the acceptability of monitoring, and summarize the range of technologies being used for in-home localization. Methods: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology was followed. MEDLINE, Embase, CINAHL, and Scopus were searched with 2 reviewers performing screening, extractions, and quality assessments. Results: A total of 1935 articles were found, with 36 technology-focused articles and 10 articles that reported on patient outcomes being included. From moderate- to high-quality studies, 2 studies reported mixed results on identifying mild cognitive dementia or frailty, while 4 studies reported mixed results on the acceptability of localization technology. Technologies included ambient sensors; Bluetooth- or Wi-Fi?received signal strength; localizer tags using radio frequency identification, ultra-wideband, Zigbee, or GPS; and inertial measurement units with localizer tags. Conclusions: The clinical utility of localization remains mixed, with in-home sensors not being able to differentiate between older adults with healthy cognition and older adults with mild cognitive impairment. However, frailty was detectable using in-home sensors. Acceptability is moderately positive, particularly with ambient sensors. Localization technologies can achieve room detection accuracies up to 92% and linear accuracies of up to 5-20 cm that may be promising for future clinical applications. Trial Registration: PROSPERO CRD42022339845; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=339845 UR - https://aging.jmir.org/2024/1/e57320 UR - http://dx.doi.org/10.2196/57320 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57320 ER - TY - JOUR AU - Hammarberg, Karin AU - Bandyopadhyay, Mridula AU - Nguyen, Hau AU - Cicuttini, Flavia AU - Stanzel, Andrea Karin AU - Brown, Helen AU - Hickey, Martha AU - Fisher, Jane PY - 2024/12/2 TI - Development and Evaluation of 4 Short, Animated Videos for Women in Midlife Promoting Positive Health Behaviors: Survey Study JO - Interact J Med Res SP - e60949 VL - 13 KW - health promotion KW - healthy aging KW - self-management KW - midlife KW - menopause KW - internet KW - video KW - animation KW - survey KW - questionnaire KW - education KW - women KW - gynecology N2 - Background: Health and health behaviors in midlife are important determinants of healthy aging. There is evidence of unmet needs for health-promoting information for women from culturally and linguistically diverse backgrounds and women with low literacy. Objective: This study aimed to (1) develop accessible short, animated videos viewable and downloadable from YouTube aimed at promoting positive health behaviors in women in midlife and (2) evaluate their accessibility, acceptability, understanding, and usability and whether this was influenced by the level of education or socioeconomic disadvantage. Methods: In collaboration with a video production company, a multidisciplinary team of academics and health professionals developed 2 short, animated videos on self-management of menopause health and 2 promoting joint health. Their accessibility, acceptability, understanding, and usability to women were evaluated in an anonymous web-based survey. Results: A total of 490 women viewed the videos and responded to the survey. Of these, 353 (72%) completed all questions. Almost all (from 321/353, 91% to 334/363, 92%) agreed that the information in the videos was ?very easy to understand.? The proportions reporting that all or some of the information in the video was new to them varied between videos from 36% (137/386) to 66% (233/353), the reported likelihood of using the practical tips offered in the videos varied from 70% (271/386) to 89% (331/373), and between 61% (235/386) and 70% (263/373) of respondents stated that they would recommend the videos to others. Education-level group comparisons revealed few differences in opinions about the videos, except that women with lower education were more likely than those with higher education to state that they would recommend the 2 joint health videos to others (36/45, 80% vs 208/318, 65%; P=.051 for video 3; and 36/44, 80% vs 197/309, 64%; P=.04 for video 4). There were no differences between women living in the least advantaged areas (Socioeconomic Indexes for Areas quintile areas 1 and 2) and those living in the most advantaged areas (Socioeconomic Indexes for Areas quintile areas 3, 4, and 5) in their responses to any of the questions about the 4 videos. Conclusions: Most women found the videos easy to understand, learned something new from watching them, planned to use the practical tips they offered, and were likely to recommend them to other women. This suggests that short, animated videos about health self-management strategies in midlife to improve the chance of healthy aging are perceived as accessible, acceptable, easy to understand, and useful by women. UR - https://www.i-jmr.org/2024/1/e60949 UR - http://dx.doi.org/10.2196/60949 UR - http://www.ncbi.nlm.nih.gov/pubmed/39621404 ID - info:doi/10.2196/60949 ER - TY - JOUR AU - Chen, Bowen AU - Yang, Chun AU - Ren, Shanshan AU - Li, Penggao AU - Zhao, Jin PY - 2024/12/2 TI - Relationship Between Internet Use and Cognitive Function Among Middle-Aged and Older Chinese Adults: 5-Year Longitudinal Study JO - J Med Internet Res SP - e57301 VL - 26 KW - aging KW - cognitive function KW - internet use KW - longitudinal study KW - fixed effects model N2 - Background: Cognitive decline poses one of the greatest global challenges for health and social care, particularly in China, where the burden on the older adult population is most pronounced. Despite the rapid expansion of internet access, there is still limited understanding of the long-term cognitive impacts of internet use among middle-aged and older adults. Objective: This study aims to explore the association between internet use and age-related cognitive decline among middle-aged and older Chinese adults. To gain a more comprehensive understanding of the effects of internet use, we also focused on assessing the impact of both the frequency of internet use and the types of internet devices on cognition. Moreover, we assessed the mediating role of internet use on cognitive function for characteristics significantly linked to cognition in stratified analysis. Methods: We analyzed data based on 12,770 dementia-free participants aged ?45 years from the China Health and Retirement Longitudinal Study. We used a fixed effects model to assess the relationship between internet use and cognitive decline and further validated it using multiple linear regression analysis, generalized estimating equations, propensity score matching, inverse probability of treatment weighting, and overlap weighting. We further examined the varying effects of internet device type and frequency on cognitive function using fixed effects models and Spearman rank correlations. The Karlson-Holm-Breen method was used to estimate the mediating role of internet use in the urban-rural cognitive gap. Results: Participants using the internet (n=1005) were younger, more likely to be male, more educated, married, retired and living in an urban area and had higher cognitive assessment scores than nonusers (n=11,765). After adjusting for demographic and health-related risk factors, there was a positive correlation between internet use and cognitive function (?=0.551, 95% CI 0.391-0.710). Over the follow-up period, persistent internet users had a markedly lower 5-year incidence of neurodegenerative diseases, at 2.2% (15/671), compared with nonusers, at 5.3% (379/7099; P<.001). The negative impact of aging (>50 years) on cognitive function was consistently less pronounced among internet users than among nonusers. Furthermore, increased frequency of internet use was associated with greater cognitive benefits for middle-aged and older adults (rs=0.378, P<.001). Among digital devices used for internet access, cell phones (?=0.398, 95% CI 0.283-0.495) seemed to have a higher level of cognitive protection than computers (?=0.147, 95% CI 0.091-0.204). The urban-rural disparity in cognitive function was partially attributed to the disparity in internet use (34.2% of the total effect, P<.001). Conclusions: This study revealed that the use of internet by individuals aged 45 years and older is associated with a reduced risk of cognitive decline. Internet use has the potential to be a viable, cost-effective, nonpharmacological intervention for cognitive decline among middle-aged and older adults. UR - https://www.jmir.org/2024/1/e57301 UR - http://dx.doi.org/10.2196/57301 UR - http://www.ncbi.nlm.nih.gov/pubmed/39539034 ID - info:doi/10.2196/57301 ER - TY - JOUR AU - Turley, Kate AU - Rafferty, Joseph AU - Bond, Raymond AU - Mulvenna, Maurice AU - Ryan, Assumpta AU - Crawford, Lloyd PY - 2024/11/29 TI - Evaluating the Impact of a Daylight-Simulating Luminaire on Mood, Agitation, Rest-Activity Patterns, and Social Well-Being Parameters in a Care Home for People With Dementia: Cohort Study JO - JMIR Mhealth Uhealth SP - e56951 VL - 12 KW - digital health KW - dementia KW - dynamic lighting KW - sensors KW - circadian rhythm KW - daylight KW - wellbeing KW - mood KW - agitation KW - sleep KW - social wellbeing KW - care home KW - older adults KW - elderly KW - cardiac KW - psychological KW - monitoring N2 - Background: Living with a diagnosis of dementia can involve managing certain behavioral and psychological symptoms. Alongside cognitive decline, this cohort expresses a suppression in melatonin production which can negatively influence their alignment of sleep or wake timings with the 24 hour day and night cycle. As a result, their circadian rhythms become disrupted. Since daylight has the capacity to stimulate the circadian rhythm and humans spend approximately 90% of their time indoors, research has shifted toward the use of indoor lighting to achieve this same effect. This type of lighting is programmed in a daylight-simulating manner; mimicking the spectral changes of the sun throughout the day. As such, this paper focuses on the use of a dynamic lighting and sensing technology used to support the circadian rhythm, behavioral and psychological symptoms, and well-being of people living with dementia. Objective: This study aimed to understand how dynamic lighting, as opposed to static lighting, may impact the well-being of those who are living with dementia. Methods: An ethically approved trial was conducted within a care home for people with dementia. Data were collected in both quantitative and qualitative formats using environmentally deployed radar sensing technology and the validated QUALIDEM (Quality of Life for People With Dementia) well-being scale, respectively. An initial 4 weeks of static baseline lighting was used before switching out for 12 weeks of dynamic lighting. Metrics were collected for 11 participants on mood, social interactions, agitation, sense of feeling, and sleep and rest-activity over a period of 16 weeks. Results: Dynamic lighting showed significant improvement with a moderate effect size in well-being parameters including positive affect (P=.03), social isolation (P=.048), and feeling at home (P=.047) after 5?10 weeks of dynamic lighting exposure. The results also highlight statistically significant improvements in rest-activity?related parameters of interdaily stability (P<.001), intradaily variation (P<.001), and relative amplitude (P=.03) from baseline to weeks 5?10, with the effect propagating for interdaily stability at weeks 10?16 as well (P<.001). Nonsignificant improvements are also noted for sleep metrics with a small effect size; however, the affect in agitation does not reflect this improvement. Conclusions: Dynamic lighting has the potential to support well-being in dementia, with seemingly stronger influence in earlier weeks where the dynamic lighting initially follows the static lighting contrast, before proceeding to aggregate as marginal gains over time. Future longitudinal studies are recommended to assess the additional impact that varying daylight availability throughout the year may have on the measured parameters. UR - https://mhealth.jmir.org/2024/1/e56951 UR - http://dx.doi.org/10.2196/56951 ID - info:doi/10.2196/56951 ER - TY - JOUR AU - Vagnetti, Roberto AU - Camp, Nicola AU - Story, Matthew AU - Ait-Belaid, Khaoula AU - Mitra, Suvobrata AU - Fowler Davis, Sally AU - Meese, Helen AU - Zecca, Massimiliano AU - Di Nuovo, Alessandro AU - Magistro, Daniele PY - 2024/11/25 TI - Social Robots and Sensors for Enhanced Aging at Home: Mixed Methods Study With a Focus on Mobility and Socioeconomic Factors JO - JMIR Aging SP - e63092 VL - 7 KW - older adults KW - motor difficulties KW - socioeconomic status KW - social assistive robots KW - monitoring technologies KW - mixed methods N2 - Background: Population aging affects society, with a profound impact on daily activities for those of a low socioeconomic status and with motor impairments. Social assistive robots (SARs) and monitoring technologies can improve older adults? well-being by assisting with and monitoring home activities. Objective: This study explored the opinions and needs of older adults, including those with motor difficulties and of a low socioeconomic status, regarding SARs and monitoring technologies at home to promote daily activities and reduce sedentary behaviors. Methods: A mixed methods approach was used, with 31 older adults divided into 3 groups: those of a low socioeconomic status, those with motor difficulties, and healthy individuals. Focus groups were conducted, and they were analyzed using thematic analysis. Perceived mental and physical well-being were assessed using the 12-Item Short Form Health Survey, and attitudes toward robots were evaluated using the Multidimensional Robot Attitude Scale. Results: The results identified 14 themes in four key areas: (1) technology use for supporting daily activities and reducing sedentary behaviors, (2) perceived barriers, (3) suggestions and preferences, and (4) actual home technology use. Lower perceived physical well-being was associated with higher levels of familiarity, interest, perceived utility, and control related to SARs. Lower perceived psychological well-being was linked to a more negative attitude, increased concerns about environmental fit, and a preference for less variety. Notably, older adults from the low?socioeconomic status group perceived less control over SARs, whereas older adults with motor difficulties expressed higher perceived utility compared to other groups, as well as higher familiarity and interest compared to the low?socioeconomic status group. Conclusions: Participants indicated that SARs and monitoring technologies could help reduce sedentary behaviors by assisting in the management of daily activities. The results are discussed in the context of these outcomes and the implementation of SARs and monitoring technologies at home. This study highlights the importance of considering the functional and socioeconomic characteristics of older adults as future users of SARs and monitoring technologies to promote widespread adoption and improve well-being within this population. UR - https://aging.jmir.org/2024/1/e63092 UR - http://dx.doi.org/10.2196/63092 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63092 ER - TY - JOUR AU - Xie, Junan AU - Li, Shilin AU - Song, Zhen AU - Shu, Lin AU - Zeng, Qing AU - Huang, Guozhi AU - Lin, Yihuan PY - 2024/11/25 TI - Functional Monitoring of Patients With Knee Osteoarthritis Based on Multidimensional Wearable Plantar Pressure Features: Cross-Sectional Study JO - JMIR Aging SP - e58261 VL - 7 KW - knee osteoarthritis KW - KOA KW - 40-m fast-paced walk test KW - 40mFPWT KW - timed up-and-go test KW - TUGT KW - timed up and go KW - TUG KW - functional assessment KW - monitoring KW - wearable KW - gait KW - walk test KW - plantar KW - knee KW - joint KW - arthritis KW - gait analysis KW - regression model KW - machine learning N2 - Background: Patients with knee osteoarthritis (KOA) often present lower extremity motor dysfunction. However, traditional radiography is a static assessment and cannot achieve long-term dynamic functional monitoring. Plantar pressure signals have demonstrated potential applications in the diagnosis and rehabilitation monitoring of KOA. Objective: Through wearable gait analysis technology, we aim to obtain abundant gait information based on machine learning techniques to develop a simple, rapid, effective, and patient-friendly functional assessment model for the KOA rehabilitation process to provide long-term remote monitoring, which is conducive to reducing the burden of social health care system. Methods: This cross-sectional study enrolled patients diagnosed with KOA who were able to walk independently for 2 minutes. Participants were given clinically recommended functional tests, including the 40-m fast-paced walk test (40mFPWT) and timed up-and-go test (TUGT). We used a smart shoe system to gather gait pressure data from patients with KOA. The multidimensional gait features extracted from the data and physical characteristics were used to establish the KOA functional feature database for the plantar pressure measurement system. 40mFPWT and TUGT regression prediction models were trained using a series of mature machine learning algorithms. Furthermore, model stacking and average ensemble learning methods were adopted to further improve the generalization performance of the model. Mean absolute error (MAE), mean absolute percentage error (MAPE), and root mean squared error (RMSE) were used as regression performance metrics to evaluate the results of different models. Results: A total of 92 patients with KOA were included, exhibiting varying degrees of severity as evaluated by the Kellgren and Lawrence classification. A total of 380 gait features and 4 physical characteristics were extracted to form the feature database. Effective stepwise feature selection determined optimal feature subsets of 11 variables for the 40mFPWT and 10 variables for the TUGT. Among all models, the weighted average ensemble model using 4 tree-based models had the best generalization performance in the test set, with an MAE of 2.686 seconds, MAPE of 9.602%, and RMSE of 3.316 seconds for the prediction of the 40mFPWT and an MAE of 1.280 seconds, MAPE of 12.389%, and RMSE of 1.905 seconds for the prediction of the TUGT. Conclusions: This wearable plantar pressure feature technique can objectively quantify indicators that reflect functional status and is promising as a new tool for long-term remote functional monitoring of patients with KOA. Future work is needed to further explore and investigate the relationship between gait characteristics and functional status with more functional tests and in larger sample cohorts. UR - https://aging.jmir.org/2024/1/e58261 UR - http://dx.doi.org/10.2196/58261 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58261 ER - TY - JOUR AU - Bavngaard, Vinther Martin AU - Lund, Anne AU - Thordardottir, Björg AU - Rasmussen, Břrve Erik PY - 2024/11/22 TI - The Uses and Experiences of Synchronous Communication Technology for Home-Dwelling Older Adults in a Home Care Services Context: Qualitative Systematic Review JO - J Med Internet Res SP - e59285 VL - 26 KW - systematic review KW - qualitative KW - thematic synthesis KW - communication technology KW - relatives KW - home care services KW - aging in place KW - home-dwelling KW - older adult KW - aging KW - gerontology KW - European KW - effectiveness KW - information KW - technology KW - health care provider KW - cross-disciplinary KW - telehealth KW - telemonitoring N2 - Background: European health care systems regard information and communication technology as a necessity in supporting future health care provision by community home care services to home-dwelling older adults. Communication technology enabling synchronous communication between 2 or more human actors at a distance constitutes a significant component of this ambition, but few reviews have synthesized research relating to this particular type of technology. As evaluations of information and communication technology in health care services favor measurements of effectiveness over the experiences and dynamics of putting these technologies into use, the nuances involved in technology implementation processes are often omitted. Objective: This review aims to systematically identify and synthesize qualitative findings on the uses and experiences of synchronous communication technology for home-dwelling older adults in a home care services context. Methods: The review follows the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 checklist for reporting. We conducted a cross-disciplinary search in 5 databases for papers published between 2011 and 2023 that yielded 4210 citations. A total of 13 studies were included after 4 screening phases and a subsequent appraisal of methodological quality guided by the Critical Appraisal Skills Programme tool. From these, prespecified data were extracted and incorporated in a 3-stage thematic synthesis producing 4 analytical themes. Results: The first theme presented the multiple trajectories that older users? technology acceptance could take, namely straightforward, gradual, partial, and resistance laden, notwithstanding outright rejection. It also emphasized both instrumental and emotional efforts by the older adults? relatives in facilitating acceptance. Moving beyond acceptance, the second theme foregrounded the different types of work involved in attempts to integrate the technology by older users, their relatives, and health care providers. Theme 3 highlighted how the older users? physical and cognitive conditions formed a contextual backdrop challenging this integration work, together with challenges related to spatial context. Finally, consequences derived from taking the technology into use could be of a both enabling and complicating nature as integration reconfigured the way users related to themselves and each other. Conclusions: The acceptance and integration of synchronous communication technology for older adults involves multiple user groups in work tending to the technology, to the users themselves, and to each other through intergroup negotiations. This review?s original contribution consists of its attention to the dynamics across different user groups in deriving consequences from using the technology in question, in addition to its assertion that such consequences may be both intentional and unintentional. We argue that our findings may be used to provide nuance to policies addressing?and practices taking place in?contexts that involve similar user technology constellations to the ones explored in this paper. Trial Registration: PROSPERO CRD42023414243; https://tinyurl.com/wrha6j3f UR - https://www.jmir.org/2024/1/e59285 UR - http://dx.doi.org/10.2196/59285 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59285 ER - TY - JOUR AU - Ricci, Sofia Fabiana AU - Liguori, Lorenzo AU - Palermo, Eduardo AU - Rizzo, John-Ross AU - Porfiri, Maurizio PY - 2024/11/18 TI - Navigation Training for Persons With Visual Disability Through Multisensory Assistive Technology: Mixed Methods Experimental Study JO - JMIR Rehabil Assist Technol SP - e55776 VL - 11 KW - assistive technology KW - human-computer interaction KW - multisensory feedback KW - virtual reality KW - visual impairment KW - haptic N2 - Background: Visual disability is a growing problem for many middle-aged and older adults. Conventional mobility aids, such as white canes and guide dogs, have notable limitations that have led to increasing interest in electronic travel aids (ETAs). Despite remarkable progress, current ETAs lack empirical evidence and realistic testing environments and often focus on the substitution or augmentation of a single sense. Objective: This study aims to (1) establish a novel virtual reality (VR) environment to test the efficacy of ETAs in complex urban environments for a simulated visual impairment (VI) and (2) evaluate the impact of haptic and audio feedback, individually and combined, on navigation performance, movement behavior, and perception. Through this study, we aim to address gaps to advance the pragmatic development of assistive technologies (ATs) for persons with VI. Methods: The VR platform was designed to resemble a subway station environment with the most common challenges faced by persons with VI during navigation. This environment was used to test our multisensory, AT-integrated VR platform among 72 healthy participants performing an obstacle avoidance task while experiencing symptoms of VI. Each participant performed the task 4 times: once with haptic feedback, once with audio feedback, once with both feedback types, and once without any feedback. Data analysis encompassed metrics such as completion time, head and body orientation, and trajectory length and smoothness. To evaluate the effectiveness and interaction of the 2 feedback modalities, we conducted a 2-way repeated measures ANOVA on continuous metrics and a Scheirer-Ray-Hare test on discrete ones. We also conducted a descriptive statistical analysis of participants? answers to a questionnaire, assessing their experience and preference for feedback modalities. Results: Results from our study showed that haptic feedback significantly reduced collisions (P=.05) and the variability of the pitch angle of the head (P=.02). Audio feedback improved trajectory smoothness (P=.006) and mitigated the increase in the trajectory length from haptic feedback alone (P=.04). Participants reported a high level of engagement during the experiment (52/72, 72%) and found it interesting (42/72, 58%). However, when it came to feedback preferences, less than half of the participants (29/72, 40%) favored combined feedback modalities. This indicates that a majority preferred dedicated single modalities over combined ones. Conclusions: AT is crucial for individuals with VI; however, it often lacks user-centered design principles. Research should prioritize consumer-oriented methodologies, testing devices in a staged manner with progression toward more realistic, ecologically valid settings to ensure safety. Our multisensory, AT-integrated VR system takes a holistic approach, offering a first step toward enhancing users? spatial awareness, promoting safer mobility, and holds potential for applications in medical treatment, training, and rehabilitation. Technological advancements can further refine such devices, significantly improving independence and quality of life for those with VI. UR - https://rehab.jmir.org/2024/1/e55776 UR - http://dx.doi.org/10.2196/55776 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55776 ER - TY - JOUR AU - Wong, Ching Arkers Kwan AU - Bayuo, Jonathan AU - Su, Jing Jing AU - Wong, Yuet Frances Kam AU - Chow, Sum Karen Kit AU - Wong, Po Bonnie AU - Wong, Man Siu AU - Hui, Vivian PY - 2024/11/18 TI - Effectiveness of the Support From Community Health Workers and Health Care Professionals on the Sustained Use of Wearable Monitoring Devices Among Community-Dwelling Older Adults: Feasibility Randomized Controlled Trial JO - J Med Internet Res SP - e52435 VL - 26 KW - wearable monitoring device KW - lay worker KW - smartwatch KW - older adult KW - nurse KW - engagement KW - attrition KW - wearable KW - user experience N2 - Background: The wearable monitoring device (WMD) is emerging as a promising tool for community-dwelling older adults to monitor personal health, enhance awareness of their activities, and promote healthy behaviors. However, the sustained use of WMDs among this population remains a significant challenge. Objective: This study aims to implement an interventional program that promotes and motivates the continued use of WMDs among older adults through a peer and professional support approach. This program will facilitate the integration of WMDs into their daily lives. Methods: This feasibility trial examined the following: (1) the usability of the WMD from the users? perspectives; (2) the feasibility of the Live With Wearable Monitoring Device program; and (3) the effectiveness of the Live With Wearable Monitoring Device program among community-dwelling older adults. The intervention, based on Self-Determination Theory, involved using the Live With Wearable Monitoring Device program over a 3-month period, with ongoing professional and peer support provided by community health workers, aided by a nurse and social workers. This support included 1 home visit and biweekly communication via WhatsApp. Data were collected at baseline and at 1, 3, and 6 months. Results: A total of 39 participants were enrolled in the intervention group, while 37 participants were in the control group. The recruitment rate was high (76/89, 85%), and the attrition rate was low (8/76, 11%), indicating that the program is feasible for older adults. Participants in the intervention group exhibited higher self-efficacy, lower anxiety levels, and used the smartwatch more frequently, in terms of both days and hours, compared with the control group. A between-group difference was observed in self-efficacy between the intervention and control groups (?=3.31, 95% CI 0.36-6.25, P=.03), with statistically significant higher mean values recorded at all 4 time points. Conclusions: It is clear that merely providing a WMD to older adults does not guarantee its usage, particularly for those unfamiliar with how to utilize its health-related functions in their daily routines. This study implemented a theory-based program aimed at enhancing the ongoing use of WMDs among older adults, suggesting that continuous professional and peer support may significantly influence WMD usage. Trial Registration: ClinicalTrials.gov NCT05269303; https://clinicaltrials.gov/ct2/show/NCT05269303 UR - https://www.jmir.org/2024/1/e52435 UR - http://dx.doi.org/10.2196/52435 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/52435 ER - TY - JOUR AU - Dumassais, Shirley AU - Grewal, Singh Karl AU - Aubin, Gabrielle AU - O'Connell, Megan AU - Phillips, A. Natalie AU - Wittich, Walter PY - 2024/11/15 TI - Exploring the Qualitative Experiences of Administering and Participating in Remote Research via Telephone Using the Montreal Cognitive Assessment-Blind: Cross-Sectional Study of Older Adults JO - JMIR Form Res SP - e58537 VL - 8 KW - neuropsychological tests KW - telemedicine KW - social inclusion KW - telehealth KW - remote KW - qualitative KW - neuropsychological KW - cognitive KW - screening KW - assessment KW - perception KW - perspective KW - telephone KW - cross-sectional KW - thematic KW - mobile phone KW - Montreal Cognitive Assessment KW - MoCA N2 - Background: The COVID-19 pandemic caused a drastic shift in the practice of research and clinical services. It has been noted that cognition measured via in-person versus remote methods differ substantially, and it is possible that subjective and experiential differences exist between modalities. Objective: The aim of the study is to explore the perceptions of both researchers and older adult participants on the experience of remotely conducted research using a cognitive screener. Methods: We conducted a thematic analysis of the experience of engaging in remote research from both the participant (n=10) and researcher (n=4) perspectives. The research interaction was framed through teleadministration of the Montreal Cognitive Assessment-Blind (suitable for telephone administration) and administration of a subsequent semistructured debriefing interview. Participant perspectives were garnered during debriefing interviews, while researcher insights were collected via self-reported qualitative field notes completed following each research session. Results: Data aggregated into themes of barriers and facilitators from the lenses of both participants and researchers. Participants noted facilitators including short instrument length, convenience, and presession contact; barriers included the length of the interaction, some tasks being more challenging on the phone, and the potential for participant dishonesty. Research assistants noted several facilitators: instrument length, rapport building, ability to prepare for and record sessions, and comfort with the protocol; barriers were items with too many response options, telephone issues (eg, response delays), and concerns about participant comprehension. Conclusions: These results suggest remote telephone-delivered cognitive screening tools as a feasible and acceptable method of research inquiry. The findings provide a starting point for the inclusion of diverse populations in research to capture underrepresented groups whose input would immensely benefit our understanding of remotely delivered cognitive screening measures. Further, we offer materials (eg, checklists), which can be used in future investigations to promote future inclusive research and increase generalizability. UR - https://formative.jmir.org/2024/1/e58537 UR - http://dx.doi.org/10.2196/58537 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58537 ER - TY - JOUR AU - Mao, Qian AU - Zhao, Zhen AU - Yu, Lisha AU - Zhao, Yang AU - Wang, Hailiang PY - 2024/11/12 TI - The Effects of Virtual Reality?Based Reminiscence Therapies for Older Adults With Cognitive Impairment: Systematic Review JO - J Med Internet Res SP - e53348 VL - 26 KW - virtual reality KW - reminiscence therapy KW - cognitive impairment KW - older adults KW - mobile phone N2 - Background: Reminiscence therapy (RT) is a commonly used nonpharmaceutical treatment for cognitive impairment. Artifacts or conversations are used in RT to recall individuals? memories and past experiences. Virtual reality (VR) has increasingly been used as an assistive technology during RT. However, the effects of VR-based RT (VR-RT) methods remain unclear, and insights into the related benefits and challenges are urgently needed. Objective: The study aims to systematically review the effects of VR-RTs for older adults with cognitive impairment. Methods: Seven databases (MEDLINE, Academic Search Premier, CINAHL, Web of Science, PubMed, the Cochrane Central Register of Controlled Trials, and ScienceDirect) were searched to identify relevant articles published from inception to August 10, 2023. Peer-reviewed publications that assessed the effect of VR-RTs (ie, using virtual clues to evoke participants? memories or past experiences) on cognitive-related outcomes were included. Two independent researchers conducted the literature search, review, and data extraction processes. A narrative synthesis approach was used to analyze the extracted data. Results: Of the 537 identified articles, 22 were ultimately included in the data analysis. The results revealed that VR-RTs could maintain cognitive status (4/4, 100%) and reduce anxiety (2/2, 100%) in older adults with cognitive impairment. Nevertheless, one study found a cognitive improvement after VR-RTs, whereas cognitive degradation was observed at a 3- to 6-month follow-up measure. Around 88% (7/8) of the included studies indicated that VR-RTs improved memory; however, the evidence regarding the beneficial effects of VR-RTs was limited in improving quality of life (1/4, 25%) and reducing apathy (0/2, 0%) and depression (1/3, 33%). The results indicated that VR-RTs are safe, engaging, acceptable, and satisfying for older adults with cognitive impairment. In VR scenarios, personalized stimulus materials related to the users? youth experiences were more effective for treating cognitive impairment than other stimulus materials. Conclusions: The results of this systematic review demonstrate the potential benefits of VR-RT for older adults with cognitive impairment, especially in improving emotion and memory and maintaining cognitive status. VR-RT is also safe and enjoyable for older adults. However, due to the trial heterogeneity of included studies, we can only provide qualitative results instead of performing meta-analysis to quantify the effect size of VR-RTs. Thus, more randomized controlled trials are required to examine the designs and effects of VR-RTs for groups of older adults with specific needs. UR - https://www.jmir.org/2024/1/e53348 UR - http://dx.doi.org/10.2196/53348 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53348 ER - TY - JOUR AU - Chung, Jane AU - Pretzer-Aboff, Ingrid AU - Parsons, Pamela AU - Falls, Katherine AU - Bulut, Eyuphan PY - 2024/11/12 TI - Using a Device-Free Wi-Fi Sensing System to Assess Daily Activities and Mobility in Low-Income Older Adults: Protocol for a Feasibility Study JO - JMIR Res Protoc SP - e53447 VL - 13 KW - Wi-Fi sensing KW - dementia KW - mild cognitive impairment KW - older adults KW - health disparities KW - in-home activities KW - mobility KW - machine learning N2 - Background: Older adults belonging to racial or ethnic minorities with low socioeconomic status are at an elevated risk of developing dementia, but resources for assessing functional decline and detecting cognitive impairment are limited. Cognitive impairment affects the ability to perform daily activities and mobility behaviors. Traditional assessment methods have drawbacks, so smart home technologies (SmHT) have emerged to offer objective, high-frequency, and remote monitoring. However, these technologies usually rely on motion sensors that cannot identify specific activity types. This group often lacks access to these technologies due to limited resources and technology experience. There is a need to develop new sensing technology that is discreet, affordable, and requires minimal user engagement to characterize and quantify various in-home activities. Furthermore, it is essential to explore the feasibility of developing machine learning (ML) algorithms for SmHT through collaborations between clinical researchers and engineers and involving minority, low-income older adults for novel sensor development. Objective: This study aims to examine the feasibility of developing a novel channel state information?based device-free, low-cost Wi-Fi sensing system, and associated ML algorithms for localizing and recognizing different patterns of in-home activities and mobility in residents of low-income senior housing with and without mild cognitive impairment. Methods: This feasibility study was conducted in collaboration with a wellness care group, which serves the healthy aging needs of low-income housing residents. Prior to this feasibility study, we conducted a pilot study to collect channel state information data from several activity scenarios (eg, sitting, walking, and preparing meals) using the proposed Wi-Fi sensing system continuously over a week in apartments of low-income housing residents. These activities were videotaped to generate ground truth annotations to test the accuracy of the ML algorithms derived from the proposed system. Using qualitative individual interviews, we explored the acceptability of the Wi-Fi sensing system and implementation barriers in the low-income housing setting. We use the same study protocol for the proposed feasibility study. Results: The Wi-Fi sensing system deployment began in November 2022, with participant recruitment starting in July 2023. Preliminary results will be available in the summer of 2025. Preliminary results are focused on the feasibility of developing ML models for Wi-Fi sensing?based activity and mobility assessment, community-based recruitment and data collection, ground truth, and older adults? Wi-Fi sensing technology acceptance. Conclusions: This feasibility study can make a contribution to SmHT science and ML capabilities for early detection of cognitive decline among socially vulnerable older adults. Currently, sensing devices are not readily available to this population due to cost and information barriers. Our sensing device has the potential to identify individuals at risk for cognitive decline by assessing their level of physical function by tracking their in-home activities and mobility behaviors, at a low cost. International Registered Report Identifier (IRRID): DERR1-10.2196/53447 UR - https://www.researchprotocols.org/2024/1/e53447 UR - http://dx.doi.org/10.2196/53447 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53447 ER - TY - JOUR AU - Leong, Ying Qiao AU - Lee, Vien V. AU - Ng, Ying Wei AU - Vijayakumar, Smrithi AU - Lau, Yin Ni AU - Mauritzon, Ingela AU - Blasiak, Agata AU - Ho, Dean PY - 2024/11/11 TI - Older Adults? Perspectives and Experiences With Digital Health in Singapore: Qualitative Study JO - JMIR Hum Factors SP - e58641 VL - 11 KW - digital health KW - gerontology KW - geriatrics KW - elder KW - aging KW - Singapore KW - qualitative KW - mHealth KW - mobile health KW - experience KW - technology use KW - interview KW - perspective KW - acceptance KW - technology adoption N2 - Background: Technology use among older adults is increasingly common. Even though there is potential in leveraging technology to help them manage their health, only a small fraction of them use it for health-related purposes. Objective: This study seeks to understand the perspectives of and experiences with digital health (DH) among older adults in Singapore. Methods: A total of 16 participants (age range 60-80 years; n=11, 69% female) were interviewed for approximately an hour (range 27-64 minutes) about their health, DH use, and DH experiences. The interviews were recorded, transcribed verbatim, and thematically analyzed. Results: Five main themes emerged from the interview: support in developing DH literacy, credibility, cost and benefit considerations, intrinsic drive to be healthy, and telehealth. Older adults need support in familiarizing themselves with DH. When considering DH options, older adults often relied on credible sources and preferred DH to be free. Monetary incentives were brought up as motivators. The intrinsic drive to live longer and healthily was expressed to be a huge encouragement to use DH to help obtain health-related knowledge and achieve healthy living goals. The idea of telehealth was also appealing among older adults but was seen to be more suited for individuals who have issues accessing a physical clinic. Conclusions: Our findings offer insights into the various aspects that matter to older adults in the adoption of DH, which in turn can help reshape their health-seeking behavior and lifestyle. As such, policy makers and DH implementors are encouraged to take these into consideration and align their strategies accordingly. UR - https://humanfactors.jmir.org/2024/1/e58641 UR - http://dx.doi.org/10.2196/58641 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58641 ER - TY - JOUR AU - Kershner, Kyle AU - Morton, David AU - Robison, Justin AU - N'dah, Williams Kindia AU - Fanning, Jason PY - 2024/11/8 TI - Assessing the Feasibility and Acceptability of Virtual Reality for Remote Group-Mediated Physical Activity in Older Adults: Pilot Randomized Controlled Trial JO - JMIR Form Res SP - e53156 VL - 8 KW - virtual reality KW - physical activity KW - videoconference KW - social connection KW - remote meeting KW - gerontology KW - physical inactivity KW - at-home intervention KW - descriptive statistics KW - eHealth KW - comorbidity KW - cybersickness N2 - Background: Physical inactivity represents a major health concern for older adults. Most social, at-home physical activity (PA) interventions use videoconference, email, or telephone communication for program delivery. However, evidence suggests that these platforms may hinder the social connection experienced by users. Recent advancements in virtual reality (VR) suggest that it may be a rich platform for social, at-home interventions because it offers legitimate options for intervention delivery and PA. Objective: This pilot study aims to determine the feasibility and acceptability of VR compared to videoconference as a medium for remote group-mediated behavioral intervention for older adults. The information generated from this investigation will inform the use of VR as a medium for intervention delivery. Methods: Nine low-active older adults (mean age 66.8, SD 4.8 y) were randomized to a 4-week home-based, group-mediated PA intervention delivered via VR or videoconference. Feasibility (ie, the total number of sessions attended and the number of VR accesses outside of scheduled meetings) and acceptability (ie, the number of participants reporting high levels of nausea, program evaluations using Likert-style prompts with responses ranging from ?5=very difficult or disconnected to 5=very easy or connected, and participant feedback on immersion and social connection) are illustrated via descriptive statistics and quotes from open-ended responses. Results: None of the participants experienced severe VR-related sickness before randomization, with a low average sickness rating of 1.6 (SD 1.6) out of 27 points. Attendance rates for group meetings were 98% (59/60) and 96% (46/48) for the VR and videoconference groups, respectively. Outside of scheduled meeting times, participants reported a median of 5.5 (IQR 5.3-5.8, range 0-27) VR accesses throughout the entire intervention. Program evaluations suggested that participants felt personally connected to their peers (VR group: median 3.0, IQR 2.5-3.5; videoconference group: median 3.0, IQR 2.7-3.3), found that goals were easy to accomplish (VR group: median 3.0, IQR 2.8-3.3; videoconference group: median 3.0, IQR 2.6-3.4), and had ease in finding PA options (VR group: median 4.0, IQR 3.5-4.3; videoconference group: median 2.0, IQR 1.6-2.4) and engaging in meaningful dialogue with peers (VR group: median 4.0, IQR 4.0-4.0; videoconference group: median 3.5, IQR 3.3-3.8). Open-ended responses regarding VR use indicated increased immersion experiences and intrinsic motivation for PA. Conclusions: These findings suggest that VR may be a useful medium for social PA programming in older adults, given it was found to be feasible and acceptable in this sample. Importantly, all participants indicated low levels of VR-related sickness before randomization, and both groups demonstrated very high attendance at meetings with their groups and behavioral coaches, which is promising for using VR and videoconference in future interventions. Modifications for future iterations of similar interventions are provided. Further work using larger samples and longer follow-up durations is needed. Trial Registration: ClinicalTrials.gov NCT04756245; https://www.clinicaltrials.gov/study/NCT04756245 UR - https://formative.jmir.org/2024/1/e53156 UR - http://dx.doi.org/10.2196/53156 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53156 ER - TY - JOUR AU - Gordon, P. Nancy AU - Yin, Chelsea AU - Lo, C. Joan PY - 2024/11/7 TI - Examining Whether Patient Portal and Video Visit Use Differs by Race and Ethnicity Among Older Adults in a US Integrated Health Care Delivery System: Cross-Sectional Electronic Health Record and Survey-Based Study JO - JMIR Aging SP - e63814 VL - 7 KW - patient portal use KW - video visit use KW - older adults KW - racial and ethnic differences KW - telehealth KW - mobile phone N2 - Background: Health care systems are increasingly encouraging patients to use patient portals and participate in video visits. However, there is limited information about how portal use differs among older adults. Objective: This study aimed to understand how patient portal and video visit use differed by age, race, and ethnicity among older adult patients with access to the same digital health resources. Methods: This cross-sectional study used electronic health record and survey data for adults aged 65 to 85 years who were members of a large Northern California health care delivery system throughout 2019 and 2020. The electronic health record cohort (N=471,152) included 320,686 White, 35,892 Black, 44,922 Latino, 20,786 Chinese, 28,732 Filipino, 8473 South Asian, 6716 Japanese, 2930 Vietnamese, and 2015 Korean adults. Racial and ethnic group and age group (65 to 75 years vs 76 to 85 years) differences in having a patient portal account by December 2020, the performance of 2 portal activities (sending ?1 message to a clinician in 2019 or 2020 and viewing ?1 laboratory test result in 2020), and having ?1 video visit during 2020 were examined. Modified log-Poisson regression was used to examine prevalence ratios for portal and video visit use, comparing racial and ethnic groups to White adults and Asian ethnic groups to Chinese adults after adjusting for sex and age. Data from a 2020 member survey were used to compare internet use factors among 2867 White, 306 Black, 343 Latino, 225 Chinese, and 242 Filipino adults. Results: Black, Latino, and Filipino adults were less likely to have a patient portal account than White adults, and Filipino adults were less likely to have a patient portal account than Chinese adults. Black, Latino, Filipino, Korean, Vietnamese, and South Asian adults were less likely to have sent messages and viewed test results than White adults, while Chinese and Japanese adults? use of these features was similar to that of White adults. Filipino, Vietnamese, and Korean adults were less likely to have performed the aforementioned activities than Chinese adults. Video visit use was lower among Black and Latino adults and higher among Chinese and South Asian adults compared with White adults (aged 76 to 85 years) and lower among Filipino, Korean, and Vietnamese adults compared to Chinese adults. Survey data suggested that underlying differences in internet use may partially explain the lower use of messaging by Black, Latino, and Filipino adults compared with White and Chinese adults. Conclusions: Patient portal and video visit use differed by race, ethnicity, and age group among older adult patients with access to the same patient portal. Internet use factors may contribute to these differences. Differences in patient portal and video visit use across Asian subgroups underscore the importance of disaggregating use data by Asian ethnicity. UR - https://aging.jmir.org/2024/1/e63814 UR - http://dx.doi.org/10.2196/63814 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63814 ER - TY - JOUR AU - Abhari, Shahabeddin AU - McMurray, Josephine AU - Randhawa, Tanveer AU - Bin Noon, Gaya AU - Hanjahanja-Phiri, Thokozani AU - McNeil, Heather AU - Manning, Fiona AU - Debergue, Patricia AU - Teague, Jennifer AU - Pelegrini Morita, Plinio PY - 2024/10/31 TI - Exploring the Landscape of Standards and Guidelines in AgeTech Design and Development: Scoping Review and Thematic Analysis JO - JMIR Aging SP - e58196 VL - 7 KW - aging in place KW - technology KW - gerontechnology KW - AgeTech KW - assistive technology KW - older adult KW - aging KW - ambient assisted living KW - active assisted living N2 - Background: AgeTech (technology for older people) offers digital solutions for older adults supporting aging in place, including digital health, assistive technology, Internet of Things, medical devices, robotics, wearables, and sensors. This study underscores the critical role of standards and guidelines in ensuring the safety and effectiveness of these technologies for the health of older adults. As the aging demographic expands, the focus on robust standards becomes vital, reflecting a collective commitment to improving the overall quality of life for older individuals through thoughtful and secure technology integration. Objective: This scoping review aims to investigate the current state of standards and guidelines applied in AgeTech design and development as reported in academic literature. We explore the existing knowledge of these standards and guidelines and identify key gaps in the design and development of AgeTech guidelines and standards in scholarly publications. Methods: The literature review adhered to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Searches were carried out across multiple databases, including Scopus, IEEE, PubMed, Web of Science, EBSCO, CINAHL, Cochrane, and Google Scholar, using a search string incorporating concepts such as ?older people,? ?technology,? and ?standards or guidelines.? Alternative terms, Boolean operators, and truncation were used for comprehensive coverage in each database. The synthesis of results and data analysis involved both quantitative and qualitative methods. Results: Initially, 736 documents were identified across various databases. After applying specific inclusion and exclusion criteria and a screening process, 58 documents were selected for full-text review. The findings highlight that the most frequently addressed aspect of AgeTech standards or guidelines is related to ?design and development,? constituting 36% (21/58) of the literature; ?usability and user experience? was the second most prevalent aspect, accounting for 19% (11/58) of the documents. In contrast, ?privacy and security? (1/58, 2%) and ?data quality? (1/58, 2%) were the least addressed aspects. Similarly, ?ethics,? ?integration and interoperability,? ?accessibility,? and ?acceptance or adoption? each accounted for 3% (2/58) of the documents. In addition, a thematic analysis identified qualitative themes that warrant further exploration of variables. Conclusions: This study investigated the available knowledge regarding standards and guidelines in AgeTech design and development to evaluate their current status in academic literature. The substantial focus on assistive technologies and ambient assisted living technologies confirmed their vital role in AgeTech. The findings provide valuable insights for interested parties and point to prioritized areas for further development and research in the AgeTech domain. UR - https://aging.jmir.org/2024/1/e58196 UR - http://dx.doi.org/10.2196/58196 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58196 ER - TY - JOUR AU - Cotter, M. Lynne AU - Shah, Dhavan AU - Brown, Kaitlyn AU - Mares, Marie-Louise AU - Landucci, Gina AU - Saunders, Sydney AU - Johnston, C. Darcie AU - Pe-Romashko, Klaren AU - Gustafson, David AU - Maus, Adam AU - Thompson, Kasey AU - Gustafson, H. David PY - 2024/10/30 TI - Decoding the Influence of eHealth on Autonomy, Competence, and Relatedness in Older Adults: Qualitative Analysis of Self-Determination Through the Motivational Technology Model JO - JMIR Aging SP - e56923 VL - 7 KW - self-determination theory KW - usability KW - mobile technology model KW - aging KW - eHealth KW - mobile health KW - mHealth KW - smart displays KW - video calls KW - older adult KW - chronic conditions KW - mobile phone N2 - Background: Older adults adopt and use eHealth systems to build autonomy, competence, and relatedness and engage in healthy behaviors. The motivational technology model posits that technology features, such as those on websites, smart displays, and mobile phones, must allow for navigability, interactivity, and customizability, which spur feelings of self-determination and intrinsic motivation. We studied ElderTree, an online system for older adults that provides on-demand videos of healthy living content, self-monitoring, and weekly researcher-hosted video meetings. Objective: We aimed to understand the theoretical crossover between the motivational technology model and self-determination theory using features of ElderTree to understand the usability of the technology and how it may support older adults? autonomy, competence, and relatedness. Methods: Drawing participants from a randomized controlled trial of a mobile health app for older adults with multiple chronic conditions, we conducted qualitative interviews with 22 older adults about their use of the app; the interviews were coded using qualitative thematic analysis. Results: Older adults did find that features within ElderTree such as content available on demand, good navigation, and weekly researcher-led video calls supported feelings of autonomy, competence, and relatedness, respectively. Individual differences such as a background using computers also influenced participants? experiences with the smart displays. Conclusions: Participants confirmed the features that increased internal motivation, such as interactivity correlating with feelings of relatedness, but they also found other ways to support autonomous health behavior change beyond narrow views of navigability, interactivity, and customization. UR - https://aging.jmir.org/2024/1/e56923 UR - http://dx.doi.org/10.2196/56923 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56923 ER - TY - JOUR AU - Strandberg, Susanna AU - Ekstedt, Mirjam AU - Fagerström, Cecilia AU - Backĺberg, Sofia PY - 2024/10/28 TI - Cocreation of a Video Feedback Tool for Managing Self-Care at Home With Pairs of Older Adults: Remote Experience-Based Co-Design Study JO - JMIR Form Res SP - e57219 VL - 8 KW - chronic illness KW - eHealth KW - experience-based co-design KW - older adults KW - self-care KW - video feedback N2 - Background: Involving older adults in co-design processes is essential in developing digital technologies and health care solutions to enhance self-care management at home, especially for older adults with chronic illness and their companions. Remote co-design approaches could provide technologically sustainable solutions that address their personal needs. Objective: This study aimed to cocreate and test the usability of a video feedback tool to facilitate self-care management at home. Methods: This experience-based co-design approach involved collaboration between 4 pairs of older adults, 4 researchers, and 2 service designers in three steps: (1) six iterative workshops (5 remote and 1 in person) to cocreate self-care exercises within an existing video feedback tool by identifying factors influencing self-care management; (2) developing and refining the self-care exercises based on suggestions from the older adults; and (3) usability testing of the cocreated exercises with the 4 pairs of older adults in their homes. Among the older adults (68-78 years), 3 adults had heart failure and 1 adult had hypertension. Data were analyzed inductively through thematic analysis and deductively using the USABILITY (Use of Technology to Engage in Adaptation by Older Adults and/or Those With Low or Limited Literacy) framework. Results: The identified influencing factors guiding the contents and format development of 2 new self-care exercises were that pairs of older adults support and learn from each other in performing self-care, which increases their motivation and engagement in practicing self-care at home. The usability test of the 2 new self-care exercises, ?Breathing exercises? and ?Picking up from the floor,? revealed that the pairs found the exercises and the video feedback component valuable for learning and understanding, for example, by comparison of performances highlighting movement variability. However, they found it difficult to manage the video feedback tool on their own, and a support structure or tailored education or training was requested. Conclusions: This study emphasizes that the video feedback tool holds the potential to facilitate learning and understanding in self-care management, which may support motivation. The studied video feedback tool can be beneficial for pairs of older adults managing self-care at home as a complement to traditional health care services, but an accurate supporting structure is required. The effectiveness of the video feedback tool and its integration into existing health care services still need to be assessed and improved through careful design and structured support. UR - https://formative.jmir.org/2024/1/e57219 UR - http://dx.doi.org/10.2196/57219 UR - http://www.ncbi.nlm.nih.gov/pubmed/39466305 ID - info:doi/10.2196/57219 ER - TY - JOUR AU - Ding, Huitong AU - Ho, Kristi AU - Searls, Edward AU - Low, Spencer AU - Li, Zexu AU - Rahman, Salman AU - Madan, Sanskruti AU - Igwe, Akwaugo AU - Popp, Zachary AU - Burk, Alexa AU - Wu, Huanmei AU - Ding, Ying AU - Hwang, H. Phillip AU - Anda-Duran, De Ileana AU - Kolachalama, B. Vijaya AU - Gifford, A. Katherine AU - Shih, C. Ludy AU - Au, Rhoda AU - Lin, Honghuang PY - 2024/10/25 TI - Assessment of Wearable Device Adherence for Monitoring Physical Activity in Older Adults: Pilot Cohort Study JO - JMIR Aging SP - e60209 VL - 7 KW - physical activity KW - remote monitoring KW - wearable device KW - adherence KW - older adults N2 - Background: Physical activity has emerged as a modifiable behavioral factor to improve cognitive function. However, research on adherence to remote monitoring of physical activity in older adults is limited. Objective: This study aimed to assess adherence to remote monitoring of physical activity in older adults within a pilot cohort from objective user data, providing insights for the scalability of such monitoring approaches in larger, more comprehensive future studies. Methods: This study included 22 participants from the Boston University Alzheimer?s Disease Research Center Clinical Core. These participants opted into wearing the Verisense watch as part of their everyday routine during 14-day intervals every 3 months. Eighteen continuous physical activity measures were assessed. Adherence was quantified daily and cumulatively across the follow-up period. The coefficient of variation was used as a key metric to assess data consistency across participants over multiple days. Day-to-day variability was estimated by calculating intraclass correlation coefficients using a 2-way random-effects model for the baseline, second, and third days. Results: Adherence to the study on a daily basis outperformed cumulative adherence levels. The median proportion of adherence days (wearing time surpassed 90% of the day) stood at 92.1%, with an IQR spanning from 86.9% to 98.4%. However, at the cumulative level, 32% (7/22) of participants in this study exhibited lower adherence, with the device worn on fewer than 4 days within the requested initial 14-day period. Five physical activity measures have high variability for some participants. Consistent activity data for 4 physical activity measures might be attainable with just a 3-day period of device use. Conclusions: This study revealed that while older adults generally showed high daily adherence to the wearable device, consistent usage across consecutive days proved difficult. These findings underline the effectiveness of wearables in monitoring physical activity in older populations and emphasize the ongoing necessity to simplify usage protocols and enhance user engagement to guarantee the collection of precise and comprehensive data. UR - https://aging.jmir.org/2024/1/e60209 UR - http://dx.doi.org/10.2196/60209 ID - info:doi/10.2196/60209 ER - TY - JOUR AU - Timon, M. Claire AU - Heffernan, Emma AU - Kilcullen, Sophia AU - Hopper, Louise AU - Lee, Hyowon AU - Gallagher, Pamela AU - Smeaton, F. Alan AU - Moran, Kieran AU - Hussey, Pamela AU - Murphy, Catriona PY - 2024/10/24 TI - Developing Independent Living Support for Older Adults Using Internet of Things and AI-Based Systems: Co-Design Study JO - JMIR Aging SP - e54210 VL - 7 KW - independent living KW - gerontology KW - geriatric KW - older adult KW - elderly KW - aging KW - Internet of Things KW - IoT KW - wearable electronic device KW - medical device KW - daily living activities KW - quality of life KW - QoL KW - artificial intelligence KW - AI KW - algorithm KW - predictive model KW - predictive analytics KW - predictive system KW - practical model N2 - Background: The number of older people with unmet health care and support needs is increasing substantially due to the challenges facing health care systems worldwide. There are potentially great benefits to using the Internet of Things coupled with artificial intelligence to support independent living and the measurement of health risks, thus improving quality of life for the older adult population. Taking a co-design approach has the potential to ensure that these technological solutions are developed to address specific user needs and requirements. Objective: The aim of this study was to investigate stakeholders? perceptions of independent living and technology solutions, identify stakeholders? suggestions on how technology could assist older adults to live independently, and explore the acceptability and usefulness of a prototype Internet of Things solution called the NEX system to support independent living for an older adult population. Methods: The development of the NEX system was carried out in 3 key phases with a strong focus on diverse stakeholder involvement. The initial predesign exploratory phase recruited 17 stakeholders, including older adults and family caregivers, using fictitious personas and scenarios to explore initial perceptions of independent living and technology solutions. The subsequent co-design and testing phase expanded this to include a comprehensive web-based survey completed by 380 stakeholders, encompassing older adults, family caregivers, health care professionals, and home care support staff. This phase also included prototype testing at home by 7 older adults to assess technology needs, requirements, and the initial acceptability of the system. Finally, in the postdesign phase, workshops were held between academic and industry partners to analyze data collected from the earlier stages and to discuss recommendations for the future development of the system. Results: The predesign phase revealed 3 broad themes: loneliness and technology, aging and technology, and adopting and using technology. The co-design phase highlighted key areas where technology could assist older adults to live independently: home security, falls and loneliness, remote monitoring by family members, and communication with clients. Prototype testing revealed that the acceptability aspects of the prototype varied across technology types. Ambient sensors and voice-activated assistants were described as the most acceptable technology by participants. Last, the postdesign analysis process highlighted that ambient sensors have the potential for automatic detection of activities of daily living, resulting in key recommendations for future developments and deployments in this area. Conclusions: This study demonstrates the significance of incorporating diverse stakeholder perspectives in developing solutions that support independent living. Additionally, it emphasizes the advantages of prototype testing in home environments, offering crucial insights into the real-world experiences of users interacting with technological solutions. International Registered Report Identifier (IRRID): RR2-10.2196/35277 UR - https://aging.jmir.org/2024/1/e54210 UR - http://dx.doi.org/10.2196/54210 ID - info:doi/10.2196/54210 ER - TY - JOUR AU - Wan, Xiaonan AU - Lin, Zhengyu AU - Duan, Chengcheng AU - Zeng, Zhitong AU - Zhang, Chencheng AU - Li, Dianyou PY - 2024/10/23 TI - Comparison of the Burdens and Attitudes Between Standard and Web-Based Remote Programming for Deep Brain Stimulation in Parkinson Disease: Survey Study JO - JMIR Aging SP - e57503 VL - 7 KW - remote programming KW - Parkinson disease KW - deep brain stimulation KW - telemedicine KW - economic evaluation N2 - Background: Remote programming enables physicians to adjust implantable pulse generators over the internet for patients with Parkinson disease who have undergone deep brain stimulation (DBS) surgery. Despite these technological advances, the demand for and attitudes toward remote programming compared with standard programming among patients with Parkinson disease are still not well understood. Objective: This study aims to investigate the preferences and perceptions associated with these 2 programming methods among patients with Parkinson disease through a web-based survey. Methods: A web-based survey was administered to 463 patients with Parkinson disease who have undergone DBS surgery. The survey aimed to assess the burdens associated with postoperative programming and to compare patients? attitudes toward the 2 different programming methods. Results: A total of 225 patients completed the survey, all of whom had undergone standard programming, while 132 patients had also experienced remote programming. Among those who received standard programming, 191 (85%) patients required the support of more than 1 caregiver, 129 (58%) patients experienced over 2 days of lost work time, 98 (42%) patients incurred expenses ranging from US $42 to US $146, and 14 (6%) patients spent over US $421. Of the 132 patients who had used remote programming, 81 (62%) patients indicated a preference for remote programming in the future. However, challenges with remote programming persisted, including difficulties in obtaining official prescriptions, a lack of medical insurance coverage, and limited medical resources. Conclusions: Postoperative programming of DBS imposes significant burdens on patients and their caregivers during standard programming sessions?burdens that could be mitigated through remote programming. While patient satisfaction with remote programming is high, it is imperative for clinicians to develop personalized programming strategies tailored to the needs of different patients. UR - https://aging.jmir.org/2024/1/e57503 UR - http://dx.doi.org/10.2196/57503 ID - info:doi/10.2196/57503 ER - TY - JOUR AU - Ortiz-Barrios, Miguel AU - Cleland, Ian AU - Donnelly, Mark AU - Gul, Muhammet AU - Yucesan, Melih AU - Jiménez-Delgado, Isabel Genett AU - Nugent, Chris AU - Madrid-Sierra, Stephany PY - 2024/10/22 TI - Integrated Approach Using Intuitionistic Fuzzy Multicriteria Decision-Making to Support Classifier Selection for Technology Adoption in Patients with Parkinson Disease: Algorithm Development and Validation JO - JMIR Rehabil Assist Technol SP - e57940 VL - 11 KW - Parkinson disease KW - technology adoption KW - intuitionistic fuzzy analytic hierarchy process KW - intuitionistic fuzzy decision-making trial and evaluation laboratory KW - combined compromise solution N2 - Background: Parkinson disease (PD) is reported to be among the most prevalent neurodegenerative diseases globally, presenting ongoing challenges and increasing burden on health care systems. In an effort to support patients with PD, their carers, and the wider health care sector to manage this incurable condition, the focus has begun to shift away from traditional treatments. One of the most contemporary treatments includes prescribing assistive technologies (ATs), which are viewed as a way to promote independent living and deliver remote care. However, the uptake of these ATs is varied, with some users not ready or willing to accept all forms of AT and others only willing to adopt low-technology solutions. Consequently, to manage both the demands on resources and the efficiency with which ATs are deployed, new approaches are needed to automatically assess or predict a user?s likelihood to accept and adopt a particular AT before it is prescribed. Classification algorithms can be used to automatically consider the range of factors impacting AT adoption likelihood, thereby potentially supporting more effective AT allocation. From a computational perspective, different classification algorithms and selection criteria offer various opportunities and challenges to address this need. Objective: This paper presents a novel hybrid multicriteria decision-making approach to support classifier selection in technology adoption processes involving patients with PD. Methods: First, the intuitionistic fuzzy analytic hierarchy process (IF-AHP) was implemented to calculate the relative priorities of criteria and subcriteria considering experts? knowledge and uncertainty. Second, the intuitionistic fuzzy decision-making trial and evaluation laboratory (IF-DEMATEL) was applied to evaluate the cause-effect relationships among criteria/subcriteria. Finally, the combined compromise solution (CoCoSo) was used to rank the candidate classifiers based on their capability to model the technology adoption. Results: We conducted a study involving a mobile smartphone solution to validate the proposed methodology. Structure (F5) was identified as the factor with the highest relative priority (overall weight=0.214), while adaptability (F4) (D-R=1.234) was found to be the most influencing aspect when selecting classifiers for technology adoption in patients with PD. In this case, the most appropriate algorithm for supporting technology adoption in patients with PD was the A3 - J48 decision tree (M3=2.5592). The results obtained by comparing the CoCoSo method in the proposed approach with 2 alternative methods (simple additive weighting and technique for order of preference by similarity to ideal solution) support the accuracy and applicability of the proposed methodology. It was observed that the final scores of the algorithms in each method were highly correlated (Pearson correlation coefficient >0.8). Conclusions: The IF-AHP-IF-DEMATEL-CoCoSo approach helped to identify classification algorithms that do not just discriminate between good and bad adopters of assistive technologies within the Parkinson population but also consider technology-specific features like design, quality, and compatibility that make these classifiers easily implementable by clinicians in the health care system. UR - https://rehab.jmir.org/2024/1/e57940 UR - http://dx.doi.org/10.2196/57940 ID - info:doi/10.2196/57940 ER - TY - JOUR AU - Valdés-Aragonés, Myriam AU - Pérez-Rodríguez, Rodrigo AU - Carnicero, Antonio José AU - Moreno-Sánchez, A. Pedro AU - Oviedo-Briones, Myriam AU - Villalba-Mora, Elena AU - Abizanda-Soler, Pedro AU - Rodríguez-Mańas, Leocadio PY - 2024/10/22 TI - Effects of Monitoring Frailty Through a Mobile/Web-Based Application and a Sensor Kit to Prevent Functional Decline in Frail and Prefrail Older Adults: FACET (Frailty Care and Well Function) Pilot Randomized Controlled Trial JO - J Med Internet Res SP - e58312 VL - 26 KW - frailty KW - functional status KW - older adults KW - new technologies KW - sensor KW - monitoring system KW - information and communication technologies KW - mobile app KW - sensor kit KW - sensors KW - technological ecosystem KW - clinical intervention N2 - Background: Frailty represents a state of susceptibility to stressors and constitutes a dynamic process. Untreated, this state can progress to disability. Hence, timely detection of alterations in patients? frailty status is imperative to institute prompt clinical interventions and impede frailty progression. With this aim, the FACET (Frailty Care and Well Function) technological ecosystem was developed to provide clinically gathered data from the home to a medical team for early intervention. Objective: The aim of this study was to assess whether the FACET technological ecosystem prevents frailty progression and improves frailty status, according to the frailty phenotype criteria and Frailty Trait Scale-5 items (FTS-5) at 3 and 6 months of follow-up. Methods: This randomized clinical trial involved 90 older adults aged ?70 years meeting 2 or more Fried frailty phenotype criteria, having 4 or more comorbidities, and having supervision at home. This study was conducted between August 2018 and June 2019 at the geriatrics outpatient clinics in Getafe University Hospital and Albacete University Hospital. Participants were randomized into a control group receiving standard treatment and the intervention group receiving standard treatment along with the FACET home monitoring system. The system monitored functional tests at home (gait speed, chair stand test, frailty status, and weight). Outcomes were assessed using multivariate linear regression models for continuous response and multivariate logistic models for dichotomous response. P values less than .05 were considered statistically significant. Results: The mean age of the participants was 82.33 years, with 28% (25/90) being males. Participants allocated to the intervention group showed a 74% reduction in the risk of deterioration in the FTS-5 score (P=.04) and 92% lower likelihood of worsening by 1 point according to Fried frailty phenotype criteria compared to the control group (P=.02) at 6 months of follow-up. Frailty status, when assessed through FTS-5, improved in the intervention group at 3 months (P=.004) and 6 months (P=.047), while when the frailty phenotype criteria were used, benefits were shown at 3 months of follow-up (P=.03) but not at 6 months. Conclusions: The FACET technological ecosystem helps in the early identification of changes in the functional status of prefrail and frail older adults, facilitating prompt clinical interventions, thereby improving health outcomes in terms of frailty and functional status and potentially preventing disability and dependency. Trial Registration: ClinicalTrials.gov NCT03707145; https://clinicaltrials.gov/study/NCT03707145 UR - https://www.jmir.org/2024/1/e58312 UR - http://dx.doi.org/10.2196/58312 UR - http://www.ncbi.nlm.nih.gov/pubmed/39436684 ID - info:doi/10.2196/58312 ER - TY - JOUR AU - Miller, M. Lyndsey AU - Kaye, Jeffrey AU - Lindauer, Allison AU - Au-Yeung, M. Wan-Tai AU - Rodrigues, K. Nathaniel AU - Czaja, J. Sara PY - 2024/10/18 TI - Remote Passive Sensing of Older Adults? Activities and Function: User-Centered Design Considerations for Behavioral Interventions Conducted in the Home Setting JO - J Med Internet Res SP - e54709 VL - 26 KW - user-centered design KW - remote passive sensing KW - remote monitoring KW - behavioral interventions KW - caregiving KW - dementia KW - Alzheimer KW - monitoring KW - gerontology KW - geriatrics KW - older adult KW - aging KW - usability KW - acceptability KW - trust KW - behavioral UR - https://www.jmir.org/2024/1/e54709 UR - http://dx.doi.org/10.2196/54709 UR - http://www.ncbi.nlm.nih.gov/pubmed/39423003 ID - info:doi/10.2196/54709 ER - TY - JOUR AU - Kilaberia, R. Tina AU - Hu, Yuanyuan AU - Bell, F. Janice PY - 2024/10/18 TI - Habit and Help?Experiences of Technology Use During the COVID-19 Pandemic: Interview Study Among Older Adults JO - JMIR Form Res SP - e58242 VL - 8 KW - pandemic KW - older people KW - technology habit KW - subjective experience KW - acceptance of technology N2 - Background: The COVID-19 pandemic compelled older adults to engage with technology to a greater extent given emergent public health observance and home-sheltering restrictions in the United States. This study examined subjective experiences of technology use among older adults as a result of unforeseen and widespread public health guidance catalyzing their use of technology differently, more often, or in new ways. Objective: This study aimed to explore whether older adults scoring higher on the Unified Theory of Acceptance and Use of Technology questionnaire fared better in aspects of technology use, and reported better subjective experiences, in comparison with those scoring lower. Methods: A qualitative study using prevalence and thematic analyses of data from 18 older adults (mean age 79 years) in 2 groups: 9 scoring higher and 9 scoring lower on the Unified Theory of Acceptance and Use of Technology questionnaire. Results: Older adults were fairly competent technology users across both higher- and lower-scoring groups. The higher-scoring group noted greater use of technology in terms of telehealth and getting groceries and household items. Cognitive difficulty was described only among the lower-scoring group; they used technology less to get groceries and household items and to obtain health information. Qualitative themes depict the role of habit in technology use, enthusiasm about technology buttressed by the protective role of technology, challenges in technology use, and getting help regardless of technology mastery. Conclusions: Whereas the pandemic compelled older adults to alter or increase technology use, it did not change their global outlook on technology use. Older adults? prepandemic habits of technology use and available help influenced the degree to which they made use of technology during the COVID-19 pandemic. UR - https://formative.jmir.org/2024/1/e58242 UR - http://dx.doi.org/10.2196/58242 UR - http://www.ncbi.nlm.nih.gov/pubmed/39422990 ID - info:doi/10.2196/58242 ER - TY - JOUR AU - Rizvi, L. Shireen AU - Ruork, K. Allison AU - Yin, Qingqing AU - Yeager, April AU - Taylor, E. Madison AU - Kleiman, M. Evan PY - 2024/10/9 TI - Using Biosensor Devices and Ecological Momentary Assessment to Measure Emotion Regulation Processes: Pilot Observational Study With Dialectical Behavior Therapy JO - JMIR Ment Health SP - e60035 VL - 11 KW - wearable device KW - ecological momentary assessment KW - emotion regulation KW - psychotherapy mechanisms KW - dialectical behavior therapy KW - wearable KW - wristwatch KW - novel technology KW - psychological KW - treatment KW - pilot study KW - adult KW - personality disorder KW - mental health KW - mobile phone KW - EMA KW - observational study N2 - Background: Novel technologies, such as ecological momentary assessment (EMA) and wearable biosensor wristwatches, are increasingly being used to assess outcomes and mechanisms of change in psychological treatments. However, there is still a dearth of information on the feasibility and acceptability of these technologies and whether they can be reliably used to measure variables of interest. Objective: Our objectives were to assess the feasibility and acceptability of incorporating these technologies into dialectical behavior therapy and conduct a pilot evaluation of whether these technologies can be used to assess emotion regulation processes and associated problems over the course of treatment. Methods: A total of 20 adults with borderline personality disorder were enrolled in a 6-month course of dialectical behavior therapy. For 1 week out of every treatment month, participants were asked to complete EMA 6 times a day and to wear a biosensor watch. Each EMA assessment included measures of several negative affect and suicidal thinking, among other items. We used multilevel correlations to assess the contemporaneous association between electrodermal activity and 11 negative emotional states reported via EMA. A multilevel regression was conducted in which changes in composite ratings of suicidal thinking were regressed onto changes in negative affect. Results: On average, participants completed 54.39% (SD 33.1%) of all EMA (range 4.7%?92.4%). They also wore the device for an average of 9.52 (SD 6.47) hours per day and for 92.6% of all days. Importantly, no associations were found between emotional state and electrodermal activity, whether examining a composite of all high-arousal negative emotions or individual emotional states (within-person r ranged from ?0.026 to ?0.109). Smaller changes in negative affect composite scores were associated with greater suicidal thinking ratings at the subsequent timepoint, beyond the effect of suicidal thinking at the initial timepoint. Conclusions: Results indicated moderate overall compliance with EMA and wearing the watch; however, there was no concurrence between EMA and wristwatch data on emotions. This pilot study raises questions about the reliability and validity of these technologies incorporated into treatment studies to evaluate emotion regulation mechanisms. UR - https://mental.jmir.org/2024/1/e60035 UR - http://dx.doi.org/10.2196/60035 ID - info:doi/10.2196/60035 ER - TY - JOUR AU - Pani, Jasmine AU - Lorusso, Letizia AU - Toccafondi, Lara AU - D'Onofrio, Grazia AU - Ciccone, Filomena AU - Russo, Sergio AU - Giuliani, Francesco AU - Sancarlo, Daniele AU - Calamida, Novella AU - Vignani, Gianna AU - Pihl, Tarmo AU - Rovini, Erika AU - Cavallo, Filippo AU - Fiorini, Laura PY - 2024/10/9 TI - How Time, Living Situation, and Stress Related to Technology Influence User Acceptance and Usability of a Socialization Service for Older Adults and Their Formal and Informal Caregivers: Six-Month Pilot Study JO - JMIR Aging SP - e54736 VL - 7 KW - active aging KW - longitudinal study KW - technostress KW - technology usability and acceptance KW - scaling up N2 - Background: Considering the growing population of older adults, addressing the influence of loneliness among this demographic group has become imperative, especially due to the link between social isolation and deterioration of mental and physical well-being. Technology has the potential to be used to create innovative solutions to increase socialization and potentially promote healthy aging. Objective: This 6-month study examined the usability and acceptability of a technology-based socialization service and explored how stress and living situation affect older adults? and their ecosystem?s perceptions of technology, investigating cross-sectional and longitudinal differences among and across user groups. Methods: Participants were recruited in Tuscany and Apulia (Italy) through a network of social cooperatives and a research hospital, respectively. A total of 20 older adults were provided with the same technology installed on a tablet and on a smart television. The technology has three functionalities: video calling, playing games, and sharing news. Additionally, 20 informal caregivers (IC) and 13 formal caregivers (FC) connected to the older adults were included in the study. After both initial training in the use of the system (T0) and 6 months of using the system (T6), questionnaires on usability, acceptability, and technostress were filled in by older adults, IC, and FC. Nonparametric or parametric tests were conducted to investigate group differences at both time points and changes over time. Additional analyses on older adults were done to assess whether differences in usability and acceptability were related to living situation (ie, alone or with someone). Furthermore, correlation analyses were performed between usability, acceptability, and stress toward technology at T0 and T6. Results: At both T0 and T6, older adults had lower usability scores than IC and FC and higher anxiety than IC. Over time, there was a significant decrease in older adults? attitudes toward technology score, depicting a negative attitude over time (T0 median 4.2, IQR 0.5; T6 median 3.7, IQR 0.8; Cohen d=0.7), while there was no change for IC and FC. At T0, those living alone had lower acceptability than those living with someone but this difference disappeared at T6. People or participants living with someone had a decline in anxiety, attitudes toward technology, enjoyment, and perceived usefulness. Stress toward technology affected usability and acceptability in the older adult group entering the study (?=?.85) but this was not observed after 6 months. In the IC group, stress affected trust at T0 (?=?.23) but not at T6. Conclusions: At the start of the study, older adults judged the system to be less usable and more stressful than did the caregivers. Indeed, at first, technostress was correlated with usability and acceptability; however, with repeated use, technostress did not influence the perception of technology. Overall, getting accustomed to technology decreased anxiety and stress toward technology. UR - https://aging.jmir.org/2024/1/e54736 UR - http://dx.doi.org/10.2196/54736 ID - info:doi/10.2196/54736 ER - TY - JOUR AU - Wang, Ning AU - Zhou, Siyu AU - Liu, Zhuo AU - Han, Ying PY - 2024/9/20 TI - Perceptions and Satisfaction With the Use of Digital Medical Services in Urban Older Adults of China: Mixed Methods Study JO - J Med Internet Res SP - e48654 VL - 26 KW - digital medical services KW - older adults KW - Technology Acceptance Model KW - perception KW - behavioral intention KW - satisfaction N2 - Background: In an aging and information-driven society, older adults have distinct perceptions of and specific demands for digital medical services. It is essential for society to understand these needs and develop a more thoughtful approach to digital health care. Objective: This study aims to evaluate the behavioral intention and satisfaction of older adults with digital medical services by identifying the perceived factors and the pathways through which these factors influence their behavior. Methods: This study used a mixed methods approach, combining qualitative and quantitative analyses. A focus group interview was conducted with 30 randomly selected older adults, and the interviews were transcribed verbatim and coded using grounded theory. In addition, 876 valid questionnaires were collected to describe older adults? perceptions of and satisfaction with digital medical care. Then, t tests and ANOVA were used to explore differences among various demographic groups, while hierarchical multiple regression was conducted to identify the factors most closely related to satisfaction. Structural equation modeling was used to identify multiple mediating effects. Results: The qualitative study identified the core category of ?medical service relief and transformation paths for older adults in the context of digital reform.? Quantitative analysis revealed that more than half of the older adults were satisfied with digital medical services, and behavioral intentions were higher among those with higher incomes and education levels. Structural equation modeling confirmed that external variables, such as digital skills training, positively influenced perceived ease of use (?=.594, P<.001), perceived usefulness (?=.544, P<.001), and promoted digital medical behavioral intentions (?=.256, P<.001), while also reducing perceived risk (?=?.295, P<.001). Additionally, perceived ease of use (?=.168, P<.001) and perceived usefulness (?=.508, P<.001) positively impacted behavioral intention, whereas perceived risk (?=?.05, P=.037) exerted a negative influence. Furthermore, behavioral intention (?=.641, P<.001) significantly and positively affected older adults? satisfaction with digital medical care. The mediation test identified 4 significant paths: (1) external variables ? perceived ease of use ? behavioral intention (effect size of 13.9%); (2) external variables ? perceived usefulness ? behavioral intention (effect size of 38.4%); (3) external variables ? perceived ease of use ? perceived usefulness ? behavioral intention (effect size of 10.1%); and (4) a direct effect (35.5%) from external variables to behavioral intention. Conclusions: Based on the study?s findings, addressing the needs of older adults and enhancing perceived usefulness are the most effective ways to encourage the use of digital health care devices. Community support plays a crucial role in helping older adults integrate into digital health care, and adapting the design of services and products to suit their needs improves their perceptions of digital health care. This, in turn, promotes usage behavior and satisfaction, while the negative impact of perceived risk remains minimal. UR - https://www.jmir.org/2024/1/e48654 UR - http://dx.doi.org/10.2196/48654 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/48654 ER - TY - JOUR AU - Happe, Lisa AU - Sgraja, Marie AU - Quinten, Vincent AU - Förster, Mareike AU - Diekmann, Rebecca PY - 2024/9/17 TI - Requirement Analysis of Different Variants of a Measurement and Training Station for Older Adults at Risk of Malnutrition and Reduced Mobility: Focus Group Study JO - JMIR Aging SP - e58714 VL - 7 KW - gerontechnology KW - physical activity KW - diet KW - technical assistance system KW - health data KW - qualitative research N2 - Background: Demographic change is leading to an increasing proportion of older people in the German population and requires new approaches for prevention and rehabilitation to promote the independence and health of older people. Technical assistance systems can offer a promising solution for the early detection of nutritional and physical deficits and the initiation of appropriate interventions. Such a system should combine different components, such as devices for assessing physical and nutritional status, educational elements on these topics, and training and feedback options. The concept is that the whole system can be used independently by older adults (aged ?70 years) for monitoring and early detection of problems in nutrition or physical function, as well as providing opportunities for intervention. Objective: This study aims to develop technical and digital elements for a measurement and training station (MuTs) with an associated app. Through focus group discussions, target group requirements, barriers, and favorable components for such a system were identified. Methods: Older adults (aged ?70 years) were recruited from a community-based setting as well as from a geriatric rehabilitation center. Focus group interviews were conducted between August and November 2022. Following a semistructured interview guideline, attitudes, requirements, preferences, and barriers for the MuTs were discussed. Discussions were stimulated by videos, demonstrations of measuring devices, and participants? ratings of the content presented using rankings. After conducting 1 focus group in the rehabilitation center and 2 in the community, the interview guide was refined, making a more detailed discussion of identified elements and aspects possible. The interviews were recorded, transcribed verbatim, and analyzed using content analysis. Results: A total of 21 older adults (female participants: n=11, 52%; mean age 78.5, SD 4.6 years) participated in 5 focus group discussions. There was a strong interest in the independent measurement of health parameters, such as pulse and hand grip strength, especially among people with health problems who would welcome feedback on their health development. Participants emphasized the importance of personal guidance and interaction before using the device, as well as the need for feedback mechanisms and personalized training for everyday use. Balance and coordination were mentioned as preferred training areas in a MuTs. New training options that motivate and invite people to participate could increase willingness to use the MuTs. Conclusions: The target group is generally open and interested in tracking and optimizing diet and physical activity. A general willingness to use a MuTs independently was identified, as well as a compelling need for guidance and feedback on measurement and training to be part of the station. UR - https://aging.jmir.org/2024/1/e58714 UR - http://dx.doi.org/10.2196/58714 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58714 ER - TY - JOUR AU - Van der Roest, Geralde Henriëtte AU - Christie, Liane Hannah AU - Franco-Martin, Angel Manuel AU - Dröes, Rose-Marie AU - de Vugt, Elizabeth Marjolein AU - Meiland, Franka PY - 2024/9/13 TI - Determinants of Successful Implementation of Assistive Technologies for Dementia: Exploratory Survey JO - JMIR Aging SP - e53640 VL - 7 KW - assistive technology KW - dementia KW - implementation KW - caregiving KW - psychosocial research N2 - Background: Despite positive results for the use of assistive technologies (ATs) in dementia, the uptake of ATs lags behind. It is considered important to assess determinants of successful or unsuccessful implementation of ATs. Objective: We explored factors that influence the implementation of ATs for community-dwelling people with dementia, with the aim to better understand potentially effective implementation strategies. Methods: A cross-sectional survey for researchers was developed and disseminated, exploring factors that influence either successful or unsuccessful implementation of ATs for dementia. The survey consisted of closed and open questions. Results: The response rate was 10% (21/206); the 21 respondents who completed the survey were from 8 countries. Determinants of implementation were described for 21 ATs, of which 12 were successfully and 9 were unsuccessfully implemented. Various types of ATs were included, such as online platforms, sensors, or physical aids. The main determinants of implementation success were related to the AT itself, contextual factors, research activities, and implementation strategies. There was a lack of research data on some ethical issues and cost-effectiveness. Conclusions: This study provided insight into some main barriers to and facilitators of implementation of ATs in dementia related to the AT itself, context, research-related activities, and applied implementation strategies. Lessons were formulated for various stakeholders to improve the implementation effectiveness of ATs in dementia. UR - https://aging.jmir.org/2024/1/e53640 UR - http://dx.doi.org/10.2196/53640 ID - info:doi/10.2196/53640 ER - TY - JOUR AU - Glavas, Costas AU - Scott, David AU - Sood, Surbhi AU - George, S. Elena AU - Daly, M. Robin AU - Gvozdenko, Eugene AU - de Courten, Barbora AU - Jansons, Paul PY - 2024/9/13 TI - Exploring the Feasibility of Digital Voice Assistants for Delivery of a Home-Based Exercise Intervention in Older Adults With Obesity and Type 2 Diabetes Mellitus: Randomized Controlled Trial JO - JMIR Aging SP - e53064 VL - 7 KW - older adults KW - type 2 diabetes mellitus KW - voice activation KW - digital health KW - exercise N2 - Background: Current clinical guidelines for the management of type 2 diabetes mellitus (T2DM) in older adults recommend the use of antihyperglycemic medications, monitoring of blood glucose levels, regular exercise, and a healthy diet to improve glycemic control and reduce associated comorbidities. However, adherence to traditional exercise programs is poor (<35%). Common barriers to adherence include fear of hypoglycemia and the need for blood glucose level monitoring before exercise. Digital health strategies offer great promise for managing T2DM as they facilitate patient-practitioner communication, support self-management, and improve access to health care services for underserved populations. We have developed a novel web-based software program allowing practitioners to create tailored interventions and deliver them to patients via digital voice assistants (DVAs) in their own homes. Objective: We aim to evaluate the feasibility of a 12-week, home-based, personalized lifestyle intervention delivered and monitored by DVAs for older adults with obesity and T2DM. Methods: In total, 50 older adults with obesity aged 50-75 years with oral hypoglycemic agent?treated T2DM were randomized to the intervention (DVA, n=25) or a control group (n=25). Participants allocated to the DVA group were prescribed a home-based muscle strengthening exercise program (~20- to 30-min sessions) and healthy eating intervention, delivered via DVAs (Alexa Echo Show 8; Amazon) using newly developed software (?Buddy Link?; Great Australian Pty Ltd). Control group participants received generalized physical activity information via email. Outcomes were feasibility, DVA usability (System Usability Scale), and objectively assessed physical activity and sedentary time (wrist-worn accelerometers). Results: In total, 45 (90%) out of 50 participants completed this study. Mean adherence to prescribed exercise was 85% (SD 43%) with no intervention-related adverse events. System usability was rated above average (70.4, SD 16.9 out of 100). Compared with controls, the DVA group significantly decreased sedentary time (mean difference ?67, SD 23; 95% CI ?113 to ?21 min/d), which was represented by a medium to large effect size (d=?0.6). Conclusions: A home-based lifestyle intervention delivered and monitored by health professionals using DVAs was feasible for reducing sedentary behavior and increasing moderate-intensity activity in older adults with obesity and T2DM. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12621000307808; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=381364&isReview=true UR - https://aging.jmir.org/2024/1/e53064 UR - http://dx.doi.org/10.2196/53064 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53064 ER - TY - JOUR AU - Huisingh-Scheetz, Megan AU - Nicholson III, F. Roscoe AU - Shervani, Saira AU - Smith, Chelsea AU - Danilovich, Margaret AU - Finch, Laura AU - Montoya, Yadira AU - Hawkley, C. Louise PY - 2024/9/12 TI - A Voice-Activated Device Exercise and Social Engagement Program for Older Adult?Care Partner Dyads: Pilot Clinical Trial and Focus Group Study Evaluating the Feasibility, Use, and Estimated Functional Impact of EngAGE JO - JMIR Aging SP - e56502 VL - 7 KW - voice-activated device KW - voice-activated devices KW - frailty KW - frail KW - weak KW - weakness KW - technology KW - activity KW - physical activity KW - exercise KW - exercising KW - caregiver KW - caregivers KW - caregiving KW - caretaker KW - caretakers KW - caretaking KW - care-giver KW - care-givers KW - care-giving KW - care-taker KW - care-takers KW - care-taking KW - gerontology KW - geriatric KW - geriatrics KW - older adult KW - older adults KW - elder KW - elderly KW - older person KW - older people KW - ageing KW - aging KW - voice activation KW - digital health KW - exercises KW - online exercises KW - participatory design KW - new devices KW - health devices KW - technology development KW - mobile phone N2 - Background: Maintaining exercise is essential for healthy aging but difficult to sustain. EngAGE is a socially motivated exercise program delivered over a voice-activated device that targets older adult?care partner dyads. Objective: This 10-week pilot study aimed to assess EngAGE feasibility and use, obtain user experience feedback, and estimate potential impact on function. Methods: In total, 10 older adults aged ?65 years were recruited from an independent living residence together with their self-identified care partners. EngAGE delivered National Institute on Aging Go4Life exercises to older adults daily, while care partners received progress reports and prompts to send encouraging messages that were read aloud by the device to the older adult. Older adults? use was tracked, and physical function was assessed at baseline and follow-up. Follow-up focus group data provided qualitative feedback. Results: On average, participants completed 393.7 individual exercises over the 10-week intervention period or 39.4 exercises/wk (range 48-492, median 431, IQR 384-481, SD 112.4) without injury and used EngAGE on an average of 41 of 70 days or 4.1 d/wk (range 7-66, median 51, IQR 23-56, and SD 21.2 days). Mean grip strength increased nonsignificantly by 1.3 kg (preintervention mean 26.3 kg, SD 11.0; postintervention mean 27.6 kg, SD 11.6; P=.34), and 4 of 10 participants improved by a minimal clinically important difference (MCID) of 2.5 kg. Further, the time for 5-repeated chair stands significantly reduced by 2.3 seconds (preintervention mean 12, SD 3.6 s; postintervention mean 9.7, SD 2.7 s; P=.02), and 3 of 9 participants improved by an MCID of ?2.3 seconds. Furthermore, 3-meter usual walk performance was brisk at baseline (mean 2.1, SD 0.4 s) and decreased by 0.1 seconds (postintervention 2, SD 0.4 s; P=.13), although 5 of 9 participants improved by a MCID of 0.05 m/s. Qualitative results showed perceived benefits, favored program features, and areas for improvement. Conclusions: We present a pilot study of a new voice-activated device application customized to older adult users that may serve as a guide to other technology development for older adults. Our pilot study served to further refine the application and to inform a larger trial testing EngAGE?s impact on functional outcomes, a necessary step for developing evidence-based technology tools. UR - https://aging.jmir.org/2024/1/e56502 UR - http://dx.doi.org/10.2196/56502 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56502 ER - TY - JOUR AU - Tan, Kian Cheng AU - Lou, Q. Vivian W. AU - Cheng, Man Clio Yuen AU - He, Chu Phoebe AU - Khoo, Joo Veronica Eng PY - 2024/8/23 TI - Improving the Social Well-Being of Single Older Adults Using the LOVOT Social Robot: Qualitative Phenomenological Study JO - JMIR Hum Factors SP - e56669 VL - 11 KW - companionship KW - older adults KW - social well-being KW - pets KW - social robots KW - elderly KW - wellbeing KW - qualitative research KW - robot KW - companion KW - body temperature KW - development KW - research design KW - design KW - interviews KW - psychosocial support KW - support KW - psychosocial KW - temperature regulation KW - social KW - care home KW - aging KW - ageing KW - robotics KW - well-being KW - loneliness KW - technology KW - mobile phone N2 - Background: This study examined the social well-being of single older adults through the companionship of a social robot, LOVOT (Love+Robot; Groove X). It is designed as a companion for older adults, providing love and affection through verbal and physical interaction. We investigated older adults? perceptions of the technology and how they benefitted from interacting with LOVOT, to guide the future development of social robots. Objective: This study aimed to use a phenomenological research design to understand the participants? experiences of companionship provided by the social robot. Our research focused on (1) examining the social well-being of single older adults through the companionship of social robots and (2) understanding the perceptions of single older adults when interacting with social robots. Given the prevalence of technology use to support aging, understanding single older adults? social well-being and their perceptions of social robots is essential to guide future research on and design of social robots. Methods: A total of 5 single women, aged 60 to 75 years, participated in the study. The participants interacted independently with the robot for a week in their own homes and then participated in a poststudy interview to share their experiences. Results: In total, 4 main themes emerged from the participants? interactions with LOVOT, such as caring for a social robot, comforting presence of the social robot, meaningful connections with the social robot, and preference for LOVOT over pets. Conclusions: The results indicate that single older adults can obtain psychosocial support by interacting with LOVOT. LOVOT is easily accepted as a companion and makes single older adults feel like they have a greater sense of purpose and someone to connect with. This study suggests that social robots can provide companionship to older adults who live alone. Social robots can help alleviate loneliness by allowing single older adults to form social connections with robots as companions. These findings are particularly important given the rapid aging of the population and the increasing number of single-person households in Singapore. UR - https://humanfactors.jmir.org/2024/1/e56669 UR - http://dx.doi.org/10.2196/56669 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56669 ER - TY - JOUR AU - Muehlensiepen, Felix AU - Petit, Pascal AU - Knitza, Johannes AU - Welcker, Martin AU - Vuillerme, Nicolas PY - 2024/8/19 TI - Identification of Motivational Determinants for Telemedicine Use Among Patients With Rheumatoid Arthritis in Germany: Secondary Analysis of Data From a Nationwide Cross-Sectional Survey Study JO - J Med Internet Res SP - e47733 VL - 26 KW - telemedicine KW - rheumatoid arthritis KW - rheumatology KW - primary care KW - health services research KW - eHealth KW - data analysis KW - survey KW - Germany KW - tool KW - care KW - willingness KW - sociodemographic KW - age KW - telehealth KW - digital transition N2 - Background: Previous studies have demonstrated telemedicine to be an effective tool to complement rheumatology care and address workforce shortage. With the COVID-19 outbreak, telemedicine experienced a massive upswing. An earlier analysis revealed that the motivation of patients with rheumatic and musculoskeletal diseases to use telemedicine is closely connected to their disease. It remains unclear which factors are associated with patients? motivation to use telemedicine in certain rheumatic and musculoskeletal diseases groups, such as rheumatoid arthritis (RA). Objective: This study aims to identify factors that determine the willingness to try telemedicine among patients diagnosed with RA. Methods: We conducted a secondary analysis of data from a German nationwide cross-sectional survey among patients with RA. Bayesian univariate logistic regression analysis was applied to the data to determine which factors were associated with willingness to try telemedicine. Predictor variables (covariates) studied individually included sociodemographic factors (eg, age, sex) and health characteristics (eg, health status). All the variables positively and negatively associated with willingness to try telemedicine in the univariate analyses were then considered for Bayesian model averaging analysis after a selection based on the variance inflation factor (? 2.5) to identify determinants of willingness to try telemedicine. Results: Among 438 surveyed patients in the initial study, 210 were diagnosed with RA (47.9%). Among them, 146 (69.5%) answered either yes or no regarding willingness to try telemedicine and were included in the analysis. A total of 22 variables (22/55, 40%) were associated with willingness to try telemedicine (region of practical equivalence %?5). A total of 9 determinant factors were identified using Bayesian model averaging analysis. Positive determinants included desiring telemedicine services provided by a rheumatologist (odds ratio [OR] 13.7, 95% CI 5.55-38.3), having prior knowledge of telemedicine (OR 2.91, 95% CI 1.46-6.28), residing in a town (OR 2.91, 95% CI 1.21-7.79) or city (OR 0.56, 95% CI 0.23-1.27), and perceiving one?s health status as moderate (OR 1.87, 95% CI 0.94-3.63). Negative determinants included the lack of an electronic device (OR 0.1, 95% CI 0.01-0.62), absence of home internet access (OR 0.1, 95% CI 0.02-0.39), self-assessment of health status as bad (OR 0.44, 95% CI 0.21-0.89) or very bad (OR 0.47, 95% CI 0.06-2.06), and being aged between 60 and 69 years (OR 0.48, 95% CI 0.22-1.04) or older than 70 years (OR 0.38, 95% CI 0.16-0.85). Conclusions: The results suggest that some patients with RA will not have access to telemedicine without further support. Older patients, those not living in towns, those without adequate internet access, reporting a bad health status, and those not owning electronic devices might be excluded from the digital transformation in rheumatology and might not have access to adequate RA care. These patient groups certainly require support for the use of digital rheumatology care. UR - https://www.jmir.org/2024/1/e47733 UR - http://dx.doi.org/10.2196/47733 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/47733 ER - TY - JOUR AU - Reicherzer, Leah AU - Scheermesser, Mandy AU - Kläy, Adrian AU - Duarte, E. Jaime AU - Graf, S. Eveline PY - 2024/8/9 TI - Barriers and Facilitators to the Use of Wearable Robots as Assistive Devices: Qualitative Study With Older Adults and Physiotherapists JO - JMIR Rehabil Assist Technol SP - e52676 VL - 11 KW - assistive device KW - barriers KW - facilitators KW - mobility KW - older adults KW - wearable robots N2 - Background: Light wearable robots have the potential to assist older adults with mobility impairments in daily life by compensating for age-related decline in lower extremity strength. Physiotherapists may be the first point of contact for older adults with these devices. Objective: The aims of this study were to explore views of older adults and physiotherapists on wearable robots as assistive devices for daily living and to identify the barriers and facilitators to their use. Methods: Six older adults (aged 72?88 years) tested a wearable robot (Myosuit) and participated in semistructured interviews. A focus group with 6 physiotherapists who had a minimum of 5 years of professional experience and specialized in geriatrics was conducted. Data were analyzed using thematic qualitative text analysis. Results: Older adults perceived benefits and had positive use experiences, yet many saw no need to use the technology for themselves. Main barriers and facilitators to its use were the perception of usefulness, attitudes toward technology, ease of use, and environmental factors such as the support received. Physiotherapists named costs, reimbursement schemes, and complexity of the technology as limiting factors. Conclusions: A light wearable robot?the Myosuit?was found to be acceptable to study participants as an assistive device. Although characteristics of the technology are important, the use and acceptance by older adults heavily depend on perceived usefulness and need. UR - https://rehab.jmir.org/2024/1/e52676 UR - http://dx.doi.org/10.2196/52676 ID - info:doi/10.2196/52676 ER - TY - JOUR AU - Kokorelias, Marie Kristina AU - McMurray, Josephine AU - Chu, Charlene AU - Astell, Arlene AU - Grigorovich, Alisa AU - Kontos, Pia AU - Babineau, Jessica AU - Bytautas, Jessica AU - Ahuja, Ashley AU - Iaboni, Andrea PY - 2024/8/8 TI - Technology-Enabled Recreation and Leisure Programs and Activities for Older Adults With Cognitive Impairment: Rapid Scoping Review JO - JMIR Neurotech SP - e53038 VL - 3 KW - scoping review KW - review methods KW - review methodology KW - knowledge synthesis KW - synthesis KW - syntheses KW - scoping KW - rapid review KW - rapid reviews KW - gerontology KW - geriatric KW - geriatrics KW - older adult KW - older adults KW - elder KW - elderly KW - older person KW - older people KW - ageing KW - aging KW - gerontechnology KW - technology KW - recreation KW - recreational KW - leisure KW - hobby KW - hobbies KW - cognitive KW - MCI KW - Alzheimer KW - dementia KW - digital health N2 - Background: Recreational and leisure activities significantly contribute to the well-being of older adults, positively impacting physical, cognitive, and mental health. However, limited mobility and cognitive decline often impede access to these activities, particularly for individuals living with dementia. With the increasing availability of digital technologies, there is a rising interest in using technology to deliver recreation and leisure activities for cognitively impaired individuals, acknowledging its potential to provide diverse experiences. The COVID-19 pandemic further highlighted the need for virtual program delivery, especially for individuals in long-term care settings, leading to the development of tools like the Dementia Isolation Toolkit aimed at supporting compassionate isolation. To better support future implementations of the DIT, our rapid scoping review explores evidence-based, technology-enabled recreation programs for older adults with cognitive impairments, which promote well-being. Objective: We conducted a rapid scoping review of published peer-reviewed literature to answer the following research question: What recreation and leisure programs or activities are being delivered using technology to adults living with dementia or another form of cognitive impairment? Methods: In total, 6 databases were searched by an Information Specialist. Single reviewers performed title or abstract review, full-text screening, data extraction, and study characteristic summarization. Results: A total of 92 documents representing 94 studies were identified. The review identified a variety of technology-enabled delivery methods, including robots, gaming consoles, tablets, televisions, and computers, used to engage participants in recreational and leisure activities. These technologies impacted mood, cognition, functional activity, and overall well-being among older adults with cognitive impairments. Activities for socializing were the most common, leveraging technologies such as social robots and virtual companions, while relaxation methods used virtual reality and digital reminiscence therapy. However, challenges included technological complexity and potential distress during reminiscing activities, prompting recommendations for diversified research settings, and increased sample sizes to comprehensively understand technology's impact on leisure among this demographic. Conclusions: The findings suggest that technology-enabled recreational activities, such as socializing, relaxation and self-awareness activities, music and dance, exergaming, and art, can positively impact the mood and overall well-being of older adults with cognitive impairment. Future research should embrace a more inclusive approach, integrating design, diverse settings, and a broader sample of older adults to develop technology-driven leisure activities tailored to their unique needs and promote their effective use. UR - https://neuro.jmir.org/2024/1/e53038 UR - http://dx.doi.org/10.2196/53038 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53038 ER - TY - JOUR AU - Kokorelias, Marie Kristina AU - Grigorovich, Alisa AU - Harris, T. Maurita AU - Rehman, Umair AU - Ritchie, Louise AU - Levy, M. AnneMarie AU - Denecke, Kerstin AU - McMurray, Josephine PY - 2024/8/7 TI - Longitudinal Coadaptation of Older Adults With Wearables and Voice-Activated Virtual Assistants: Scoping Review JO - J Med Internet Res SP - e57258 VL - 26 KW - older adults KW - coadaptation KW - voice recognition KW - virtual assistant KW - wearable KW - artificial intelligence KW - smart-assistive technology KW - scoping review KW - review methods KW - review methodology KW - knowledge synthesis KW - synthesis KW - scoping KW - older adult KW - gerontechnology KW - technology KW - smart technology KW - smart technologies KW - smart KW - geriatrics KW - older people KW - geriatric KW - scoping literature review KW - protocol KW - Internet of Things KW - IoT KW - aging KW - PRISMA-ScR KW - Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews KW - user-centered design KW - design KW - user centered KW - mobile phone N2 - Background: The integration of smart technologies, including wearables and voice-activated devices, is increasingly recognized for enhancing the independence and well-being of older adults. However, the long-term dynamics of their use and the coadaptation process with older adults remain poorly understood. This scoping review explores how interactions between older adults and smart technologies evolve over time to improve both user experience and technology utility. Objective: This review synthesizes existing research on the coadaptation between older adults and smart technologies, focusing on longitudinal changes in use patterns, the effectiveness of technological adaptations, and the implications for future technology development and deployment to improve user experiences. Methods: Following the Joanna Briggs Institute Reviewer?s Manual and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines, this scoping review examined peer-reviewed papers from databases including Ovid MEDLINE, Ovid Embase, PEDro, Ovid PsycINFO, and EBSCO CINAHL from the year 2000 to August 28, 2023, and included forward and backward searches. The search was updated on March 1, 2024. Empirical studies were included if they involved (1) individuals aged 55 years or older living independently and (2) focused on interactions and adaptations between older adults and wearables and voice-activated virtual assistants in interventions for a minimum period of 8 weeks. Data extraction was informed by the selection and optimization with compensation framework and the sex- and gender-based analysis plus theoretical framework and used a directed content analysis approach. Results: The search yielded 16,143 papers. Following title and abstract screening and a full-text review, 5 papers met the inclusion criteria. Study populations were mostly female participants and aged 73-83 years from the United States and engaged with voice-activated virtual assistants accessed through smart speakers and wearables. Users frequently used simple commands related to music and weather, integrating devices into daily routines. However, communication barriers often led to frustration due to devices? inability to recognize cues or provide personalized responses. The findings suggest that while older adults can integrate smart technologies into their lives, a lack of customization and user-friendly interfaces hinder long-term adoption and satisfaction. The studies highlight the need for technology to be further developed so they can better meet this demographic?s evolving needs and call for research addressing small sample sizes and limited diversity. Conclusions: Our findings highlight a critical need for continued research into the dynamic and reciprocal relationship between smart technologies and older adults over time. Future studies should focus on more diverse populations and extend monitoring periods to provide deeper insights into the coadaptation process. Insights gained from this review are vital for informing the development of more intuitive, user-centric smart technology solutions to better support the aging population in maintaining independence and enhancing their quality of life. International Registered Report Identifier (IRRID): RR2-10.2196/51129 UR - https://www.jmir.org/2024/1/e57258 UR - http://dx.doi.org/10.2196/57258 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57258 ER - TY - JOUR AU - Clohessy, Sophie AU - Kempton, Christian AU - Ryan, Kate AU - Grinbergs, Peter AU - Elliott, T. Mark PY - 2024/8/1 TI - Exploring Older Adults' Perceptions of Using Digital Health Platforms for Self-Managing Musculoskeletal Health Conditions: Focus Group Study JO - JMIR Aging SP - e55693 VL - 7 KW - musculoskeletal KW - digital health platform KW - physiotherapy self-management KW - digital triaging KW - phone app KW - qualitative KW - focus group KW - mobile phone N2 - Background: Digital technologies can assist and optimize health care processes. This is increasingly the case in the musculoskeletal health domain, where digital platforms can be used to support the self-management of musculoskeletal conditions, as well as access to services. However, given a large proportion of the population with musculoskeletal conditions are older adults (aged ?60 years), it is important to consider the acceptability of such platforms within this demographic. Objective: This study aims to explore participants? opinions and perceptions on the use of digital platforms for supporting the self-management of musculoskeletal conditions within older adult (aged ?60 years) populations and to gather their opinions on real examples. Methods: A total of 2 focus groups (focus group 1: 6/15, 40%; focus group 2: 9/15, 60%) were conducted, in which participants answered questions about their thoughts on using digital health platforms to prevent or manage musculoskeletal conditions. Participants were further presented with 2 example scenarios, which were then discussed. Interviews were audio recorded, transcribed, and analyzed thematically. Participants were aged ?60 years and with or without current musculoskeletal conditions. Prior experience of using smartphone apps or other digital health platforms for musculoskeletal conditions was not required. Focus groups took place virtually using the Teams (Microsoft Corp) platform. Results: A total of 6 themes were identified across both focus groups: ?experiences of digital health platforms,? ?preference for human contact,? ?barriers to accessing clinical services,? ?individual differences and digital literacy,? ?trust in technology,? and ?features and benefits of digital health technologies.? Each theme is discussed in detail based on the interview responses. The findings revealed that most participants had some existing experience with digital health platforms for preventing or managing musculoskeletal conditions. Overall, there was a lack of trust in and low expectations of quality for digital platforms for musculoskeletal health within this age group. While there was some concern about the use of digital platforms in place of in-person health consultations, several benefits were also identified. Conclusions: Results highlighted the need for better communication on the benefits of using digital platforms to support the self-management of musculoskeletal conditions, without the platforms replacing the role of the health care professionals. The concerns about which apps are of suitable quality and trustworthiness lead us to recommend raising public awareness around the role of organizations that verify and assess the quality of digital health platforms. UR - https://aging.jmir.org/2024/1/e55693 UR - http://dx.doi.org/10.2196/55693 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55693 ER - TY - JOUR AU - Johnson, K. Joshua AU - Longhurst, K. Jason AU - Gevertzman, Michael AU - Jefferson, Corey AU - Linder, M. Susan AU - Bethoux, Francois AU - Stilphen, Mary PY - 2024/7/31 TI - The Use of Telerehabilitation to Improve Movement-Related Outcomes and Quality of Life for Individuals With Parkinson Disease: Pilot Randomized Controlled Trial JO - JMIR Form Res SP - e54599 VL - 8 KW - rehabilitation KW - physical therapy KW - PT KW - physiotherapy KW - telehealth KW - Parkinson disease KW - tele-rehabilitation KW - telerehabilitation KW - TR KW - exercise KW - physical activity KW - exercise therapy KW - tele-health KW - mHealth KW - mobile health KW - app KW - apps KW - application KW - applications KW - digital health KW - smartphone KW - smartphones KW - Parkinson?s disease KW - Parkinson KW - Parkinsons KW - Parkinsonism KW - PD N2 - Background: Individuals with Parkinson disease (PD) can improve their overall mobility and participation in daily activities as they engage in frequent exercise. Despite the need for individually tailored exercises, persons with PD often face barriers to accessing physical rehabilitation professionals who can provide them. Telerehabilitation (TR) may facilitate access to necessary and individually tailored rehabilitation for individuals with PD. Objective: The purpose of this study was to assess the feasibility of TR for individuals with PD and explore clinical outcomes compared to in-person care. Methods: This was a pilot randomized controlled trial conducted at 2 outpatient neurorehabilitation clinics with 3 study groups: clinic+TR, TR-only, and usual care (UC). TR was administered using a web-based application with a mobile app option. One-hour interventions were performed weekly for 4 weeks, in-person for the clinic+TR and UC groups and virtually for the TR-only group. Home exercises were provided on paper for the UC group and via the web-based platform for the clinic+TR and TR-only groups. Feasibility was assessed by recruitment and retention success and patient and therapist satisfaction, as rated in surveys. Clinical outcomes were explored using performance and patient-reported measures in between- and within-group analyses. Results: Of 389 patients screened, 68 (17.5%) met eligibility criteria, and 20 (29.4% of those eligible) were enrolled (clinic+TR, n=6; TR-only, n=6; and UC, n=8). One patient (TR-only) was withdrawn due to a non?study-related injurious fall. Regardless of group allocation, both patients and therapists generally rated the mode of care delivery as ?good? or ?very good? across all constructs assessed, including overall satisfaction and safety. In the analysis of all groups, there were no differences in clinical outcomes at the discharge visit. Within-group differences (from baseline to discharge) were also generally not significant except in the UC group (faster 5-time sit-to-stand time and higher mini balance evaluation systems test balance score) and clinic+TR group (higher mini balance evaluation systems test balance score). Conclusions: High satisfaction amongst patients and clinicians regardless of group, combined with nonsignificant between-group differences in clinical outcomes, suggest that TR is feasible for individuals with PD in early-moderate stages. Future trials with a larger sample are necessary to test clinical effectiveness. As larger trials enroll patients with diverse characteristics (eg, in terms of age, disease progression, caregiver support, technology access and capacity, etc), they could begin to identify opportunities for matching patients to the optimal utilization of TR as part of the therapy episode. Trial Registration: ClinicalTrials.gov NCT06246747; https://clinicaltrials.gov/study/NCT06246747 UR - https://formative.jmir.org/2024/1/e54599 UR - http://dx.doi.org/10.2196/54599 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54599 ER - TY - JOUR AU - Engelsma, Thomas AU - Heijmink, Simone AU - Hendriksen, A. Heleen M. AU - Visser, C. Leonie N. AU - Lemstra, W. Afina AU - Jaspers, M. Monique W. AU - Peute, P. Linda W. PY - 2024/7/31 TI - Capturing Usability Problems for People Living With Dementia by Applying the DEMIGNED Principles in Usability Evaluation Methods: Mixed Methods Study JO - JMIR Hum Factors SP - e54032 VL - 11 KW - dementia KW - design principles KW - digital health KW - memory clinic KW - usability evaluation KW - mobile phone N2 - Background: Dementia-related impairments can cause complex barriers to access, use, and adopt digital health technologies (DHTs). These barriers can contribute to digital health inequities. Therefore, literature-based design principles called DEMIGNED have been developed to support the design and evaluation of DHTs for this rapidly increasing population. Objective: This study aims to apply the DEMIGNED principles in usability evaluation methods to (1) capture usability problems on a mobile website providing information resources for people visiting a memory clinic, including those living with subjective cognitive decline (SCD), mild cognitive impairment (MCI), or dementia, and (2) investigate the realness of usability problems captured by the DEMIGNED principles in expert testing, specifically for mobile websites that act as a means of providing DHTs. Methods: First, a heuristic evaluation was conducted, with the DEMIGNED principles serving as domain-specific guidelines, with 3 double experts (experienced in both usability and dementia) and 2 usability engineering experts. Second, think-aloud sessions were conducted with patients visiting a memory clinic who were living with SCD, MCI, or dementia. Results: The heuristic evaluation resulted in 36 unique usability problems. A representative sample of 7 people visiting a memory clinic participated in a think-aloud session, including 4 (57%) with SCD, 1 (14%) with MCI, and 2 (29%) with dementia. The analysis of the think-aloud sessions revealed 181 encounters with usability problems. Of these encounters, 144 (79.6%) could be mapped to 18 usability problems identified in the heuristic evaluation. The remaining 37 (20.4%) encounters from the user testing revealed another 10 unique usability problems. Usability problems frequently described in the think-aloud sessions encompassed difficulties with using the search function, discrepancies between the user?s expectations and the content organization, the need for scrolling, information overload, and unclear system feedback. Conclusions: By applying the DEMIGNED principles in expert testing, evaluators were able to capture 79.6% (144/181) of all usability problem encounters in the user testing of a mobile website for people visiting a memory clinic, including people living with dementia. Regarding unique usability problems, 50% (18/36) of the unique usability problems identified during the heuristic evaluation were captured by the user-testing sessions. Future research should look into the applicability of the DEMIGNED principles to other digital health functionalities to increase the accessibility of digital health and decrease digital health inequity for this complex and rapidly increasing population. UR - https://humanfactors.jmir.org/2024/1/e54032 UR - http://dx.doi.org/10.2196/54032 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54032 ER - TY - JOUR AU - Chien, Shao-Yun AU - Zaslavsky, Oleg AU - Berridge, Clara PY - 2024/7/3 TI - Technology Usability for People Living With Dementia: Concept Analysis JO - JMIR Aging SP - e51987 VL - 7 KW - usability KW - dementia KW - older adults KW - technology KW - concept analysis KW - mobile phone N2 - Background: Usability is a key indicator of the quality of technology products. In tandem with technological advancements, potential use by individuals with dementia is increasing. However, defining the usability of technology for individuals with dementia remains an ongoing challenge. The diverse and progressive nature of dementia adds complexity to the creation of universal usability criteria, highlighting the need for focused deliberations. Technological interventions offer potential benefits for people living with dementia and caregivers. Amid COVID-19, technology?s role in health care access is growing, especially among older adults. Enabling the diverse population of people living with dementia to enjoy the benefits of technologies requires particular attention to their needs, desires, capabilities, and vulnerabilities to potential harm from technologies. Successful technological interventions for dementia require meticulous consideration of technology usability. Objective: This concept analysis aims to examine the usability of technology in the context of individuals living with dementia to establish a clear definition for usability within this specific demographic. Methods: The framework by Walker and Avant was used to guide this concept analysis. We conducted a literature review spanning 1984 to 2024, exploring technology usability for people with dementia through the PubMed, Web of Science, and Google Scholar databases using the keywords ?technology usability? and ?dementia.? We also incorporated clinical definitions and integrated interview data from 29 dyads comprising individuals with mild Alzheimer dementia and their respective care partners, resulting in a total of 58 older adults. This approach aimed to offer a more comprehensive portrayal of the usability needs of individuals living with dementia, emphasizing practical application. Results: The evidence from the literature review unveiled that usability encompasses attributes such as acceptable learnability, efficiency, and satisfaction. The clinical perspective on dementia stages, subtypes, and symptoms underscores the importance of tailored technology usability assessment. Feedback from 29 dyads also emphasized the value of simplicity, clear navigation, age-sensitive design, personalized features, and audio support. Thus, design should prioritize personalized assistance for individuals living with dementia, moving away from standardized technological approaches. Synthesized from various sources, the defined usability attributes for individuals living with dementia not only encompass the general usability properties of effectiveness, efficiency, and satisfaction but also include other key factors: adaptability, personalization, intuitiveness, and simplicity, to ensure that technology is supportive and yields tangible benefits for this demographic. Conclusions: Usability is crucial for people living with dementia when designing technological interventions. It necessitates an understanding of user characteristics, dementia stages, symptoms, needs, and tasks, as well as consideration of varied physical requirements, potential sensory loss, and age-related changes. Disease progression requires adapting to evolving symptoms. Recommendations include versatile, multifunctional technology designs; accommodating diverse needs; and adjusting software functionalities for personalization. Product feature classification can be flexible based on user conditions. UR - https://aging.jmir.org/2024/1/e51987 UR - http://dx.doi.org/10.2196/51987 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51987 ER - TY - JOUR AU - Greene, Leanne AU - Rahja, Miia AU - Laver, Kate AU - Wong, Vun Vun AU - Leung, Chris AU - Crotty, Maria PY - 2024/6/27 TI - Hospital Staff Perspectives on the Drivers and Challenges in Implementing a Virtual Rehabilitation Ward: Qualitative Study JO - JMIR Aging SP - e54774 VL - 7 KW - gerontology KW - geriatric KW - geriatrics KW - older adult KW - older adults KW - elder KW - elderly KW - older person KW - older people KW - ageing KW - aging KW - aged KW - telerehabilitation KW - rehabilitation KW - rehab KW - workflow KW - hospitalization KW - health services accessibility KW - accessibility KW - clinical decision-making KW - equipment failure KW - telemedicine KW - telehealth KW - tele-medicine KW - tele-health KW - virtual care KW - virtual health KW - virtual medicine KW - remote consultation KW - telephone consultation KW - video consultation KW - remote consultations KW - telephone consultations KW - video consultations KW - personnel KW - hospital N2 - Background: Over the past decade, the adoption of virtual wards has surged. Virtual wards aim to prevent unnecessary hospital admissions, expedite home discharge, and enhance patient satisfaction, which are particularly beneficial for the older adult population who faces risks associated with hospitalization. Consequently, substantial investments are being made in virtual rehabilitation wards (VRWs), despite evidence of varying levels of success in their implementation. However, the facilitators and barriers experienced by virtual ward staff for the rapid implementation of these innovative care models remain poorly understood. Objective: This paper presents insights from hospital staff working on an Australian VRW in response to the growing demand for programs aimed at preventing hospital admissions. We explore staff?s perspectives on the facilitators and barriers of the VRW, shedding light on service setup and delivery. Methods: Qualitative interviews were conducted with 21 VRW staff using the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework. The analysis of data was performed using framework analysis and the 7 domains of the NASSS framework. Results: The results were mapped onto the 7 domains of the NASSS framework. (1) Condition: Managing certain conditions, especially those involving comorbidities and sociocultural factors, can be challenging. (2) Technology: The VRW demonstrated suitability for technologically engaged patients without cognitive impairment, offering advantages in clinical decision-making through remote monitoring and video calls. However, interoperability issues and equipment malfunctions caused staff frustration, highlighting the importance of promptly addressing technical challenges. (3) Value proposition: The VRW empowered patients to choose their care location, extending access to care for rural communities and enabling home-based treatment for older adults. (4) Adopters and (5) organizations: Despite these benefits, the cultural shift from in-person to remote treatment introduced uncertainties in workflows, professional responsibilities, resource allocation, and intake processes. (6) Wider system and (7) embedding: As the service continues to develop to address gaps in hospital capacity, it is imperative to prioritize ongoing adaptation. This includes refining the process of smoothly transferring patients back to the hospital, addressing technical aspects, ensuring seamless continuity of care, and thoughtfully considering how the burden of care may shift to patients and their families. Conclusions: In this qualitative study exploring health care staff?s experience of an innovative VRW, we identified several drivers and challenges to implementation and acceptability. The findings have implications for future services considering implementing VRWs for older adults in terms of service setup and delivery. Future work will focus on assessing patient and carer experiences of the VRW. UR - https://aging.jmir.org/2024/1/e54774 UR - http://dx.doi.org/10.2196/54774 ID - info:doi/10.2196/54774 ER - TY - JOUR AU - Palmier, Cécilia AU - Rigaud, Anne-Sophie AU - Ogawa, Toshimi AU - Wieching, Rainer AU - Dacunha, Sébastien AU - Barbarossa, Federico AU - Stara, Vera AU - Bevilacqua, Roberta AU - Pino, Maribel PY - 2024/6/18 TI - Identification of Ethical Issues and Practice Recommendations Regarding the Use of Robotic Coaching Solutions for Older Adults: Narrative Review JO - J Med Internet Res SP - e48126 VL - 26 KW - robotic coaching solutions KW - ethical issues KW - ethical recommendations KW - older adults KW - geriatrics KW - guidelines N2 - Background: Technological advances in robotics, artificial intelligence, cognitive algorithms, and internet-based coaches have contributed to the development of devices capable of responding to some of the challenges resulting from demographic aging. Numerous studies have explored the use of robotic coaching solutions (RCSs) for supporting healthy behaviors in older adults and have shown their benefits regarding the quality of life and functional independence of older adults at home. However, the use of RCSs by individuals who are potentially vulnerable raises many ethical questions. Establishing an ethical framework to guide the development, use, and evaluation practices regarding RCSs for older adults seems highly pertinent. Objective: The objective of this paper was to highlight the ethical issues related to the use of RCSs for health care purposes among older adults and draft recommendations for researchers and health care professionals interested in using RCSs for older adults. Methods: We conducted a narrative review of the literature to identify publications including an analysis of the ethical dimension and recommendations regarding the use of RCSs for older adults. We used a qualitative analysis methodology inspired by a Health Technology Assessment model. We included all article types such as theoretical papers, research studies, and reviews dealing with ethical issues or recommendations for the implementation of these RCSs in a general population, particularly among older adults, in the health care sector and published after 2011 in either English or French. The review was performed between August and December 2021 using the PubMed, CINAHL, Embase, Scopus, Web of Science, IEEE Explore, SpringerLink, and PsycINFO databases. Selected publications were analyzed using the European Network of Health Technology Assessment Core Model (version 3.0) around 5 ethical topics: benefit-harm balance, autonomy, privacy, justice and equity, and legislation. Results: In the 25 publications analyzed, the most cited ethical concerns were the risk of accidents, lack of reliability, loss of control, risk of deception, risk of social isolation, data confidentiality, and liability in case of safety problems. Recommendations included collecting the opinion of target users, collecting their consent, and training professionals in the use of RCSs. Proper data management, anonymization, and encryption appeared to be essential to protect RCS users? personal data. Conclusions: Our analysis supports the interest in using RCSs for older adults because of their potential contribution to individuals? quality of life and well-being. This analysis highlights many ethical issues linked to the use of RCSs for health-related goals. Future studies should consider the organizational consequences of the implementation of RCSs and the influence of cultural and socioeconomic specificities of the context of experimentation. We suggest implementing a scalable ethical and regulatory framework to accompany the development and implementation of RCSs for various aspects related to the technology, individual, or legal aspects. UR - https://www.jmir.org/2024/1/e48126 UR - http://dx.doi.org/10.2196/48126 UR - http://www.ncbi.nlm.nih.gov/pubmed/38888953 ID - info:doi/10.2196/48126 ER - TY - JOUR AU - Goerss, Doreen AU - Köhler, Stefanie AU - Rong, Eleonora AU - Temp, Gesine Anna AU - Kilimann, Ingo AU - Bieber, Gerald AU - Teipel, Stefan PY - 2024/6/7 TI - Smartwatch-Based Interventions for People With Dementia: User-Centered Design Approach JO - JMIR Aging SP - e50107 VL - 7 KW - assistive technology KW - user-centered design KW - usability KW - dementia KW - smartwatch KW - mobile phone N2 - Background: Assistive technologies can help people living with dementia maintain their everyday activities. Nevertheless, there is a gap between the potential and use of these materials. Involving future users may help close this gap, but the impact on people with dementia is unclear. Objective: We aimed to determine if user-centered development of smartwatch-based interventions together with people with dementia is feasible. In addition, we evaluated the extent to which user feedback is plausible and therefore helpful for technological improvements. Methods: We examined the interactions between smartwatches and people with dementia or people with mild cognitive impairment. All participants were prompted to complete 2 tasks (drinking water and a specific cognitive task). Prompts were triggered using a smartphone as a remote control and were repeated up to 3 times if participants failed to complete a task. Overall, 50% (20/40) of the participants received regular prompts, and 50% (20/40) received intensive audiovisual prompts to perform everyday tasks. Participants? reactions were observed remotely via cameras. User feedback was captured via questionnaires, which included topics like usability, design, usefulness, and concerns. The internal consistency of the subscales was calculated. Plausibility was also checked using qualitative approaches. Results: Participants noted their preferences for particular functions and improvements. Patients struggled with rating using the Likert scale; therefore, we assisted them with completing the questionnaire. Usability (mean 78 out of 100, SD 15.22) and usefulness (mean 9 out of 12) were rated high. The smartwatch design was appealing to most participants (31/40, 76%). Only a few participants (6/40, 15%) were concerned about using the watch. Better usability was associated with better cognition. The observed success and self-rated task comprehension were in agreement for most participants (32/40, 80%). In different qualitative analyses, participants? responses were, in most cases, plausible. Only 8% (3/40) of the participants were completely unaware of their irregular task performance. Conclusions: People with dementia can have positive experiences with smartwatches. Most people with dementia provided valuable information. Developing assistive technologies together with people with dementia can help to prioritize the future development of functional and nonfunctional features. UR - https://aging.jmir.org/2024/1/e50107 UR - http://dx.doi.org/10.2196/50107 UR - http://www.ncbi.nlm.nih.gov/pubmed/38848116 ID - info:doi/10.2196/50107 ER - TY - JOUR AU - Cohen Elimelech, Ortal AU - Rosenblum, Sara AU - Tsadok-Cohen, Michal AU - Meyer, Sonya AU - Ferrante, Simona AU - Demeter, Naor PY - 2024/5/30 TI - Three Perspectives on Older Adults? Daily Performance, Health, and Technology Use During COVID-19: Focus Group Study JO - JMIR Aging SP - e53141 VL - 7 KW - daily activity KW - health KW - technology use KW - older adult KW - qualitative study KW - focus group KW - COVID-19 N2 - Background: During COVID-19 lockdowns, older adults? engagement in daily activities was severely affected, causing negative physical and mental health implications. Technology flourished as a means of performing daily activities in this complex situation; however, older adults often struggled to effectively use these opportunities. Despite the important role of older adults? social environments?including their families and health professionals?in influencing their technology use, research into their unique perspectives is lacking. Objective: This study aimed to explore the daily activity performance, health, and technology use experiences of healthy independent Israeli adults (aged ?65 years) during COVID-19 from a 3-dimensional perspective: older adults, older adults? family members, and health professionals. Methods: Nine online focus groups, averaging 6-7 participants per group, were conducted with older adults, family members, and health professionals (N=59). Data were analyzed using thematic analysis and constant comparative methods. Results: The intertwining of daily activity performance and health emerged as a central theme, with differences between the groups. Older adults prioritized their self-fulfilling routines based on motivation and choice, especially in social-familial activities. In contrast, family members and health professionals focused on serious physical and mental health COVID-19?related consequences. A consensus among all three groups revealed the meaningful role of technology use during this period in bridging functional limitations. Participants delved into technology?s transformative power, focusing on the need for technology to get engaged in daily activities. Conclusions: This study illustrates the profound interplay between daily activity performances, physical and mental health, and technology use, using a 3-dimensional approach. Its focus on technology?s uses and benefits sheds light on what older adults need to increase their technology use. Interventions for improving digital activity performance can be tailored to meet older adults? needs and preferences by focusing on motivational and preference-related activities. UR - https://aging.jmir.org/2024/1/e53141 UR - http://dx.doi.org/10.2196/53141 ID - info:doi/10.2196/53141 ER - TY - JOUR AU - Murabito, M. Joanne AU - Faro, M. Jamie AU - Zhang, Yuankai AU - DeMalia, Angelo AU - Hamel, Alexander AU - Agyapong, Nakesha AU - Liu, Hongshan AU - Schramm, Eric AU - McManus, D. David AU - Borrelli, Belinda PY - 2024/5/30 TI - Smartphone App Designed to Collect Health Information in Older Adults: Usability Study JO - JMIR Hum Factors SP - e56653 VL - 11 KW - mobile application surveys KW - mixed methods KW - electronic data collection KW - mHealth KW - mobile health KW - mobile application KW - mobile applications KW - app KW - apps KW - application KW - applications KW - digital health KW - digital technology KW - digital intervention KW - digital interventions KW - smartphone KW - smartphones KW - usability KW - usable KW - usableness KW - usefulness KW - utility KW - health information N2 - Background: Studies evaluating the usability of mobile-phone assessments in older adults are limited. Objective: This study aims to identify design-based barriers and facilitators to mobile app survey completion among 2 samples of older adults; those in the Framingham Heart Study and a more diverse sample from a hospital-based setting. Methods: We used mixed methods to identify challenging and beneficial features of the mobile app in participants from the electronic Framingham Heart Study (n=15; mean age of 72 years; 6/15, 40% women; 15/15, 100% non-Hispanic and White) and among participants recruited from a hospital-based setting (n=15; mean age of 71 years; 7/15, 47% women; 3/15, 20% Hispanic; and 8/15, 53% non-White). A variety of app-based measures with different response formats were tested, including self-reported surveys, pictorial assessments (to indicate body pain sites), and cognitive testing tasks (eg, Trail Making Test and Stroop). Participants completed each measure using a think-aloud protocol, while being audio- and video-recorded with a qualitative interview conducted at the end of the session. Recordings were coded for participant usability errors by 2 pairs of coders. Participants completed the Mobile App Rating Scale to assess the app (response range 1=inadequate to 5=excellent). Results: In electronic Framingham Heart Study participants, the average total Mobile App Rating Scale score was 7.6 (SD 1.1), with no significant differences in the hospital-based sample. In general, participants were pleased with the app and found it easy to use. A large minority had at least 1 navigational issue, most committed only once. Most older adults did not have difficulty completing the self-reported multiple-choice measures unless it included lengthy instructions but participants had usability issues with the Stroop and Trail Making Test. Conclusions: Our methods and results help guide app development and app-based survey construction for older adults, while also giving consideration to sociodemographic differences. UR - https://humanfactors.jmir.org/2024/1/e56653 UR - http://dx.doi.org/10.2196/56653 UR - http://www.ncbi.nlm.nih.gov/pubmed/38815261 ID - info:doi/10.2196/56653 ER - TY - JOUR AU - Glenn, Jordan AU - Sarmadi, Parmoon AU - Cristman, Paul AU - Kim, Gabrielle AU - Lin, Ting-Hsuan AU - Kashyap, Vikram PY - 2024/5/27 TI - Using the TrueLoo Smart Device to Record Toileting Sessions in Older Adults: Retrospective Validation and Acceptance Study JO - JMIR Aging SP - e50856 VL - 7 KW - activities of daily living KW - toileting habits KW - bowel movements KW - elder care KW - smart toileting KW - monitoring technology N2 - Background: Because of the relationship between independent living and activities of daily living, care teams spend significant time managing assisted living residents? toileting problems. Recently, the TrueLoo was developed as a connected toilet seat to automatically log and monitor toileting sessions. Objective: This study aimed to demonstrate the validity of the TrueLoo to (1) record and identify toileting sessions with regard to stool and urine events; (2) compare the results with the person-reported, standard-of-care methods; and (3) establish metrics of user acceptability and ease of use in a assisted living facility population. Methods: We used two phases: (1) initial development of the TrueLoo algorithms to accurately identify urine and stool events and (2) evaluation of the algorithms against person-reported, standard-of-care methods commonly used in assisted living facilities. Phase 2 analyzed data over a 3-day period from 52 devices. Participants? age ranged from 63 to 101 (mean 84, SD 9.35) years. Acceptability and ease-of-use data were also collected. Results: Regarding the development of the TrueLoo algorithm for urine assessment, sensitivity and specificity of 96% and 85% were observed when evaluating a gold-standard labeled data set, respectively (F1-score=0.95). For stool, sensitivity and specificity of 90% and 79% were observed, respectively (F1-score=0.85). Regarding the TrueLoo algorithm in assisted living settings, classification performance statistics for urine assessment revealed sensitivity and specificity of 84% and 94%, respectively (F1-score=0.90), and for stool, 92% and 98%, respectively (F1-score=0.91). Throughout the study, 46 person-reported instances of urine were documented, compared with 630 recorded by the TrueLoo. For stool events, 116 person-reported events were reported, compared with 153 by the TrueLoo. This indicates that person-reported events were captured 7% (46/630) of the time for urine and 76% (116/153) of the time for stool. Overall, 45% (32/71) of participants said that the new toilet seat was better than their previous one, 84% (60/71) reported that using the TrueLoo was easy, and 99% (69/71) said that they believed the system could help aging adults. Over 98% (69/71) of participants reported that they would find alerts related to their health valuable and would be willing to share this information with their doctor. When asked about sharing information with caregivers, 66% (46/71) reported that they would prefer the TrueLoo to send information and alerts to their caregiver, as opposed to the participant having to personally communicate those details. Conclusions: The TrueLoo accurately recorded toileting sessions compared with standard-of-care methods, successfully establishing metrics of user acceptability and ease of use in assisted living populations. While additional validation studies are warranted, data presented in this paper support the use of the TrueLoo in assisted living settings as a model of event monitoring during toileting. UR - https://aging.jmir.org/2024/1/e50856 UR - http://dx.doi.org/10.2196/50856 UR - http://www.ncbi.nlm.nih.gov/pubmed/38801659 ID - info:doi/10.2196/50856 ER - TY - JOUR AU - Lemos, Marta AU - Henriques, Rita Ana AU - Lopes, Gil David AU - Mendonça, Nuno AU - Victorino, André AU - Costa, Andreia AU - Arriaga, Miguel AU - Gregório, Joăo Maria AU - de Sousa, Rute AU - Canhăo, Helena AU - Rodrigues, M. Ana PY - 2024/5/17 TI - Usability and Utility of a Mobile App to Deliver Health-Related Content to an Older Adult Population: Pilot Noncontrolled Quasi-Experimental Study JO - JMIR Form Res SP - e46151 VL - 8 KW - DigiAdherence KW - mHealth KW - mobile app KW - technology KW - utility KW - usability KW - ICT KW - application KW - patient-centered KW - tool KW - prevention KW - falls KW - treatment KW - nutrition KW - physical activity KW - pilot study KW - older adults KW - adherence KW - engagement KW - compliance N2 - Background: Digital patient-centered interventions may be important tools for improving and promoting social interaction, health, and well-being among older adults. In this regard, we developed a mobile app called DigiAdherence for an older adult population, which consisted of easy-to-access short videos and messages, to improve health-related knowledge among them and prevent common health conditions, such as falls, polypharmacy, treatment adherence, nutritional problems, and physical inactivity. Objective: This study aimed to assess the usability and utility of the DigiAdherence app among Portuguese older adults 65 years or older. Methods: In this pilot noncontrolled quasi-experimental study, older adults who were patients at the primary health care center in Portimăo, Portugal, and owned a smartphone or tablet were recruited. Participants were assessed at baseline, given access to the DigiAdherence app for 1 month, and assessed again immediately after 30 days (first assessment) and 60 days after stopping the use of the app (second assessment). App usability and utility (primary outcomes) were analyzed in the first follow-up assessment using a structured questionnaire with 8 items. In the second follow-up assessment, our focus was on knowledge acquired through the app. Secondary outcomes such as treatment adherence and health-related quality of life were also assessed. Results: The study included 26 older adults. Most participants rated the different functionalities of the app positively and perceived the app as useful, attractive, and user-friendly (median score of 6 on a 7-point Likert scale). In addition, after follow-up, participants reported having a sense of security and greater knowledge in preventing falls (16/24, 67%) and managing therapies and polypharmacy (16/26, 62%). Conclusions: The DigiAdherence mobile app was useful and highly accepted by older adults, who developed more confidence regarding health-related knowledge. International Registered Report Identifier (IRRID): RR2-10.2196/29675 UR - https://formative.jmir.org/2024/1/e46151 UR - http://dx.doi.org/10.2196/46151 UR - http://www.ncbi.nlm.nih.gov/pubmed/38758585 ID - info:doi/10.2196/46151 ER - TY - JOUR AU - Shashidhara, N. Y. AU - Raghavendra, G. AU - P Kundapur, Poornima AU - Binil, V. PY - 2024/5/13 TI - Effectiveness of Gerontechnology Empowerment Program on Awareness and Use of Mobile Apps Among Older Adults for Instrumental Activities of Daily Living: Protocol for a Cluster Randomized Controlled Trial JO - JMIR Res Protoc SP - e53587 VL - 13 KW - gerontechnology KW - older adults KW - awareness KW - older people KW - instrumental activities of daily living KW - iADLs KW - mobile apps KW - mobile phone KW - empowerment N2 - Background: Instrumental activities of daily living (iADLs) are crucial for older adults to live independently. Health care and technological advancements will increase the older adult population and life expectancy globally. Difficulties with iADLs impact older adults? quality of life. Mobile apps can assist older adults, but many require help due to limited awareness. Lack of awareness is a barrier to app use. Existing literature mainly covers health care and app design, needing more focus on iADL apps for older adults. Objective: The study objectives encompass 2 main aspects: first, to evaluate the awareness, use, and factors influencing the use of apps among older adults for iADLs; and second, to create and assess the effectiveness of a gerontechnology empowerment program (GEP) for older adults on the awareness and use of apps for iADLs. Methods: This research uses a quantitative approach divided into 2 distinct phases. In phase 1, we conduct a descriptive survey to assess the level of awareness and use of mobile apps for iADLs and identify the factors that influence the use of such apps among older adults. To ensure clarity and comprehension among participants, we provide them with a subject information sheet in both Kannada and English. The data collected during this phase enable us to gain insights into awareness levels, use patterns, and factors that shape older adults? use of apps for iADLs. The results serve as the foundation for designing the GEP. In phase 2, a cluster randomization method will be used to select older adults aged 60 to 75 years in Udupi district, Karnataka, India, who are active smartphone users. These participants will be divided into 2 groups: the experimental and the control groups. The experimental group will join the GEP. The sample size for phase 1 is 554, and phase 2 is 50. To assess the effectiveness of this program, we will measure the outcomes before and after its implementation using the same assessment tools used in phase 1. Results: This study is funded by the Indian Council of Medical Research (Adhoc/193/2022/SBHSR on November 18, 2022). Phase 1 data collection is expected to be completed by November 2023, and phase 2 is scheduled to commence in the upcoming months. Phase 1 and 2 findings will be analyzed and discussed in the main paper, which we intend to submit to a high-quality peer-reviewed journal for publication. The research protocol, informed consent forms, and associated documentation received approval from institutional ethics committees (214/2020). Conclusions: Upon the successful testing of the GEP, it can be recommended that welfare departments encourage older adults to use mobile apps for iADLs and establish training programs to provide support to older adults in using these apps. Trial Registration: Clinical Trials Registry - India CTRI/2020/09/027977; https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=NDUxMzM=&Enc=&userName=027977 International Registered Report Identifier (IRRID): DERR1-10.2196/53587 UR - https://www.researchprotocols.org/2024/1/e53587 UR - http://dx.doi.org/10.2196/53587 UR - http://www.ncbi.nlm.nih.gov/pubmed/38739442 ID - info:doi/10.2196/53587 ER - TY - JOUR AU - Sien, Sang-Wha AU - Kobekyaa, Kyerepagr Francis AU - Puts, Martine AU - Currie, Leanne AU - Tompson, Margaret AU - Hedges, Penelope AU - McGrenere, Joanna AU - Mariano, Caroline AU - Haase, R. Kristen PY - 2024/5/8 TI - Tailored Self-Management App to Support Older Adults With Cancer and Multimorbidity: Development and Usability Testing JO - JMIR Aging SP - e53163 VL - 7 KW - cancer KW - aging KW - self-management KW - usability testing KW - design thinking KW - design KW - oncology KW - develop KW - development KW - usability KW - gerontology KW - geriatric KW - geriatrics KW - older adult KW - older adults KW - elder KW - elderly KW - older person KW - older people KW - ageing KW - mHealth KW - mobile health KW - app KW - apps KW - application KW - applications KW - symptom KW - symptoms KW - comorbidity KW - comorbidities KW - comorbid KW - multimorbidity KW - multimorbidities KW - co-design N2 - Background: Globally, cancer predominates in adults aged older than 60 years, and 70% of older adults have ?1 chronic condition. Cancer self-management interventions can improve symptom management and confidence, but few interventions target the complex needs of older adults with cancer and multimorbidity. Despite growing evidence of digital health tools in cancer care, there is a paucity of theoretically grounded digital self-management supports for older adults. Many apps for older adults have not been co-designed with older adults to ensure that they are tailored to their specific needs, which would increase usability and uptake. Objective: We aim to report on the user evaluations of a self- and symptom-management app to support older adults living with cancer and multimorbidity. Methods: This study used Grey?s self-management framework, a design thinking approach, and involved older adults with lived experiences of cancer to design a medium-fidelity app prototype. Older adults with cancer or caregivers were recruited through community organizations or support groups to participate in co-designing or evaluations of the app. Data from interviews were iteratively integrated into the design process and analyzed using descriptive statistics and thematic analyses. Results: In total, 15 older adults and 3 caregivers (n=18) participated in this study: 10 participated (8 older adults and 2 caregivers) in the design of the low-fidelity prototype, and 10 evaluated (9 older adults and 1 caregiver) the medium-fidelity prototype (2 older adults participated in both phases). Participants emphasized the importance of tracking functions to make sense of information across physical symptoms and psychosocial aspects; a clear display; and the organization of notes and reminders to communicate with care providers. Participants also emphasized the importance of medication initiation or cessation reminders to mitigate concerns related to polypharmacy. Conclusions: This app has the potential to support the complex health care needs of older adults with cancer, creating a ?home base? for symptom management and support. The findings from this study will position the researchers to conduct feasibility testing and real-world implementation. UR - https://aging.jmir.org/2024/1/e53163 UR - http://dx.doi.org/10.2196/53163 UR - http://www.ncbi.nlm.nih.gov/pubmed/38717806 ID - info:doi/10.2196/53163 ER - TY - JOUR AU - Boudreau, Hannah Jacqueline AU - Moo, R. Lauren AU - Kennedy, A. Meaghan AU - Conti, Jennifer AU - Anwar, Chitra AU - Pimentel, B. Camilla AU - Nearing, A. Kathryn AU - Hung, W. William AU - Dryden, M. Eileen PY - 2024/5/7 TI - Needs for Successful Engagement in Telemedicine Among Rural Older US Veterans and Their Caregivers: Qualitative Study JO - JMIR Form Res SP - e50507 VL - 8 KW - caregivers KW - geriatrics KW - older adults KW - rural veterans KW - rural KW - specialty care KW - telehealth KW - telemedicine KW - veterans N2 - Background: Telemedicine is an important option for rural older adults who often must travel far distances to clinics or forgo essential care. In 2014, the Geriatric Research, Education, and Clinical Centers (GRECC) of the US Veterans Health Administration (VA) established a national telemedicine network called GRECC Connect. This network increased access to geriatric specialty care for the 1.4 million rural VA-enrolled veterans aged 65 years or older. The use of telemedicine skyrocketed during the COVID-19 pandemic, which disproportionately impacted older adults, exacerbating disparities in specialty care access as overburdened systems shut down in-person services. This surge presented a unique opportunity to study the supports necessary for those who would forgo telemedicine if in-person care were available. Objective: In spring 2021, we interviewed veterans and their informal caregivers to (1) elicit their experiences attempting to prepare for a video visit with a GRECC Connect geriatric specialist and (2) explore facilitators and barriers to successful engagement in a telemedicine visit. Methods: We conducted a cross-sectional qualitative evaluation with patients and their caregivers who agreed to participate in at least 1 GRECC Connect telemedicine visit in the previous 3 months. A total of 30 participants from 6 geographically diverse GRECC Connect hub sites agreed to participate. Semistructured interviews were conducted through telephone or the VA?s videoconference platform for home telemedicine visits (VA Video Connect) per participant preference. We observed challenges and, when needed, provided real-time technical support to facilitate VA Video Connect use for interviews. All interviews were recorded with permission and professionally transcribed. A team of 5 researchers experienced in qualitative research analyzed interview transcripts using rapid qualitative analysis. Results: From 30 participant interviews, we identified the following 4 categories of supports participants described regarding successful engagement in telemedicine, as defined by visit completion, satisfaction, and willingness to engage in telemedicine in the future: (1) caregiver presence to facilitate technology setup and communication; (2) flexibility in visit modality (eg, video from home or a clinic or telephone); (3) technology support (eg, determining device compatibility or providing instruction and on-demand assistance); and (4) assurance of comfort with web-based communication, including orientation to features like closed captioning. Supports were needed at multiple points before the visit, and participants stressed the importance of eliciting the varying needs and preferences of each patient-caregiver dyad. Though many initially agreed to a telemedicine visit because of pandemic-related clinic closures, participants were satisfied with telemedicine and willing to use it for other types of health care visits. Conclusions: To close gaps in telemedicine use among rural older adults, supports must be tailored to individuals, accounting for technology availability and comfort, as well as availability of and need for caregiver involvement. Comprehensive scaffolding of support starts well before the first telemedicine visit. UR - https://formative.jmir.org/2024/1/e50507 UR - http://dx.doi.org/10.2196/50507 UR - http://www.ncbi.nlm.nih.gov/pubmed/38713503 ID - info:doi/10.2196/50507 ER - TY - JOUR AU - Roberts, Lynae R. AU - Cherry, D. Katelin AU - Mohan, P. Desh AU - Statler, Tiffany AU - Kirkendall, Eric AU - Moses, Adam AU - McCraw, Jennifer AU - Brown III, E. Andrew AU - Fofanova, Y. Tatiana AU - Gabbard, Jennifer PY - 2024/5/6 TI - A Personalized and Interactive Web-Based Advance Care Planning Intervention for Older Adults (Koda Health): Pilot Feasibility Study JO - JMIR Aging SP - e54128 VL - 7 KW - advance care planning KW - ACP KW - digital health tools KW - system usability KW - gerontology KW - geriatric KW - geriatrics KW - older adult KW - older adults KW - elder KW - elderly KW - older person KW - older people KW - ageing KW - aging KW - adoption KW - acceptance KW - usability KW - digital health KW - platform KW - website KW - websites N2 - Background: Advance care planning (ACP) is a process that involves patients expressing their personal goals, values, and future medical care preferences. Digital applications may help facilitate this process, though their use in older adults has not been adequately studied. Objective: This pilot study aimed to evaluate the reach, adoption, and usability of Koda Health, a web-based patient-facing ACP platform, among older adults. Methods: Older adults (aged 50 years and older) who had an active Epic MyChart account at an academic health care system in North Carolina were recruited to participate. A total of 2850 electronic invitations were sent through MyChart accounts with an embedded hyperlink to the Koda platform. Participants who agreed to participate were asked to complete pre- and posttest surveys before and after navigating through the Koda Health platform. Primary outcomes were reach, adoption, and System Usability Scale (SUS) scores. Exploratory outcomes included ACP knowledge and readiness. Results: A total of 161 participants enrolled in the study and created an account on the platform (age: mean 63, SD 9.3 years), with 80% (129/161) of these participants going on to complete all steps of the intervention, thereby generating an advance directive. Participants reported minimal difficulty in using the Koda platform, with an overall SUS score of 76.2. Additionally, knowledge of ACP (eg, mean increase from 3.2 to 4.2 on 5-point scale; P<.001) and readiness (eg, mean increase from 2.6 to 3.2 on readiness to discuss ACP with health care provider; P<.001) significantly increased from before to after the intervention. Conclusions: This study demonstrated that the Koda Health platform is feasible, had above-average usability, and improved ACP documentation of preferences in older adults. Our findings indicate that web-based health tools like Koda may help older individuals learn about and feel more comfortable with ACP while potentially facilitating greater engagement in care planning. UR - https://aging.jmir.org/2024/1/e54128 UR - http://dx.doi.org/10.2196/54128 ID - info:doi/10.2196/54128 ER - TY - JOUR AU - Lee, Shinduk AU - Ory, G. Marcia AU - Vollmer Dahlke, Deborah AU - Smith, Lee Matthew PY - 2024/5/1 TI - Technology Use Among Older Adults and Their Caregivers: Cross-Sectional Survey Study JO - JMIR Aging SP - e50759 VL - 7 KW - technology KW - caregiving KW - social determinants of health KW - health disparities KW - disparity KW - disparities KW - caregiver KW - caregivers KW - carers KW - technology use KW - usage KW - gerontology KW - geriatric KW - geriatrics KW - older adult KW - older adults KW - elder KW - elderly KW - older person KW - older people KW - ageing KW - aging KW - cross-sectional KW - survey KW - surveys KW - computer use KW - device KW - devices KW - adoption KW - dyad KW - dyads N2 - Background: Informal caregivers are called upon to provide substantial care, but more needs to be known about technology use among older adult and caregiver dyads. Objective: This study described technology use among older adults and their caregivers, explored potential correlates of technology use, and highlighted implications for practice. Methods: A cross-sectional survey was conducted among unpaid caregivers of older adults (n=486). Primary outcomes were self-reported technology (devices and functions) use among caregivers and their oldest care recipient. The concordance of technology use among caregivers and care recipients was also examined. Multivariable regression models were conducted separately for caregivers and care recipients. Results: Greater proportions of caregivers used all examined technologies, except for the medication alerts or tracking function, than care recipients. Caregivers used an average of 3.4 devices and 4.2 functions, compared to 1.8 devices and 1.6 functions used by their care recipients. Among caregivers, younger age, higher income, and higher education were associated with more technology use (P<.05). Among care recipients, younger age, not having cognitive dysfunction, and caregiver?s technology use were associated with more technology use (P<.05). Conclusions: Understanding technology use patterns and device adoption across diverse caregiver and care recipient populations is increasingly important for enhancing geriatric care. Findings can guide recommendations about appropriate technology interventions and help providers communicate and share information more effectively with patients and their caregivers. UR - https://aging.jmir.org/2024/1/e50759 UR - http://dx.doi.org/10.2196/50759 ID - info:doi/10.2196/50759 ER - TY - JOUR AU - Lee, J. Edmund W. AU - Tan, W. Warrick AU - Pham, Phat Ben Tan AU - Kawaja, Ariffin AU - Theng, Yin-Leng PY - 2024/4/24 TI - Addressing Data Absenteeism and Technology Chauvinism in the Use of Gamified Wearable Gloves Among Older Adults: Moderated Usability Study JO - JMIR Serious Games SP - e47600 VL - 12 KW - wearables KW - exergames KW - older adults KW - active aging KW - rehabilitation KW - stroke N2 - Background: Digital health technologies have the potential to improve health outcomes for older adults, especially for those recovering from stroke. However, there are challenges to developing these technologies, such as data absenteeism (where older adults? views are often underrepresented in research and development) and technology chauvinism (the belief that sophisticated technology alone is the panacea to addressing health problems), which hinder their effectiveness. Objective: In this study, we aimed to address these challenges by developing a wearable glove integrated with culturally relevant exergames to motivate older adults to exercise and, for those recovering from stroke, to adhere to rehabilitation. Methods: We conducted a moderated usability study with 19 older adults, of which 11 (58%) had a history of stroke. Our participants engaged in a 30-minute gameplay session with the wearable glove integrated with exergames, followed by a quantitative survey and an in-depth interview. We used descriptive analysis to compare responses to the System Usability Scale between those who had a history of stroke and those who did not. In addition, we analyzed the qualitative interviews using a bottom-up thematic analysis to identify key themes related to the motivations and barriers regarding the use of wearable gloves for rehabilitation and exercise. Results: Our study generated several key insights. First, making the exergames exciting and challenging could improve exercise and rehabilitation motivation, but it could also have a boomerang effect, where participants may become demotivated if the games were very challenging. Second, the comfort and ease of use of the wearable gloves were important for older adults, regardless of their stroke history. Third, for older adults with a history of stroke, the functionality and purpose of the wearable glove were important in helping them with specific exercise movements. Conclusions: Our findings highlight the importance of providing contextual support for the effective use of digital technologies, particularly for older adults recovering from stroke. In addition to technology and usability factors, other contextual factors such as gamification and social support (from occupational therapists or caregivers) should be considered to provide a comprehensive approach to addressing health problems. To overcome data absenteeism and technology chauvinism, it is important to develop digital health technologies that are tailored to the needs of underserved communities. Our study provides valuable insights for the development of digital health technologies that can motivate older adults recovering from stroke to exercise and adhere to rehabilitation. UR - https://games.jmir.org/2024/1/e47600 UR - http://dx.doi.org/10.2196/47600 UR - http://www.ncbi.nlm.nih.gov/pubmed/38656778 ID - info:doi/10.2196/47600 ER - TY - JOUR AU - Bults, Marloes AU - van Leersum, Margaretha Catharina AU - Olthuis, Josef Theodorus Johannes AU - Siebrand, Egbert AU - Malik, Zohrah AU - Liu, Lili AU - Miguel-Cruz, Antonio AU - Jukema, Seerp Jan AU - den Ouden, Maria Marjolein Elisabeth PY - 2024/4/19 TI - Acceptance of a Digital Assistant (Anne4Care) for Older Adult Immigrants Living With Dementia: Qualitative Descriptive Study JO - JMIR Aging SP - e50219 VL - 7 KW - assistive technology KW - technology acceptance KW - immigrant KW - dementia KW - marginalized older adults N2 - Background: There is a need to develop and coordinate dementia care plans that use assistive technology for vulnerable groups such as immigrant populations. However, immigrant populations are seldom included in various stages of the development and implementation of assistive technology, which does not optimize technology acceptance. Objective: This study aims to gain an in-depth understanding of the acceptance of a digital personal assistant, called Anne4Care, by older adult immigrants living with dementia in their own homes. Methods: This study used a qualitative descriptive research design with naturalistic inquiry. A total of 13 older adults participated in this study. The participants were invited for 2 interviews. After an introduction of Anne4Care, the first interview examined the lives and needs of participants, their expectations, and previous experiences with assistive technology in daily life. Four months later, the second interview sought to understand facilitators and barriers, suggestions for modifications, and the role of health care professionals. Three semistructured interviews were conducted with health care professionals to examine the roles and challenges they experienced in the use and implementation of Anne4Care. Content analysis, using NVivo11, was performed on all transcripts. Results: All 13 participants had an immigration background. There were 10 male and 3 female participants, with ages ranging from 52 to 83 years. Participants were diagnosed with an early-stage form of dementia or acquired brain injury. None of the older adult participants knew or used digital assistive technology at the beginning. They obtained assistance from health care professionals and family caregivers who explained and set up the technology. Four themes were found to be critical aspects of the acceptance of the digital personal assistant Anne4Care: (1) use of Anne4Care, (2) positive aspects of Anne4Care, (3) challenges with Anne4Care, and (4) expectations. Assistance at first increased the burden on health care professionals and families. After the initial effort, most health care professionals and families experienced that Anne4Care reduced their tasks and stress. Contributions of Anne4Care included companionship, help with daily tasks, and opportunities to communicate in multiple languages. On the other hand, some participants expressed anxiety toward the use of Anne4Care. Furthermore, the platform required an internet connection at home and Anne4Care could not be used outside the home. Conclusions: Although older adult immigrants living with dementia had no previous experience with digital assistive technology specifically, the acceptance of the digital personal assistant, called Anne4Care, by older adult immigrants living with dementia was rather high. The digital assistant can be further developed to allow for interactive conversations and for use outside of one?s home. Participation of end users during various stages of the development, refinement, and implementation of health technology innovations is of utmost importance to maximize technology acceptance. UR - https://aging.jmir.org/2024/1/e50219 UR - http://dx.doi.org/10.2196/50219 UR - http://www.ncbi.nlm.nih.gov/pubmed/38639994 ID - info:doi/10.2196/50219 ER - TY - JOUR AU - Jabin, Rahman Md Shafiqur AU - Samuriwo, Ray AU - Chilaka, Marcus AU - Yaroson, Vann Emilia PY - 2024/4/18 TI - Effectiveness and Experiences of Quality Improvement Interventions in Older Adult Care: Protocol for a Mixed Methods Systematic Review JO - JMIR Res Protoc SP - e56346 VL - 13 KW - patient safety KW - acceptability KW - accessibility KW - appropriateness KW - timeliness KW - equitability KW - social care N2 - Background: Quality improvement (QI) interventions are designed to resolve the recurring challenges of care for older individuals, such as working conditions for staff, roles of older individuals in their own care and their families, and relevant stakeholders. Therefore, there is a need to map the impacts of QI interventions in older adult care settings and further improve health and social care systems associated with older adults. Objective: This review aims to compile and synthesize the best available evidence regarding the effectiveness of policy and practice QI interventions in older adult care. The secondary aim is to understand the care of older individuals and QI intervention-related experiences and perspectives of stakeholders, care providers, older individuals, and their families. Methods: The mixed methods review will follow the standard methodology used by Joanna Briggs Institute. The published studies will be searched through CINAHL, MEDLINE, PsycINFO, ASSIA, and Web of Science, and the unpublished studies through Mednar, Trove, OCLC WorldCat, and Dissertations and Theses. This review included both qualitative and quantitative analyses of patients undergoing older adult care and any health and care professionals involved in the care delivery for older adults; a broad range of QI interventions, including assistive technologies, effects of training and education, improved reporting, safety programs, and medical devices; the experiences and perspectives of staff and patients; the context of older adult care setting; and a broad range of outcomes, including patient safety. The standard procedure for reporting, that is, PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, will be followed. Results: A result-based convergent synthesis design will be used in which both quantitative and qualitative studies will be analyzed separately, and the results of both syntheses will be then integrated during a final (convergent) synthesis. The integration will compare the findings of quantitative and qualitative evidence using tables in light of the results of both syntheses. Conclusions: This comprehensive review is expected to reflect on the insights into some QI interventions and their impact, outline some common challenges of quality for older adult care, and benefit both the practical usefulness of care service activities and the society at large. International Registered Report Identifier (IRRID): PRR1-10.2196/56346 UR - https://www.researchprotocols.org/2024/1/e56346 UR - http://dx.doi.org/10.2196/56346 UR - http://www.ncbi.nlm.nih.gov/pubmed/38635311 ID - info:doi/10.2196/56346 ER - TY - JOUR AU - Sobrinho, Silva Andressa Crystine da AU - Gomes, Oliveira Grace Angelica de AU - Bueno Júnior, Roberto Carlos PY - 2024/4/15 TI - Developing a Multiprofessional Mobile App to Enhance Health Habits in Older Adults: User-Centered Approach JO - JMIR Form Res SP - e54214 VL - 8 KW - information and communications technologies KW - ICTs KW - health care KW - digital inclusion KW - focus groups KW - health promotion KW - user KW - usability KW - health literacy KW - digital competencies KW - digital skills KW - mobile phone N2 - Background: Although comprehensive lifestyle habits are crucial for healthy aging, their adherence tends to decline as individuals grow older. Sustaining a healthy life over time poses a motivational challenge. Some digital tools, such as smartphone apps aimed at promoting healthy habits, have been used to counteract this decline. However, a more profound investigation is necessary into the diverse experiences of users, particularly when it concerns older adults or those who are unfamiliar with information and communications technologies. Objective: We aimed to develop a mobile app focused on promoting the health of older adults based on the principles of software engineering and a user-centered design. The project respected all ethical guidelines and involved the participation of older adults at various stages of the development of the app. Methods: This study used a mixed methods approach, combining both quantitative and qualitative methodologies for data collection. The study was conducted in Ribeirăo Pręto, Săo Paulo, Brazil, and involved 20 older adults of both genders who were aged ?60 years and enrolled in the Physical Education Program for the Elderly at the University of Săo Paulo. The research unfolded in multiple phases, encompassing the development and refinement of the app with active engagement from the participants. Results: A total of 20 participants used a mobile health app with an average age of 64.8 (SD 2.7) years. Most participants had a high school education, middle-class status, and varying health literacy (mean score 73.55, SD 26.70). Overall, 90% (18/20) of the participants owned smartphones. However, 20% (4/20) of the participants faced installation challenges and 30% (6/20) struggled with web-based searches. The focus groups assessed app usability and satisfaction. Adjustments increased satisfaction scores significantly (Suitability Assessment of Materials: 34.89% to 70.65%; System Usability Scale: 71.23 to 87.14). Participant feedback emphasized font size, navigation, visual feedback, and personalization, and suggestions included health device integration, social interaction, and in-app communication support. Conclusions: This study contributes to the development of health care technologies tailored to the older adult population, considering their specific needs. It is anticipated that the resulting app will serve as a valuable tool for promoting healthy habits and enhancing the quality of life for older adults. UR - https://formative.jmir.org/2024/1/e54214 UR - http://dx.doi.org/10.2196/54214 UR - http://www.ncbi.nlm.nih.gov/pubmed/38619865 ID - info:doi/10.2196/54214 ER - TY - JOUR AU - Correia de Barros, Ana AU - Bergmans, Mariëtte AU - Hasanaj, Kreshnik AU - Krasniqi, Drianë AU - Nóbrega, Catarina AU - Carvalho Carneiro, Bruna AU - Vasconcelos, A. Priscila AU - Quinta-Gomes, Luísa Ana AU - Nobre, J. Pedro AU - Couto da Silva, Joana AU - Mendes-Santos, Cristina PY - 2024/4/3 TI - Evaluating the User Experience of a Smartphone-Delivered Sexual Health Promotion Program for Older Adults in the Netherlands: Single-Arm Pilot Study JO - JMIR Hum Factors SP - e56206 VL - 11 KW - internet interventions KW - mobile health KW - mHealth KW - older adults KW - sexual health KW - smartphone KW - user experience KW - pilot study KW - mobile phone N2 - Background: Sexual health is an important component of quality of life in older adults. However, older adults often face barriers to attaining a fulfilling sexual life because of issues such as stigma, lack of information, or difficult access to adequate support. Objective: We aimed to evaluate the user experience of a self-guided, smartphone-delivered program to promote sexual health among older adults. Methods: The mobile app was made available to community-dwelling older adults in the Netherlands, who freely used the app for 8 weeks. User experience and its respective components were assessed using self-developed questionnaires, the System Usability Scale, and semistructured interviews. Quantitative and qualitative data were descriptively and thematically analyzed, respectively. Results: In total, 15 participants (mean age 71.7, SD 9.5 years) completed the trial. Participants showed a neutral to positive stance regarding the mobile app?s usefulness and ease of use. Usability was assessed as ?Ok/Fair.? The participants felt confident about using the mobile app. To increase user experience, participants offered suggestions to improve content and interaction, including access to specialized sexual health services. Conclusions: The sexual health promotion program delivered through a smartphone in a self-guided mode was usable. Participants? perception is that improvements to user experience, namely in content and interaction, as well as connection to external services, will likely improve usefulness and acceptance. UR - https://humanfactors.jmir.org/2024/1/e56206 UR - http://dx.doi.org/10.2196/56206 UR - http://www.ncbi.nlm.nih.gov/pubmed/38568726 ID - info:doi/10.2196/56206 ER - TY - JOUR AU - Sharma, Nikita AU - Grotenhuijs, Karen AU - Gemert-Pijnen, van J. E. W. C. AU - Oinas-Kukkonen, Harri AU - Braakman-Jansen, A. L. M. PY - 2024/3/22 TI - Low-Fidelity Prototype of a Sensor-Dependent Interaction Platform: Formative Evaluation With Informal Caregivers of Older Adults With Cognitive Impairment JO - JMIR Form Res SP - e53402 VL - 8 KW - older adult care KW - informal caregivers KW - cognitive impairment KW - sensing solutions KW - information communication platform KW - low-fidelity KW - lo-fi prototype N2 - Background: Unobtrusive sensing technologies developed for monitoring deviant behaviors in older adult care require integration with an interaction platform to facilitate the flow of information between older adults and their caregivers. However, the continuous monitoring capabilities generate a considerable amount of data that must be interpreted, filtered, and personalized before being communicated to the informal caregivers based on their specific care needs and requirements. Objective: For the effective implementation of unobtrusive sensing solutions (USSs) in the care of older adults with cognitive impairment, we aimed to explore the expectations and preconditions regarding the implementation of USSs from the perspective of informal caregivers. Subsequently, we designed and evaluated a low-fidelity prototype of an interaction platform for its conceptual workflow and usability, incorporating persuasive system design features based on the needs and requirements of informal caregivers. Methods: Overall, 6 informal caregivers of older adults with cognitive impairment living alone participated in this qualitative interview study. We explored the expectation and preconditions regarding implementation through open-ended questions and conducted a formative evaluation (usability study with a think-aloud approach) to evaluate the conceptual workflow and used persuasive system design features in the interaction platform. Overall, a combination of inductive and thematic analyses was used to analyze the interviews. Results: The results of this study present both positive and negative outcome expectations regarding the implementation of USSs, highlighting benefits such as objective decision-making and peace of mind and concerns about information overload and the potential substitution of human contact. Strategic information communication agreements between informal and formal caregivers were deemed crucial for the successful implementation of USSs in care. Overall, informal caregivers had a positive experience with the low-fidelity prototype of the interaction platform, particularly valuing the personalization feature. Conclusions: In conclusion, to achieve successful implementation, a holistic design approach is necessary, and equal consideration should be given to the personalization-privacy paradox to balance users? needs and privacy. UR - https://formative.jmir.org/2024/1/e53402 UR - http://dx.doi.org/10.2196/53402 UR - http://www.ncbi.nlm.nih.gov/pubmed/38517461 ID - info:doi/10.2196/53402 ER - TY - JOUR AU - Gately, Elizabeth Megan AU - Waller, E. Dylan AU - Metcalf, E. Emily AU - Moo, R. Lauren PY - 2024/3/14 TI - Caregivers? Role in In-Home Video Telehealth: National Survey of Occupational Therapy Practitioners JO - JMIR Rehabil Assist Technol SP - e52049 VL - 11 KW - telemedicine KW - caregivers KW - occupational therapy KW - caregiver KW - care worker KW - telehealth KW - older adults KW - older adult KW - geriatric KW - rural KW - remote KW - OT practitioner KW - web-based KW - national survey KW - role KW - home care KW - clinical support KW - mobile phone N2 - Background: Older adults face barriers to specialty care, such as occupational therapy (OT), and these challenges are worse for rural older adults. While in-home video telehealth may increase access to OT, older adults? health- and technology-related challenges may necessitate caregiver assistance. Objective: This study examines caregiver assistance with in-home OT video telehealth visits from the perspectives of OT practitioners at Veterans Health Administration (VHA). Methods: A web-based national survey of VHA OT practitioners about caregivers? role in video telehealth was conducted between January and February 2022. Survey items were developed with input from subject matter experts in geriatrics and OT and identified patient factors that necessitate caregiver participation; the extent to which caregivers assist with different types of tasks (technological and clinical tasks); and the perceived facilitators of, benefits of, and barriers to caregiver involvement. Results: Of approximately 1787 eligible VHA OT practitioners, 286 (16% response rate) participated. Not all survey items required completion, resulting in different denominators. Most respondents were female (183/226, 81%), White (163/225, 72.4%), and occupational therapists (275/286, 96.2%). Respondents were from 87 VHA medical centers, the catchment areas of which served a patient population that was 34% rural, on average (SD 0.22). Most participants (162/232, 69.8%) had >10 years of OT experience serving a patient cohort mostly aged ?65 years (189/232, 81.5%) in primarily outpatient rehabilitation (132/232, 56.9%). The top patient factors necessitating caregiver involvement were lack of technical skills, cognitive impairment, and advanced patient age, with health-related impairments (eg, hearing or vision loss) less frequent. Technological tasks that caregivers most frequently assisted with were holding, angling, moving, repositioning, or operating the camera (136/250, 54.4%) and enabling and operating the microphone and setting the volume (126/248, 50.8%). Clinical tasks that caregivers most frequently assisted with were providing patient history (143/239, 59.8%) and assisting with patient communication (124/240, 51.7%). The top facilitator of caregiver participation was clinician-delivered caregiver education about what to expect from video telehealth (152/275, 55.3%), whereas the top barrier was poor connectivity (80/235, 34%). Increased access to video telehealth (212/235, 90.2%) was the top-rated benefit of caregiver participation. Most respondents (164/232, 70.7%) indicated that caregivers were at least sometimes unavailable or unable to assist with video telehealth, in which case the appointment often shifted to phone. Conclusions: Caregivers routinely assist VHA patients with in-home OT video visits, which is invaluable to patients who are older and have complex medical needs. Barriers to caregiver involvement include caregivers? challenges with video telehealth or inability to assist, or lack of available caregivers. By elucidating the caregiver support role in video visits, this study provides clinicians with strategies to effectively partner with caregivers to enhance older patients? access to video visits. UR - https://rehab.jmir.org/2024/1/e52049 UR - http://dx.doi.org/10.2196/52049 UR - http://www.ncbi.nlm.nih.gov/pubmed/38483462 ID - info:doi/10.2196/52049 ER - TY - JOUR AU - Sterner, A. Danielle AU - Stout, R. Jeffrey AU - Lafontant, Kworweinski AU - Park, Joon-Hyuk AU - Fukuda, H. David AU - Thiamwong, Ladda PY - 2024/3/5 TI - Phase Angle and Impedance Ratio as Indicators of Physical Function and Fear of Falling in Older Adult Women: Cross-Sectional Analysis JO - JMIR Aging SP - e53975 VL - 7 KW - handgrip KW - sit-to-stand KW - fitness KW - assessment KW - functionality KW - body composition KW - balance KW - fall KW - impedance KW - bioelectrical N2 - Background: Older adults experience a significant decline in muscle integrity and function with aging. Early detection of decreased muscle quality can pave the way for interventions to mitigate the progression of age-related physical declines. Phase angle (PhA) and impedance ratio (IR) are measures of muscle integrity, which can be assessed quickly via bioelectrical impedance analysis (BIA) and may be indicative of physical function. Objective: This study aimed to characterize the relationships among handgrip strength (HGS), sit-to-stand (STS), BTrackS balance scores, fear of falling (evaluated using the Short Falls Efficacy Scale?International [Short FES-I]), and IR among community-dwelling older adult women classified as having a low or high PhA. Methods: A cross-sectional analysis was conducted with 85 older women (mean age 75.0, SD 7.2 years; mean weight 71.0, SD 15.0 kg; mean height 162.6, SD 6.1 cm). To examine the influence of PhA on performance measures, participants were divided into 2 PhA groups: high (>4.1°; n=56) and low (?4.1°; n=29). Data were nonnormative; hence, the Mann-Whitney U test was used to evaluate between-group differences, and Kendall ? coefficients were used to determine the partial correlations. Results: The low PhA group had a significantly higher IR (mean 0.85, SD 0.03) than the high PhA group (mean 0.81, SD 0.03; r=.92; P<.001). The high PhA group had superior HGS (mean 21.4, SD 6.2 kg; P=.007; r=0.36), BTrackS balance scores (mean 26.6, SD 9.5 cm; P=.03; r=0.30), and STS scores (mean 16.0, SD 5.5; P<.001; r=0.49) than the low PhA group (mean HGS 17.6, SD 4.7 kg; mean BTrackS balance score 37.1, SD 21.1 cm; mean STS score 10.7, SD 6.2). Both PhA and IR were significantly correlated with HGS and BTrackS balance, STS, and Short FES-I scores (P<.05). However, on adjusting for the whole sample?s age, only PhA was strongly correlated with HGS (?b=0.75; P=.003) and STS scores (?b=0.76; P=.002). Short FES-I scores were moderately correlated with IR (?b=0.46; P=.07) after controlling for age. No significant between-group differences were observed for height, weight, or BMI. Conclusions: PhA and IR are associated with physical function and the fear of falling in older women. However, only PhA was significantly associated with physical function (HGS and STS) independent of age. Conversely, only IR was significantly associated with the fear of falling. Diminished physical function and increased IR appear to be characteristics of older women with a PhA of ?4.1°. These findings suggest that PhA and IR measured through BIA together may serve as a valuable tool for early identification of older women at the risk of functional decline and a heightened fear of falling. Trial Registration: ClinicalTrials.gov NCT06063187; https://clinicaltrials.gov/study/NCT06063187 International Registered Report Identifier (IRRID): RR2-10.2196/27381 UR - https://aging.jmir.org/2024/1/e53975 UR - http://dx.doi.org/10.2196/53975 ID - info:doi/10.2196/53975 ER - TY - JOUR AU - Zheng, Amy AU - Bergh, Marissa AU - Patel Murali, Komal AU - Sadarangani, Tina PY - 2024/3/1 TI - Using mHealth to Improve Communication in Adult Day Services Around the Needs of People With Dementia: Mixed Methods Assessment of Acceptability and Feasibility JO - JMIR Form Res SP - e49492 VL - 8 KW - adult day services KW - primary health care KW - health communication KW - dementia KW - mobile health KW - mHealth KW - community-based KW - health care KW - older adults KW - older adult KW - chronic condition KW - health information KW - feasibility KW - acceptability KW - CareMOBI KW - mixed methods design KW - caregivers KW - caregiver KW - care workers KW - nurses KW - social workers N2 - Background: Adult day services (ADS) provide community-based health care for older adults with complex chronic conditions but rely on outdated methods for communicating users? health information with providers. CareMOBI, a novel mobile health (mHealth) app, was developed to address the need for a technological platform to improve bidirectional information exchange and communication between the ADS setting and providers. Objective: This study aims to examine the feasibility and acceptability of CareMOBI in the ADS setting. Methods: A concurrent-triangulation mixed methods design was used, and participants were client-facing ADS staff members, including direct care workers (paid caregivers), nurses, and social workers. Interviews were conducted to describe barriers and facilitators to the adoption of the CareMOBI app. The acceptability of the app was measured using an adapted version of the Technology Acceptance Model questionnaire. Data were integrated into 4 themes as anchors of an informational matrix: ease of use, clinical value, fit within workflow, and likelihood of adoption. Results: A mix of ADS staff (N=22) participated in the study. Participants reported high levels of acceptability across the 4 domains. Qualitative findings corroborated the questionnaire results; participants viewed the app as useful and were likely to implement CareMOBI in their practice. However, participants expressed a need for proper training and technical support throughout the implementation process. Conclusions: The CareMOBI app has the potential to improve care management in the ADS setting by promoting effective communication through an easy-to-use and portable method. While the integration of CareMOBI is acceptable and feasible, developing role-specific training modules and technical assistance programs is imperative for successful implementation within the ADS setting. UR - https://formative.jmir.org/2024/1/e49492 UR - http://dx.doi.org/10.2196/49492 UR - http://www.ncbi.nlm.nih.gov/pubmed/38427418 ID - info:doi/10.2196/49492 ER - TY - JOUR AU - Chang, Fangyuan AU - Sheng, Lin AU - Gu, Zhenyu PY - 2024/2/12 TI - Investigating the Integration and the Long-Term Use of Smart Speakers in Older Adults? Daily Practices: Qualitative Study JO - JMIR Mhealth Uhealth SP - e47472 VL - 12 KW - smart speaker KW - private home KW - older adults KW - long-term use KW - daily practices KW - smart speakers N2 - Background: As smart speakers become more popular, there have been an increasing number of studies on how they may benefit older adults or how older adults perceive them. Despite the increasing ownership rates of smart speakers among older adults, studies that examine their integration and the long-term use in older adults? daily practices are scarce. Objective: This study aims to uncover the integration of smart speakers into the daily practices of older adults over the long term, contributing to an in-depth understanding of maintained technology use among this demographic. Methods: To achieve these objectives, the study interviewed 20 older adults who had been using smart speakers for over 6 months. These semistructured interviews enabled participants to share their insights and experiences regarding the maintained use of smart speakers in the long term. Results: We identified 4 dimensions of the long-term use of smart speakers among older adults, including functional integration, spatial integration, cognitive integration, and semantic integration. For the functional integration of smart speakers, the study reported different types of use, including entertainment, information collection, medication reminders, companionship, environment modification, and emergency calls. For the spatial integration of smart speakers, the study showed older adults? agency in defining, changing, and reshaping daily practices through the spatial organization of smart speakers. For the cognitive integration of smart speakers, the findings showed the cognitive processes involved in adapting to and incorporating smart speakers into daily habits and routines. For the semantic integration of smart speakers, the findings revealed that older adults? enjoyable user experience and strong bonds with the device contributed to their acceptance of occasional functional errors. Finally, the study proposed several suggestions for designers and developers to better design smart speakers that promote maintainable use behaviors among older adults. Conclusions: On the basis of the findings, this study highlighted the importance of understanding how older adults use smart speakers and the practices through which they integrate them into their daily routines. The findings suggest that smart speakers can provide significant benefits for older adults, including increased convenience and improved quality of life. However, to promote maintainable use behaviors, designers and developers should consider more about the technology use contexts and the specific needs and preferences of older adults when designing these devices. UR - https://mhealth.jmir.org/2024/1/e47472 UR - http://dx.doi.org/10.2196/47472 UR - http://www.ncbi.nlm.nih.gov/pubmed/38345844 ID - info:doi/10.2196/47472 ER - TY - JOUR AU - Dawson, Rik AU - Gilchrist, Heidi AU - Pinheiro, Marina AU - Nelson, Karn AU - Bowes, Nina AU - Sherrington, Cathie AU - Haynes, Abby PY - 2024/2/7 TI - Experiences of Older Adults, Physiotherapists, and Aged Care Staff in the TOP UP Telephysiotherapy Program: Interview Study of the TOP UP Interventions JO - JMIR Aging SP - e53010 VL - 7 KW - physiotherapy KW - telehealth KW - telephysiotherapy KW - exercise KW - aged care KW - qualitative methods KW - behavior change KW - technology KW - virtual care N2 - Background: Telehealth provides opportunities for older adults to access health care. However, limited research exists on the use of telehealth within aged care services, particularly regarding physiotherapy-led fall prevention and mobility programs. Understanding the experiences and interactions of older adults, physiotherapists, and aged care service providers is crucial for the scale-up and sustainability of such essential programs. The TOP UP study, a hybrid type 1 effectiveness-implementation randomized controlled trial in aged care, used a supported multidisciplinary telephysiotherapy model to motivate older adults to engage in exercises to improve mobility and reduce falls. Objective: This qualitative substudy aims to achieve 2 primary objectives: to describe the experiences and acceptability of the TOP UP intervention for older people, physiotherapists, and aged care support workers and managers and to gain an in-depth understanding of program implementation. Methods: A purposive recruitment strategy was used to select 18 older adults who participated in the TOP UP intervention, ensuring variation in age, gender, residential status (home or residential aged care), geographic location, and cognitive levels. In addition, 7 physiotherapists, 8 aged care support workers, and 6 managers from 7 different aged care provider partners participated in this study. Semistructured interviews were conducted to explore stakeholders? experiences with the TOP UP program, gather suggestions for improvement, and obtain insights for the future implementation of similar telephysiotherapy programs. The interview framework and coding processes were informed by behavior changes and implementation frameworks. Data were analyzed using an abductive approach, informed by 2 behavioral change theories (Capability, Opportunity, Motivation, and Behavior Model and Self-Determination Theory) and the Nonadoption, Abandonment and Challenges to the Scale-Up, Spread and Sustainability of Health and Care Technologies framework. Results: All participants (n=39) reported high levels of acceptability for the TOP UP program and cited multiple perceived benefits. The thematic analysis generated 6 main themes: telephysiotherapy expands opportunity; tailored physiotherapy care with local support enhances motivation; engaging, older adult?friendly educational resources build capability; flexible reablement approach fosters autonomy; telephysiotherapy is safe, effective, and acceptable for many; and organizational commitment is required to embed telehealth. The motivation to exercise was enhanced by Zoom?s convenience, use of tailored web-based exercise resources, and companionable local support. Conclusions: This study highlights the inherent value of telephysiotherapy in aged care, emphasizing the need for investment in staff training, local support, and older adult?friendly resources in future telephysiotherapy iterations. TOP UP represents a convenient and flexible web-based care model that empowers many older adults to receive sustainable, high-quality care precisely when and where they need it. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN 1261000734864; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12621000734864 UR - https://aging.jmir.org/2024/1/e53010 UR - http://dx.doi.org/10.2196/53010 UR - http://www.ncbi.nlm.nih.gov/pubmed/38324369 ID - info:doi/10.2196/53010 ER - TY - JOUR AU - Wang, Jiamin AU - Ji, Meihua AU - Han, Yuan AU - Wu, Ying PY - 2024/1/24 TI - Development and Usability Testing of a Mobile App?Based Clinical Decision Support System for Delirium: Randomized Crossover Trial JO - JMIR Aging SP - e51264 VL - 7 KW - delirium KW - 3D-CAM KW - older adults KW - clinical decision support system KW - nurse KW - 3-Minute Diagnostic Interview for Confusion Assessment Method-Defined Delirium N2 - Background: The 3-Minute Diagnostic Interview for Confusion Assessment Method?Defined Delirium (3D-CAM) is an instrument specially developed for the assessment of delirium in general wards, with high reported sensitivity and specificity. However, the use of the 3D-CAM by bedside nurses in routine practice showed relatively poor usability, with multiple human errors during assessment. Objective: This study aimed to develop a mobile app?based delirium assessment tool based on the 3D-CAM and evaluate its usability among older patients by bedside nurses. Methods: The Delirium Assessment Tool With Decision Support Based on the 3D-CAM (3D-DST) was developed to address existing issues of the 3D-CAM and optimize the assessment process. Following a randomized crossover design, questionnaires were used to evaluate the usability of the 3D-DST among older adults by bedside nurses. Meanwhile, the performances of both the 3D-DST and the 3D-CAM paper version, including the assessment completion rate, time required for completing the assessment, and the number of human errors made by nurses during assessment, were recorded, and their differences were compared. Results: The 3D-DST included 3 assessment modules, 9 evaluation interfaces, and 16 results interfaces, with built-in reminders to guide nurses in completing the delirium assessment. In the usability testing, a total of 432 delirium assessments (216 pairs) on 148 older adults were performed by 72 bedside nurses with the 3D-CAM paper version and the 3D-DST. Compared to the 3D-CAM paper version, the mean usability score was significantly higher when using the 3D-DST (4.35 vs 3.40; P<.001). The median scores of the 6 domains of the satisfactory evaluation questionnaire for nurses using the 3D-CAM paper version and the 3D-DST were above 2.83 and 4.33 points, respectively (P<.001). The average time for completing the assessment reduced by 2.1 minutes (4.4 vs 2.3 min; P<.001) when the 3D-DST was used. Conclusions: This study demonstrated that the 3D-DST significantly improved the efficiency of delirium assessment and was considered highly acceptable by bedside nurses. Trial Registration: Chinese Clinical Trial Registry, ChiCTR-IOR-17010368; https://www.chictr.org.cn/showproj.html?proj=17671 UR - https://aging.jmir.org/2024/1/e51264 UR - http://dx.doi.org/10.2196/51264 ID - info:doi/10.2196/51264 ER - TY - JOUR AU - Wang, Xin AU - Li, Juan AU - Liang, Tianyi AU - Hasan, Ul Wordh AU - Zaman, Tuz Kimia AU - Du, Yang AU - Xie, Bo AU - Tao, Cui PY - 2024/1/23 TI - Promoting Personalized Reminiscence Among Cognitively Intact Older Adults Through an AI-Driven Interactive Multimodal Photo Album: Development and Usability Study JO - JMIR Aging SP - e49415 VL - 7 KW - aging KW - knowledge graph KW - machine learning KW - reminiscence KW - voice assistant N2 - Background: Reminiscence, a therapy that uses stimulating materials such as old photos and videos to stimulate long-term memory, can improve the emotional well-being and life satisfaction of older adults, including those who are cognitively intact. However, providing personalized reminiscence therapy can be challenging for caregivers and family members. Objective: This study aimed to achieve three objectives: (1) design and develop the GoodTimes app, an interactive multimodal photo album that uses artificial intelligence (AI) to engage users in personalized conversations and storytelling about their pictures, encompassing family, friends, and special moments; (2) examine the app?s functionalities in various scenarios using use-case studies and assess the app?s usability and user experience through the user study; and (3) investigate the app?s potential as a supplementary tool for reminiscence therapy among cognitively intact older adults, aiming to enhance their psychological well-being by facilitating the recollection of past experiences. Methods: We used state-of-the-art AI technologies, including image recognition, natural language processing, knowledge graph, logic, and machine learning, to develop GoodTimes. First, we constructed a comprehensive knowledge graph that models the information required for effective communication, including photos, people, locations, time, and stories related to the photos. Next, we developed a voice assistant that interacts with users by leveraging the knowledge graph and machine learning techniques. Then, we created various use cases to examine the functions of the system in different scenarios. Finally, to evaluate GoodTimes? usability, we conducted a study with older adults (N=13; age range 58-84, mean 65.8 years). The study period started from January to March 2023. Results: The use-case tests demonstrated the performance of GoodTimes in handling a variety of scenarios, highlighting its versatility and adaptability. For the user study, the feedback from our participants was highly positive, with 92% (12/13) reporting a positive experience conversing with GoodTimes. All participants mentioned that the app invoked pleasant memories and aided in recollecting loved ones, resulting in a sense of happiness for the majority (11/13, 85%). Additionally, a significant majority found GoodTimes to be helpful (11/13, 85%) and user-friendly (12/13, 92%). Most participants (9/13, 69%) expressed a desire to use the app frequently, although some (4/13, 31%) indicated a need for technical support to navigate the system effectively. Conclusions: Our AI-based interactive photo album, GoodTimes, was able to engage users in browsing their photos and conversing about them. Preliminary evidence supports GoodTimes? usability and benefits cognitively intact older adults. Future work is needed to explore its potential positive effects among older adults with cognitive impairment. UR - https://aging.jmir.org/2024/1/e49415 UR - http://dx.doi.org/10.2196/49415 UR - http://www.ncbi.nlm.nih.gov/pubmed/38261365 ID - info:doi/10.2196/49415 ER - TY - JOUR AU - Bergschöld, M. Jenny AU - Gunnes, Mari AU - Eide, H. Arne AU - Lassemo, Eva PY - 2024/1/22 TI - Characteristics and Range of Reviews About Technologies for Aging in Place: Scoping Review of Reviews JO - JMIR Aging SP - e50286 VL - 7 KW - aging in place KW - technology KW - gerontechnology KW - assistive technology KW - gerontology KW - geriatric KW - geriatrics KW - older adult KW - older adults KW - aging KW - scoping KW - review methods KW - review methodology KW - older people KW - evidence map KW - evidence mapping N2 - Background: It is a contemporary and global challenge that the increasing number of older people requiring care will surpass the available caregivers. Solutions are needed to help older people maintain their health, prevent disability, and delay or avoid dependency on others. Technology can enable older people to age in place while maintaining their dignity and quality of life. Literature reviews on this topic have become important tools for researchers, practitioners, policy makers, and decision makers who need to navigate and access the extensive available evidence. Due to the large number and diversity of existing reviews, there is a need for a review of reviews that provides an overview of the range and characteristics of the evidence on technology for aging in place. Objective: This study aimed to explore the characteristics and the range of evidence on technologies for aging in place by conducting a scoping review of reviews and presenting an evidence map that researchers, policy makers, and practitioners may use to identify gaps and reviews of interest. Methods: The review was conducted in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). Literature searches were conducted in Web of Science, PubMed, and Scopus using a search string that consisted of the terms ?older people? and ?technology for ageing in place,? with alternate terms using Boolean operators and truncation, adapted to the rules for each database. Results: A total of 5447 studies were screened, with 344 studies included after full-text screening. The number of reviews on this topic has increased dramatically over time, and the literature is scattered across a variety of journals. Vocabularies and approaches used to describe technology, populations, and problems are highly heterogeneous. We have identified 3 principal ways that reviews have dealt with populations, 5 strategies that the reviews draw on to conceptualize technology, and 4 principal types of problems that they have dealt with. These may be understood as methods that can inform future reviews on this topic. The relationships among populations, technologies, and problems studied in the reviews are presented in an evidence map that includes pertinent gaps. Conclusions: Redundancies and unexploited synergies between bodies of evidence on technology for aging in place are highly likely. These results can be used to decrease this risk if they are used to inform the design of future reviews on this topic. There is a need for an examination of the current state of the art in knowledge on technology for aging in place in low- and middle-income countries, especially in Africa. UR - https://aging.jmir.org/2024/1/e50286 UR - http://dx.doi.org/10.2196/50286 UR - http://www.ncbi.nlm.nih.gov/pubmed/38252472 ID - info:doi/10.2196/50286 ER - TY - JOUR AU - Zhu, Di AU - Al Mahmud, Abdullah AU - Liu, Wei PY - 2024/1/17 TI - Digital Storytelling Intervention for Enhancing the Social Participation of People With Mild Cognitive Impairment: Co-Design and Usability Study JO - JMIR Aging SP - e54138 VL - 7 KW - co-design KW - digital storytelling KW - people with mild cognitive impairment KW - MCI KW - technology-based intervention development KW - dementia KW - mobile phone N2 - Background: Community-based social participation has shown promise in delaying cognitive decline in older adults with mild cognitive impairment (MCI) who are at risk of developing dementia. Although group storytelling interventions have proven effective, the need for a skilled workforce to support people with MCI can limit broader community implementation. Technology-based interventions may offer a solution to this limitation by replicating the abilities of therapists. Objective: This study aims to co-design a digital storytelling intervention and evaluate its usability. Methods: This co-design process involved 3 stages, engaging people with MCI (n=12), their caregivers (n=4), and therapists (n=5) in Beijing, China. In the first stage, we used card sorting and voting methods to identify potential incentives for social participation and target the specific abilities that people with MCI wanted to enhance. In the second stage, we conducted brainstorming sessions with people with MCI and their caregivers to identify the potential features of a digital storytelling application named Huiyou (?meeting new friends? in Chinese). Finally, we assessed Huiyou?s usability with people with MCI and therapists, leading to iterative improvements based on the usability findings. Results: We uncovered a crucial link between boosting the self-confidence of people with MCI and their ability to address social participation challenges. Notably, we identified memory improvement and enhanced language expression as key factors for effective communication with grandchildren. Subsequently, participants suggested features and interfaces to address these challenges, leading to the development of Huiyou, a group-based digital storytelling application featuring functions such as generating story materials, conducting memory retrieval activities, and sharing stories. It received an ?excellent? rating in the User Experience Questionnaire benchmark, displaying high levels of attractiveness, dependability, stimulation, and novelty. People with MCI achieved an average task completion rate of 87% (n=19; SD 0.13) of the 22 tasks. However, feedback from people with MCI and therapists highlighted usability issues in navigation, activity management, user interface, and feature optimization, indicating a need for improved accessibility and efficiency. Conclusions: The co-design approach contributed to developing the Huiyou prototype, supporting community-based social participation. User feedback highlighted the potential of Huiyou to enhance well-being and facilitate meaningful social interactions while maintaining crucial existing relationships. UR - https://aging.jmir.org/2024/1/e54138 UR - http://dx.doi.org/10.2196/54138 UR - http://www.ncbi.nlm.nih.gov/pubmed/38231541 ID - info:doi/10.2196/54138 ER - TY - JOUR AU - Arnaert, Antonia AU - Sumbly, Pia AU - da Costa, Daniel AU - Liu, Yuxin AU - Debe, Zoumanan AU - Charbonneau, Sylvain PY - 2023/12/26 TI - Acceptance of the Apple Watch Series 6 for Telemonitoring of Older Adults With Chronic Obstructive Pulmonary Disease: Qualitative Descriptive Study Part 1 JO - JMIR Aging SP - e41549 VL - 6 KW - Apple Watch KW - chronic obstructive pulmonary disease KW - digital health KW - older adults KW - qualitative descriptive KW - technology acceptance KW - telemonitoring N2 - Background: The Apple Watch is not a medical device per se; it is a smart wearable device that is increasingly being used for health monitoring. Evidence exists that the Apple Watch Series 6 can reliably measure blood oxygen saturation (SpO2) in patients with chronic obstructive pulmonary disease under controlled circumstances. Objective: This study aimed to better understand older adults? acceptance of the Watch as a part of telemonitoring, even with these advancements. Methods: This study conducted content analysis on data collected from 10 older adults with chronic obstructive pulmonary disease who consented to wear the Watch. Results: Using the Extended Unified Theory of Acceptance and Use of Technology model, results showed that participants experienced potential health benefits; however, the inability of the Watch to reliably measure SpO2 when in respiratory distress was concerning. Participants? level of tech savviness varied, which caused some fear and frustration at the start, yet all felt supported by family and would have explored more features if they owned the Watch. All agreed that the Watch is mainly a medical tool and not a gadget. Conclusions: To conclude, although the Watch may enhance their physical health and well-being, results indicated that participants are more likely to accept the Watch if it ultimately proves to be useful when experiencing respiratory distress. UR - https://aging.jmir.org/2023/1/e41549 UR - http://dx.doi.org/10.2196/41549 UR - http://www.ncbi.nlm.nih.gov/pubmed/38147371 ID - info:doi/10.2196/41549 ER - TY - JOUR AU - Choi, Soyoung AU - Sajib, Zaman Md Refat Uz AU - Manzano, Jenna AU - Chlebek, Joseph Christian PY - 2023/12/25 TI - mHealth Technology Experiences of Middle-Aged and Older Individuals With Visual Impairments: Cross-Sectional Interview Study JO - JMIR Form Res SP - e52410 VL - 7 KW - aging KW - mobile health KW - older adults KW - technology KW - visual impairment KW - wearables KW - wearable KW - vision KW - visual KW - qualitative analysis KW - health behavior KW - mHealth KW - mHealth technology KW - digital technology KW - medical application KW - application KW - app KW - applications KW - usage KW - well-being KW - cross-section interview KW - interview KW - interviews KW - tracking KW - health data KW - symptom monitoring KW - monitor KW - monitoring KW - symptom KW - symptoms KW - physical activity KW - walking KW - routine KW - mobile phone N2 - Background: Current mobile health (mHealth) technology is predominantly designed with a visual orientation, often resulting in user interfaces that are inaccessible to visually impaired users. While mHealth technology offers potential for facilitating chronic illness management and enhancing health behaviors among visually impaired older populations, understanding its usage remains limited. Objective: This qualitative research aimed to explore the mHealth technology experiences of middle-aged and older individuals with visual impairments including the accessibility and usability issues they faced. Methods: The qualitative exploration was structured using the mHealth for Older Users framework. Cross-sectional interviews were conducted via Zoom between June 1 and July 31, 2023, using an interview protocol for data collection. A thematic analysis approach was employed to analyze the transcribed interview scripts. Results: Of the 7 participants who took part in the Zoom interviews, 3 were men and 4 were women, with ages ranging from 53 to 70 years. Most participants adopted mHealth apps and wearable devices for promoting health. They exhibited 3 distinct adoption patterns. Seven themes were emerged from the perceived challenges in using mHealth technologies: (1) a scarcity of accessible user manuals, (2) user interfaces that are not visually impaired-friendly, (3) health data visualizations that are not accessible, (4) unintuitive arrangement of app content, (5) health information that is challenging to comprehend, (6) cognitive overload caused by an excess of audible information, and (7) skepticism regarding the accuracy of health records. mHealth technologies seem to positively affect the health and health management of participants. Conclusions: Design considerations for mHealth technologies should consider individuals? disabilities and chronic conditions and should emphasize the importance of providing accessible manuals and training opportunities when introducing new mHealth solutions. UR - https://formative.jmir.org/2023/1/e52410 UR - http://dx.doi.org/10.2196/52410 UR - http://www.ncbi.nlm.nih.gov/pubmed/38145472 ID - info:doi/10.2196/52410 ER - TY - JOUR AU - Martinho, Diogo AU - Crista, Vítor AU - Carneiro, Joăo AU - Matsui, Kenji AU - Corchado, Manuel Juan AU - Marreiros, Goreti PY - 2023/11/23 TI - Effects of a Gamified Agent-Based System for Personalized Elderly Care: Pilot Usability Study JO - JMIR Serious Games SP - e48063 VL - 11 KW - gamification KW - cognitive assistants KW - elderly care KW - coaching system KW - older people KW - technology KW - virtual assistant KW - cognitive KW - usability KW - intervention KW - physical activity KW - agent-based system N2 - Background: The global percentage of older people has increased significantly over the last decades. Information and communication technologies have become essential to develop and motivate them to pursue healthier ways of living. This paper examines a personalized coaching health care service designed to maintain living conditions and active aging among older people. Among the technologies the service includes, we highlight the use of both gamification and cognitive assistant technologies designed to support older people and an application combining a cognitive virtual assistant to directly interact with the older person and provide feedback on their current health condition and several gamification techniques to motivate the older person to stay engaged with the application and pursuit of healthier daily habits. Objective: This pilot study aimed to investigate the feasibility and usability of a gamified agent-based system for older people and obtain preliminary results on the effectiveness of the intervention regarding physical activity health outcomes. Methods: The study was designed as an intervention study comparing pre- and posttest results. The proposed gamified agent-based system was used by 12 participants over 7 days (1 week), and step count data were collected with access to the Google Fit application programming interface. Step count data after the intervention were compared with average step count data before the intervention (average daily values over a period of 4 weeks before the intervention). A?1-tailed Student t test was used to determine the relationship between the dependent and independent variables. Usability was measured using the System Usability Scale questionnaire, which was answered by 8 of the 12 participants in the study. Results: The posttest results showed significant pre- to posttest changes (P=.30; 1-tailed Student t test) with a moderate effect size (Cohen d=0.65). The application obtained an average usability score of 78. Conclusions: The presented pilot was validated, showing the positive health effects of using gamification techniques and a virtual cognitive assistant. Additionally, usability metrics considered for this study confirmed high adherence and interest from most participants in the pilot. UR - https://games.jmir.org/2023/1/e48063 UR - http://dx.doi.org/10.2196/48063 UR - http://www.ncbi.nlm.nih.gov/pubmed/37995116 ID - info:doi/10.2196/48063 ER - TY - JOUR AU - Seaton, L. Cherisse AU - Rush, L. Kathy AU - Li, Hung Eric Ping AU - Hasan, Khalad Mohammad AU - Fawcus, Linda PY - 2023/11/10 TI - Gluu Essentials Digital Skills Training for Middle-Aged and Older Adults That Makes Skills Stick: Results of a Pre-Post Intervention Study JO - JMIR Aging SP - e50345 VL - 6 KW - digital literacy KW - digital skills KW - older adults KW - mobile device proficiency KW - online KW - mobile phone N2 - Background: A number of real-world digital literacy training programs exist to support engagement with mobile devices, but these have been understudied. Objective: The purpose of this study was to examine the effectiveness and program acceptability of a digital skills training program among middle-aged and older adults (aged ?50 years) and to gather participants? recommendations for lifelong digital skills promotion. Methods: The Gluu Essentials digital skills training program includes learning resources to support tablet use. Through pre-post surveys, this study assessed mobile device proficiency, confidence in going online and in avoiding frauds and scams, the frequency of engaging in online activities, program engagement, acceptability, and suggestions for continued support. Results: A total of 270 middle-aged and older adults completed baseline surveys. Of these 270 participants, 145 (53.7%) completed follow-up surveys. Our findings indicate that mobile device proficiency increased (P<.001), whereas confidence was unchanged. Participants also reported going online more frequently to shop (P=.01) and access government services (P=.02) at follow-up. Program engagement varied considerably, but program acceptability was high. Participants? recommendations included the need for providing ongoing programs for support and training because technology constantly changes, reducing costs for technology and internet access, and keeping learning resources simple and easy to access. Conclusions: The Gluu Essentials digital skills training program increased mobile device proficiency and frequency of web-based activities (shopping and accessing government services) among middle-aged and older adults. UR - https://aging.jmir.org/2023/1/e50345 UR - http://dx.doi.org/10.2196/50345 UR - http://www.ncbi.nlm.nih.gov/pubmed/37948115 ID - info:doi/10.2196/50345 ER - TY - JOUR AU - Chiu, Ching-Ju AU - Lo, Yi-Hsuan AU - Montayre, Jed AU - Abu-Odah, Hammoda AU - Chen, Mei-Lan AU - Zhao, Yan Ivy PY - 2023/11/8 TI - Identifying Preferred Appearance and Functional Requirements of Aged Care Robots Among Older Chinese Immigrants: Cross-Sectional Study JO - JMIR Aging SP - e48646 VL - 6 KW - robotic technology services KW - appearance KW - function KW - aged care KW - immigrant KW - Chinese KW - robot KW - robots KW - robotic KW - robotics KW - older adults KW - elderly KW - preference KW - cross sectional KW - cross-sectional KW - survey KW - healthy aging KW - aging in place KW - social KW - isolation KW - companion KW - companionship KW - Asian KW - Asian population KW - population KW - population studies KW - aging N2 - Background: Older Chinese immigrants constitute the largest older Asian ethnic population in New Zealand. Aging in a foreign land can be complex, presenting increasing challenges for gerontology scholars, practitioners, and policy makers. Older Chinese immigrants are more susceptible to experiencing loneliness and social isolation compared to native older people, primarily due to language, transportation, and cultural barriers. These factors subsequently impact their physical and mental health. With advancements in robotic technology, aged care robots are being applied to support older people with their daily living needs. However, studies on using robots with older immigrants living in the community are sparse. Their preferences for the appearance and function of aged care robots are unclear, which impacts the acceptance and usability of robots, highlighting the need for a user-centered design approach. Objective: This study aims to explore older Chinese immigrants? needs and preferences toward the appearance and function of aged care robots and to examine their relationships with the demographic characteristics of participants. Methods: A cross-sectional design was used in this study, which was undertaken between March and May 2020. A total of 103 participants completed a web-based survey. Results: The average age of participants was 68.7 (SD 5.5) years. The results suggest that 41.7% (n=43) of the 103 participants preferred a humanlike adult appearance, while 32% (n=33) suggested an animallike appearance. These participants reported higher scores in both rigorousness and friendliness compared to others who preferred different robot appearances. Participants expressed a greater preference for the functions of housework assistance (n=86, 83.5%), language translation (n=79, 76.7%), health monitoring (n=78, 75.7%), facial expressions (n=77, 74.8%), news reading (n=66, 64.1%), and security monitoring (n=65, 63.1%). These preferences were found to be significantly associated with marital status, financial status, and duration of immigration. Conclusions: To support immigrant populations to age well in a foreign country and address the growing shortage of health and social professionals, it is important to develop reliable robotic technology services that are tailored based on the needs and preferences of individuals. We collected and compared the perspectives of immigrant and nonimmigrant participants on using robots to support aging in place. The results on users? needs and preferences inform robotic technology services, indicating a need to prioritize older Chinese immigrants? preference toward aged care robots that perform housework assistance, language translation, and health and safety monitoring, and robots with humanlike features. UR - https://aging.jmir.org/2023/1/e48646 UR - http://dx.doi.org/10.2196/48646 ID - info:doi/10.2196/48646 ER - TY - JOUR AU - Janssen, Jeroen AU - Châtel, Bas AU - Den Heijer, Nora AU - Tieben, Rob AU - Deen, Menno AU - Corten, Rense AU - Peeters, Geeske AU - Olde Rikkert, Marcel PY - 2023/10/20 TI - A Digital Gaming Intervention to Strengthen the Social Networks of Older Dutch Adults: Mixed Methods Process Evaluation of a Digitally Conducted Randomized Controlled Trial JO - JMIR Form Res SP - e45173 VL - 7 KW - eHealth KW - gerontology KW - loneliness KW - mixed methods KW - mobile games KW - qualitative research KW - serious games N2 - Background: Digital loneliness interventions for older adults are promising, yet conclusive evidence is lacking due to a lack of randomized controlled trials (RCTs) and difficulties with recruitment. Process evaluation of performed RCTs is essential to inform future interventions. Still, it is rarely carried out, resulting in an overly optimistic view of the impact of eHealth interventions on loneliness in older adults and options to conduct such research entirely remotely. Objective: We describe a mixed methods process evaluation of a digitally conducted RCT assessing the effectiveness of a mobile social gaming app to facilitate meaningful social interactions in older adults. Methods: We analyzed the questionnaire and game data of the RCT participants to evaluate recruitment and onboarding, intervention adherence, and intervention acceptability. The RCT participants were allocated either to the main group of older adults (aged 65 years or older) or the side group (aged between 18 and 64 years). The side group used networking to play with the older adults. We also conducted 6 post-RCT evaluation interviews and 1 focus group with a total of 4 RCT participants and 5 welfare organization representatives that aided in RCT recruitment. Results: In total, 371 people aged 18 years or older signed up for the RCT, of which 64% (238/371) were aged 65 years or older. Of the total sample, 20% (76/371) installed the app and signed informed consent, showing a large dropout during onboarding. The high number of questions was a relevant barrier for participants. Both questionnaire and gameplay adherence were low. Participants indicated that the games elicited contact and a feeling of togetherness and proposed challenging and competitive games with increasing difficulty levels. They suggested focusing on enjoying the games rather than administering questionnaires. Conclusions: Conducting a remote digital trial of a social gaming intervention for older adults is a great challenge. Remote recruitment and informed consent acquisition may often not result in sufficient participation. Personal engagement with fellow participants and researchers might be essential for adherence and enjoyment. Future digital gaming interventions should start with small-scale studies with in-person contact, repeated instructions, and fewer questionnaires. UR - https://formative.jmir.org/2023/1/e45173 UR - http://dx.doi.org/10.2196/45173 UR - http://www.ncbi.nlm.nih.gov/pubmed/37862093 ID - info:doi/10.2196/45173 ER - TY - JOUR AU - Muurling, Marijn AU - Au-Yeung, M. Wan-Tai AU - Beattie, Zachary AU - Wu, Chao-Yi AU - Dodge, Hiroko AU - Rodrigues, K. Nathaniel AU - Gothard, Sarah AU - Silbert, C. Lisa AU - Barnes, L. Lisa AU - Steele, S. Joel AU - Kaye, Jeffrey PY - 2023/10/11 TI - Differences in Life Space Activity Patterns Between Older Adults With Mild Cognitive Impairment Living Alone or as a Couple: Cohort Study Using Passive Activity Sensing JO - JMIR Aging SP - e45876 VL - 6 KW - passive monitoring KW - in-home sensor KW - mild cognitive impairment KW - 2-person home KW - life space activity KW - sensor KW - older adult KW - aging KW - elder KW - gerontology KW - geriatric KW - cognition KW - cognitive impairment KW - activity pattern KW - at home KW - daily activities KW - activities of daily living KW - digital health KW - old age KW - technology N2 - Background: Measuring function with passive in-home sensors has the advantages of real-world, objective, continuous, and unobtrusive measurement. However, previous studies have focused on 1-person homes only, which limits their generalizability. Objective: This study aimed to compare the life space activity patterns of participants living alone with those of participants living as a couple and to compare people with mild cognitive impairment (MCI) with cognitively normal participants in both 1- and 2-person homes. Methods: Passive infrared motion sensors and door contact sensors were installed in 1- and 2-person homes with cognitively normal residents or residents with MCI. A home was classified as an MCI home if at least 1 person in the home had MCI. Time out of home (TOOH), independent life space activity (ILSA), and use of the living room, kitchen, bathroom, and bedroom were calculated. Data were analyzed using the following methods: (1) daily averages over 4 weeks, (2) hourly averages (time of day) over 4 weeks, or (3) longitudinal day-to-day changes. Results: In total, 129 homes with people living alone (n=27, 20.9%, MCI and n=102, 79.1%, no-MCI homes) and 52 homes with people living as a couple (n=24, 46.2%, MCI and n=28, 53.8%, no-MCI homes) were included with a mean follow-up of 719 (SD 308) days. Using all 3 analysis methods, we found that 2-person homes showed a shorter TOOH, a longer ILSA, and shorter living room and kitchen use. In MCI homes, ILSA was higher in 2-person homes but lower in 1-person homes. The effects of MCI status on other outcomes were only found when using the hourly averages or longitudinal day-to-day changes over time, and they depended on the household type (alone vs residing as a couple). Conclusions: This study shows that in-home behavior is different when a participant is living alone compared to when they are living as a couple, meaning that the household type should be considered when studying in-home behavior. The effects of MCI status can be detected with in-home sensors, even in 2-person homes, but data should be analyzed on an hour-to-hour basis or longitudinally. UR - https://aging.jmir.org/2023/1/e45876 UR - http://dx.doi.org/10.2196/45876 UR - http://www.ncbi.nlm.nih.gov/pubmed/37819694 ID - info:doi/10.2196/45876 ER - TY - JOUR AU - Kokorelias, Marie Kristina AU - Grigorovich, Alisa AU - Harris, T. Maurita AU - Rehman, Umair AU - Ritchie, Louise AU - Levy, AnneMarie AU - Denecke, Kerstin AU - McMurray, Josephine PY - 2023/10/9 TI - Coadaptation Between Smart Technologies and Older Adults Over Time: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e51129 VL - 12 KW - scoping review KW - review methods KW - review methodology KW - knowledge synthesis KW - scoping KW - coadaptation KW - older adults KW - older adult KW - gerontechnology KW - technology KW - smart technology KW - smart technologies KW - smart KW - geriatrics KW - elderly KW - elder KW - geriatric KW - scoping literature review KW - protocol KW - internet of things KW - IoT KW - ageing KW - aging KW - PRISMA-ScR KW - user-centered design N2 - Background: The Internet of Things (IoT) has gained significant attention due to advancements in technology and has potential applications in meeting the needs of an aging population. Smart technologies, a subset of IoT, can support older adults in aging in place, promoting independent living and improving their quality of life. However, there is a lack of research on how older adults and smart technologies coadapt over time to maximize their benefits and sustain adoption. Objective: We will aim to comprehensively review and analyze the existing scientific literature pertaining to the coadaptation between smart technologies and older adults. The primary focus will be to investigate the extent and nature of this coadaptation process and explore how older adults and technology coevolve over time to enhance older adults' experience with technology. Methods: This scoping review will follow the methodology outlined in the Joanna Briggs Institute Reviewer's Manual and adhere to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews) guidelines for reporting. Peer-reviewed articles will be searched in databases like Ovid MEDLINE, OVID Embase, PEDro, OVID PsycINFO, EBSCO CINAHL, the Cochrane Library, Scopus, IEEE Xplore, Web of Science, and Global Index Medicus. The research team will create a data extraction form covering study characteristics, participant characteristics, underlying models and frameworks, research findings, implications for technology coadaptation, and any identified study limitations. A directed content analysis approach will be used, incorporating the Selection, Optimization, and Compensation framework and Sex- and Gender-Based Analysis Plus theoretical framework. Results: The results of this study are expected in January 2024. Conclusions: This scoping review endeavors to present a thorough overview of the available evidence concerning how smart technologies interact with older adults over an extended period. The insights gained from this review will lay the groundwork for a research program that explores how older adults adapt to and use smart technologies throughout their lives, ultimately leading to improved user satisfaction and experience and facilitating aging in place with tailored support and user-centered design principles. International Registered Report Identifier (IRRID): PRR1-10.2196/51129 UR - https://www.researchprotocols.org/2023/1/e51129 UR - http://dx.doi.org/10.2196/51129 UR - http://www.ncbi.nlm.nih.gov/pubmed/37812466 ID - info:doi/10.2196/51129 ER - TY - JOUR AU - Kwok, Ian AU - Lattie, Gardiner Emily AU - Yang, Dershung AU - Summers, Amanda AU - Grote, Veronika AU - Cotten, Paul AU - Moskowitz, Tedlie Judith PY - 2023/9/6 TI - Acceptability and Feasibility of a Socially Enhanced, Self-Guided, Positive Emotion Regulation Intervention for Caregivers of Individuals With Dementia: Pilot Intervention Study JO - JMIR Aging SP - e46269 VL - 6 KW - dementia KW - caregiving KW - eHealth KW - digital interventions KW - positive emotion KW - stress KW - coping N2 - Background: The responsibilities of being a primary caregiver for a loved one with dementia can produce significant stress for the caregiver, leading to deleterious outcomes for the caregiver?s physical and psychological health. Hence, researchers are developing eHealth interventions to provide support for caregivers. Members of our research team previously developed and tested a positive emotion regulation intervention that we delivered through videoconferencing, in which caregiver participants would meet one-on-one with a trained facilitator. Although proven effective, such delivery methods have limited scalability because they require significant resources in terms of cost and direct contact hours. Objective: This study aimed to conduct a pilot test of a socially enhanced, self-guided version of the positive emotion regulation intervention, Social Augmentation of Self-Guided Electronic Delivery of the Life Enhancing Activities for Family Caregivers (SAGE LEAF). Studies have shown that social presence or the perception of others in a virtual space is associated with enhanced learning and user satisfaction. Hence, the intervention leverages various social features (eg, discussion boards, podcasts, videos, user profiles, and social notifications) to foster a sense of social presence among participants and study team members. Methods: Usability, usefulness, feasibility, and acceptability data were collected from a pilot test in which participants (N=15) were given full access to the SAGE LEAF intervention over 6 weeks and completed preintervention and postintervention assessments (10/15, 67%). Preliminary outcome measures were also collected, with an understanding that no conclusions about efficacy could be made, because our pilot study did not have a control group and was not sufficiently powered. Results: The results suggest that SAGE LEAF is feasible, with participants viewing an average of 72% (SD 42%) of the total available intervention web pages. In addition, acceptability was found to be good, as demonstrated by participants? willingness to recommend the SAGE LEAF program to a friend or other caregiver. Applying Pearson correlational analyses, we found moderate, positive correlation between social presence scores and participants? willingness to recommend the program to others (r9=0.672; P=.03). We also found positive correlation between social presence scores and participants? perceptions about the overall usefulness of the intervention (r9=0.773; P=.009). This suggests that participants? sense of social presence may be important for the feasibility and acceptability of the program. Conclusions: In this pilot study, the SAGE LEAF intervention demonstrates potential for broad dissemination for dementia caregivers. We aim to incorporate participant feedback about how the social features may be improved in future iterations to enhance usability and to further bolster a sense of social connection among participants and study staff members. Next steps include partnering with dementia clinics and other caregiver-serving organizations across the United States to conduct a randomized controlled trial to evaluate the effectiveness of the intervention. UR - https://aging.jmir.org/2023/1/e46269 UR - http://dx.doi.org/10.2196/46269 UR - http://www.ncbi.nlm.nih.gov/pubmed/37672311 ID - info:doi/10.2196/46269 ER - TY - JOUR AU - Kouri, Andrew AU - Gupta, Samir AU - Straus, E. Sharon AU - Sale, M. Joanna E. PY - 2023/8/22 TI - Exploring the Perspectives and Experiences of Older Adults With Asthma and Chronic Obstructive Pulmonary Disease Toward Mobile Health: Qualitative Study JO - J Med Internet Res SP - e45955 VL - 25 KW - older adults KW - mHealth KW - asthma KW - chronic obstructive pulmonary disease KW - qualitative research KW - digital health KW - qualitative study KW - airway disease KW - barrier KW - health technology KW - interview KW - smartphone KW - airway KW - implementation KW - mobile phone N2 - Background: The use of mobile health (mHealth) in asthma and chronic obstructive pulmonary disease (COPD) is growing, and as the population ages, a greater number of older adults stand to benefit from mHealth-enhanced airway disease care. Though older adults are a heterogeneous population of health technology users, older age represents a potential barrier to health technology adoption, and there is currently a lack of knowledge on how older age influences mHealth use in asthma and COPD. Objective: In this qualitative study, we sought to explore the experiences and perspectives of adults who were aged 65 years and older with asthma and COPD toward mHealth use. Methods: Semistructured individual interviews were conducted with adults who were aged 65 years and older with asthma or COPD and owned a smartphone. Applying phenomenological methodology, we analyzed interview transcripts in order to develop themes and propose an essential experience of mHealth use among older adults with airway disease. We then summarized our qualitative findings and proposed strategies to leverage our results in order to guide future research and implementation efforts targeting older adults? use of airway mHealth. Results: Twenty participants (mean age 79.8, SD 4.4 years) were interviewed. Participants described a central tension between (1) the perception that mHealth could help maintain independence throughout aging and (2) an apprehension toward the ways in which mHealth could negatively affect established health care experiences. Several elements of these 2 themes are absent from previous research focusing on younger adults with asthma and COPD. The individual elements of these 2 themes informed potential strategies to optimize future older adults? use of asthma and COPD mHealth tools. Conclusions: Focusing on the perspectives and experiences of older adults with asthma and COPD in their use of mHealth identified novel understandings of health technology use in this important demographic in need of greater care. These lessons were translated into potential strategies that will need to be objectively evaluated in future airway mHealth research, development, and implementation efforts. UR - https://www.jmir.org/2023/1/e45955 UR - http://dx.doi.org/10.2196/45955 UR - http://www.ncbi.nlm.nih.gov/pubmed/37606961 ID - info:doi/10.2196/45955 ER - TY - JOUR AU - Siette, Joyce AU - Dodds, Laura AU - Sharifi, Fariba AU - Nguyen, Amy AU - Baysari, Melissa AU - Seaman, Karla AU - Raban, Magdalena AU - Wabe, Nasir AU - Westbrook, Johanna PY - 2023/6/19 TI - Usability and Acceptability of Clinical Dashboards in Aged Care: Systematic Review JO - JMIR Aging SP - e42274 VL - 6 KW - dashboard KW - visualization KW - usability KW - acceptability KW - user interface design KW - health information technology KW - aged care KW - clinical KW - database KW - development N2 - Background: The use of clinical dashboards in aged care systems to support performance review and improve outcomes for older adults receiving care is increasing. Objective: Our aim was to explore evidence from studies of the acceptability and usability of clinical dashboards including their visual features and functionalities in aged care settings. Methods: A systematic review was conducted using 5 databases (MEDLINE, Embase, PsycINFO, Cochrane Library, and CINAHL) from inception to April 2022. Studies were included in the review if they were conducted in aged care environments (home-based community care, retirement villages, and long-term care) and reported a usability or acceptability evaluation of a clinical dashboard for use in aged care environments, including specific dashboard visual features (eg, a qualitative summary of individual user experience or metrics from a usability scale). Two researchers independently reviewed the articles and extracted the data. Data synthesis was performed via narrative review, and the risk of bias was measured using the Mixed Methods Appraisal Tool. Results: In total, 14 articles reporting on 12 dashboards were included. The quality of the articles varied. There was considerable heterogeneity in implementation setting (home care 8/14, 57%), dashboard user groups (health professionals 9/14, 64%), and sample size (range 3-292). Dashboard features included a visual representation of information (eg, medical condition prevalence), analytic capability (eg, predictive), and others (eg, stakeholder communication). Dashboard usability was mixed (4 dashboards rated as high), and dashboard acceptability was high for 9 dashboards. Most users considered dashboards to be informative, relevant, and functional, highlighting the use and intention of using this resource in the future. Dashboards that had the presence of one or more of these features (bar charts, radio buttons, checkboxes or other symbols, interactive displays, and reporting capabilities) were found to be highly acceptable. Conclusions: A comprehensive summary of clinical dashboards used in aged care is provided to inform future dashboard development, testing, and implementation. Further research is required to optimize visualization features, usability, and acceptability of dashboards in aged care. UR - https://aging.jmir.org/2023/1/e42274 UR - http://dx.doi.org/10.2196/42274 UR - http://www.ncbi.nlm.nih.gov/pubmed/37335599 ID - info:doi/10.2196/42274 ER - TY - JOUR AU - Ghorayeb, Abir AU - Comber, Rob AU - Gooberman-Hill, Rachael PY - 2023/6/16 TI - Development of a Smart Home Interface With Older Adults: Multi-Method Co-Design Study JO - JMIR Aging SP - e44439 VL - 6 KW - data visualization KW - digital health KW - smart homes KW - older people KW - technology acceptance KW - qualitative research KW - mobile phone N2 - Background: Smart home technologies have the potential to support aging in place; however, older people?s perceptions of the value of smart homes may be influenced by their access to the information gathered by the technology. This information is needed to support their informed decision-making. Limited research has been conducted on how best to design visualizations of smart home data in keeping with the needs and wishes of older people. Objective: We aimed to investigate the design options that impact the usefulness of smart home systems, older people?s information needs, their perceptions of data visualization, and the ways they would like information displayed to them. Methods: We used a qualitative approach to empower the participants as co-designers. Data collection comprised a sequence of methods such as interviews, observation, focus groups, scenario design, probes, and design workshops. Each phase informed the next. Overall, 13 older adults (n=8, 62% female and n=5, 38% male; aged 65-89 years) consented to participate. A thematic approach was used to analyze the data set, and participants were actively involved in designing the in-home interface, which enabled them to better conceptualize their needs. Results: The information collected was clustered into 5 themes: enabling home, health, and self-monitoring; enabling opportunities for social inclusion and engagement; enhancing cognitive abilities; customizability of the display; and promoting inclusion in recreation and leisure activities. These themes informed 5 design sessions in which participants co-designed visual metaphors for the themes based on their own experiences in an age-inclusive manner. Together, the participants produced a user-friendly prototype, which they chose to call My Buddy. They found it useful to receive social and cognitive triggers, as well as recommendations for special diets or activities based on their mood, health, and social status. Conclusions: Smart home data visualization is much more than a nice-to-have option. Visualization is a must-have feature because it deepens the understanding of the information collected and means that technology provides information of value and relevance to older people. This may improve the acceptability and perceived utility of in-home technology. By understanding what older people want to know from smart home technology and considering how to visualize data in ways that work for them, we can provide an appropriate in-home interface. Such an interface would suggest ways or opportunities to connect and socialize; stimulate contact with close friends or family members; maintain awareness of health and well-being; provide support in decision-making, cognitive tasks, and daily life activities; and monitor health status. Older adults are the best co-designers for the development of visual metaphors that resonate with their own experiences. Our findings promote the development of technologies that foreground and reflect the information needs of older people and engage them as designers of the display. UR - https://aging.jmir.org/2023/1/e44439 UR - http://dx.doi.org/10.2196/44439 UR - http://www.ncbi.nlm.nih.gov/pubmed/37327037 ID - info:doi/10.2196/44439 ER - TY - JOUR AU - Zhu, Jieting AU - Weng, Huiting AU - Ou, Peng AU - Li, Lezhi PY - 2023/6/13 TI - Use and Acceptance of Smart Elderly Care Apps Among Chinese Medical Staff and Older Individuals: Web-Based Hybrid Survey Study JO - JMIR Form Res SP - e41919 VL - 7 KW - smart elderly care app KW - mobile health KW - smartphone N2 - Background: With the advent of China?s aging population and the popularization of smartphones, there is a huge demand for smart elderly care apps. Along with older adults and their dependents, medical staff also need to use a health management platform to manage the health of patients. However, the development of health apps and the large and growing app market pose a problem of declining quality; in fact, important differences can be observed between apps, and patients currently do not have adequate information and formal evidence to discriminate among them. Objective: The aim of this study was to investigate the cognition and usage status of smart elderly care apps among older individuals and medical staff in China. Methods: From March 1, 2022, to March 30, 2022, we used the web survey tool Sojump to conduct snowball sampling through WeChat. The survey links were initially sent to communities in 23 representative major cities in China. We asked the medical staff of community clinics to post the survey link on their WeChat Moments. From April 1 to May 10, 2022, we contacted those who selected ?Have used a smart elderly care app? in the questionnaire through WeChat for a request to participate in semistructured interviews. Participants provided informed consent in advance and interviews were scheduled. After the interviews, the audio recordings were transcribed into text and the emerging themes were analyzed and summarized. Results: A total of 810 individuals participated in this study, 54.8% (n=444) of whom were medical staff, 33.1% (n=268) were older people, and the remaining participants were certified nursing assistants (CNAs) and community workers. Overall, 60.5% (490/810) of the participants had used a smart elderly care app on their smartphone. Among the 444 medical staff who participated in the study, the vast majority (n=313, 70.5%) had never used a smart elderly care app, although 34.7% of them recommended elderly care?related apps to patients. Among the 542 medical staff, CNAs, and community workers that completed the questionnaire, only 68 (12.6%) had used a smart elderly care app. We further interviewed 23 people about their feelings and opinions about smart elderly care apps. Three themes emerged with eight subthemes, including functional design, operation interface, and data security. Conclusions: In this survey, there was a huge difference in the usage rate and demand for smart elderly care apps by the participants. Respondents are mainly concerned with app function settings, interface simplicity, and data security. UR - https://formative.jmir.org/2023/1/e41919 UR - http://dx.doi.org/10.2196/41919 UR - http://www.ncbi.nlm.nih.gov/pubmed/37310777 ID - info:doi/10.2196/41919 ER - TY - JOUR AU - Heponiemi, Tarja AU - Kainiemi, Emma AU - Virtanen, Lotta AU - Saukkonen, Petra AU - Sainio, Päivi AU - Koponen, Päivikki AU - Koskinen, Seppo PY - 2023/5/5 TI - Predicting Internet Use and Digital Competence Among Older Adults Using Performance Tests of Visual, Physical, and Cognitive Functioning: Longitudinal Population-Based Study JO - J Med Internet Res SP - e42287 VL - 25 KW - internet services KW - digital exclusion KW - digital skills KW - older adults KW - physical and cognitive decline KW - mobile phone N2 - Background: The rapidly increasing role of the internet in obtaining basic services poses challenges, especially for older adults? capabilities of getting the services they need. Research on the predictors of older adults? internet use and digital competence is especially relevant given that people are living longer than before, and the age profile of many societies is changing rapidly. Objective: We aimed to examine the associations of objective measures of physical and cognitive impairment with the nonuse of the internet for services and low digital competence among older adults. Methods: A longitudinal population-based design was used that combined data from performance tests and self-rated questionnaires. Data were gathered in 2017 and 2020 among 1426 older adults aged between 70 and 100 years in Finland. Logistic regression analyses were used to examine the associations. Results: Those who had poor near (odds ratio [OR] 1.90, 95% CI 1.36-2.66) or distant vision (OR 1.81, 95% CI 1.21-2.71), restricted or failed abduction of upper arms (OR 1.81, 95% CI 1.28-2.85), and poor results from the word list memory (OR 3.77, 95% CI 2.65-5.36) or word list delayed recall (OR 2.12, 95% CI 1.48-3.02) tests had greater odds for nonuse of the internet for services than their counterparts. Moreover, those who had poor near (OR 2.18, 95% CI 1.57-3.02) or distant vision (OR 2.14, 95% CI 1.43-3.19), poor results from the chair stand test (OR 1.57, 95% CI 1.06-2.31), restricted or failed abduction of upper arms (OR 1.74, 95% CI 1.10-2.76), and poor results from the word list memory (OR 3.41, 95% CI 2.32-5.03) or word list delayed recall (OR 2.05, 95% CI 1.39-3.04) tests had greater odds of low digital competence than their counterparts. Conclusions: According to our results, older adults? impaired physical and cognitive functioning may hamper their possibilities of accessing internet services such as digital health care services. Our results should be considered when planning digital health care services intended to be used by older adults; that is, digital solutions should also be suitable for older adults with impairments. Furthermore, face-to-face services should be provided for those who cannot use digital services, even if they are assisted properly. UR - https://www.jmir.org/2023/1/e42287 UR - http://dx.doi.org/10.2196/42287 UR - http://www.ncbi.nlm.nih.gov/pubmed/37145836 ID - info:doi/10.2196/42287 ER - TY - JOUR AU - Shin, Ri Hye AU - Um, Rang Sa AU - Yoon, Jeong Hee AU - Choi, Young Eun AU - Shin, Chul Won AU - Lee, Yun Hee AU - Kim, Sun Young PY - 2023/4/10 TI - Comprehensive Senior Technology Acceptance Model of Daily Living Assistive Technology for Older Adults With Frailty: Cross-sectional Study JO - J Med Internet Res SP - e41935 VL - 25 KW - senior technology acceptance model KW - daily living assistive technologies KW - frailty KW - older adults N2 - Background: There are considerable gaps between the need for assistive technologies and the actual adoption of these technologies among older adults, although older adults are among the groups that most need assistive technologies. Consequently, research is needed in this area because older adults? technology acceptance and influencing factors may differ depending on their level of frailty. Objective: The objective of this study was to compare frail, prefrail, and robust groups of South Korean adults regarding their behavioral intention to use daily living assistive technologies and the affecting factors?namely, technological context factors, health contexts and abilities, and attitudinal factors?based on a comprehensive senior technology acceptance model. Methods: A nationwide sample of 500 older South Korean adults (aged 55-92 years) was analyzed, and multivariate linear regression analyses of the robust, prefrail, and frail groups were performed. The independent and dependent variables consisted of 3 factors based on previous studies. First, technological context factors consisted of gerontechnology self-efficacy, gerontechnology anxiety, and facilitating conditions. Second, health contexts and abilities consisted of self-reported health conditions, cognitive ability, social relationships, psychological function, and physical function. Third and last, attitudinal factors consisted of behavioral intention to use assistive technologies, attitude toward use, perceived usefulness (PU), and perceived ease of use (PEOU). Results: The results of the analyses showed that technological context factors such as gerontechnology self-efficacy, health contexts and abilities such as self-reported health conditions and psychological function, and attitudinal factors such as attitude toward use, PU, and PEOU had significant effects on behavioral intention to use daily living assistive technologies. In particular, gerontechnology self-efficacy had a significant relationship with behavioral intention to use these technologies in the robust (r=0.120; P=.03) and prefrail (r=0.331; P<.001) groups. Psychological function (life satisfaction) had a significant relationship with behavioral intention to use these technologies in the robust group (r=?0.040; P=.02). Self-reported health conditions had a significant relationship with behavioral intention to use these technologies in the prefrail group (r=?0.169; P=.01). Although each group had a different significant relationship with the variables, attitudinal factors such as attitude toward use affected all groups (robust group: r=0.190; P=.03; prefrail group: r=0.235; P=.006; and frail group: r=0.526; P=.002). In addition, PU and PEOU in the attitudinal factors had a significant relationship with behavioral intention to use assistive technologies in the robust (PU: r=0.160; P=.01; and PEOU: r=0.350; P<.001) and prefrail (PU: r=0.265; P<.001; and PEOU: r=0.120; P=.04) groups. Conclusions: This study found that the comprehensive senior technology acceptance model of daily living assistive technologies had different associations according to the frailty group. These findings provided insights into the consideration of interventions with daily living assistive technologies for older adults with varying levels of frailty. UR - https://www.jmir.org/2023/1/e41935 UR - http://dx.doi.org/10.2196/41935 UR - http://www.ncbi.nlm.nih.gov/pubmed/37036760 ID - info:doi/10.2196/41935 ER - TY - JOUR AU - Drazich, F. Brittany AU - Lee, Won Ji AU - Bowles, H. Kathryn AU - Taylor, L. Janiece AU - Shah, Shivani AU - Resnick, Barbara AU - Kim, Nayeon AU - Szanton, L. Sarah PY - 2023/3/29 TI - Pandemic-Related Changes in Technology Use Among a Sample of Previously Hospitalized Older Adult New Yorkers: Observational Study JO - JMIR Aging SP - e41692 VL - 6 KW - older adults KW - technology KW - COVID-19 KW - well-being KW - elderly population KW - technology use KW - physical disability KW - virtual health KW - social interaction KW - digital gaming KW - digital learning N2 - Background: The COVID-19 pandemic increased the importance of technology for all Americans, including older adults. Although a few studies have indicated that older adults might have increased their technology use during the COVID-19 pandemic, further research is needed to confirm these findings, especially among different populations, and using validated surveys. In particular, research on changes in technology use among previously hospitalized community-dwelling older adults, especially those with physical disability, is needed because older adults with multimorbidity and hospital associated deconditioning were a population greatly impacted by COVID-19 and related distancing measures. Obtaining knowledge regarding previously hospitalized older adults? technology use, before and during the pandemic, could inform the appropriateness of technology-based interventions for vulnerable older adults. Objective: In this paper, we 1) described changes in older adult technology-based communication, technology-based phone use, and technology-based gaming during the COVID-19 pandemic, compared to before the COVID-19 pandemic and 2) tested whether technology use moderated the association between changes in in-person visits and well-being, controlling for covariates. Methods: Between December 2020 and January 2021 we conducted a telephone-based objective survey with 60 previously hospitalized older New Yorkers with physical disability. We measured technology-based communication through three questions pulled from the National Health and Aging Trends Study COVID-19 Questionnaire. We measured technology-based smart phone use and technology-based video gaming through the Media Technology Usage and Attitudes Scale. We used paired t tests and interaction models to analyze survey data. Results: This sample of previously hospitalized older adults with physical disability consisted of 60 participants, 63.3% of whom identified as female, 50.0% of whom identified as White, and 63.8% of whom reported an annual income of $25,000 or less. This sample had not had physical contact (such as friendly hug or kiss) for a median of 60 days and had not left their home for a median of 2 days. The majority of older adults from this study reported using the internet, owning smart phones, and nearly half learned a new technology during the pandemic. During the pandemic, this sample of older adults significantly increased their technology-based communication (mean difference=.74, P=.003), smart phone use (mean difference=2.9, P=.016), and technology-based gaming (mean difference=.52, P=.030). However, this technology use during the pandemic did not moderate the association between changes in in-person visits and well-being, controlling for covariates. Conclusions: These study findings suggest that previously hospitalized older adults with physical disability are open to using or learning technology, but that technology use might not be able to replace in-person social interactions. Future research might explore the specific components of in-person visits that are missing in virtual interactions, and if they could be replicated in the virtual environment, or through other means. UR - https://aging.jmir.org/2023/1/e41692 UR - http://dx.doi.org/10.2196/41692 UR - http://www.ncbi.nlm.nih.gov/pubmed/36881528 ID - info:doi/10.2196/41692 ER - TY - JOUR AU - Wen, Wen AU - Zhang, Yaru AU - Shi, Wenjie AU - Li, Jiajia PY - 2023/3/21 TI - Association Between Internet Use and Physical Health, Mental Health, and Subjective Health in Middle-aged and Older Adults: Nationally Representative Cross-sectional Survey in China JO - J Med Internet Res SP - e40956 VL - 25 KW - internet use KW - health status KW - middle-aged and older adults KW - China N2 - Background: Internet use is an important means of accessing health-related information. Identifying the associations between internet use and health outcomes could provide insight into strategies for improving public health among middle-aged and older adults (45 years and up). Objective: This study aimed to examine the relationship between internet use and health outcomes in middle-aged and older adults. Methods: Data were obtained from the 2018 China Health and Retirement Longitudinal Study. Physical, mental, and subjective health were assessed using the Activities of Daily Living (ADL) Scale, the 10-item Center for Epidemiologic Studies Depression Scale, and the 3-level Self-Rated Health Scale, respectively. The chi-square test and rank sum test were used to explore whether internet use was associated with health status. A multivariate logistic regression model was used to determine this association further after controlling for the confounding factors. Results: Overall, 13% (1752/13,474) of the participants used the internet. Regression analyses revealed that the prevalence of depression (odds ratio [OR] 0.59, 95% CI 0.52-0.68; P<.001), negative self-rated health (OR 0.68, 95% CI 0.61-0.76; P<.001), and difficulty with ADL (OR 0.48, 95% CI 0.39-0.60; P<.001) in the participating middle-aged and older adult was lower in those using the internet than nonusers. After controlling for confounding factors, internet use was found to be negatively associated with difficulty with ADL (urban: OR 0.44, 95% CI 0.32-0.61; P<.001 vs rural: OR 0.55, 95% CI 0.41-0.75; P<.001), depression (urban: OR 0.69, 95% CI 0.57-0.84; P<.001 vs rural: OR 0.52, 95% CI: 0.43-0.63; P<.001), and self-rated health status (urban: OR 0.70, 95% CI 0.61-0.81; P<.001 vs rural: OR 0.67, 95% CI 0.57-0.78; P<.001) among middle-aged and older adults in both urban and rural areas. Conclusions: Internet use had a positive effect on the physical and mental health of middle-aged and older adults who participated in this study. However, the internet usage rate remains low among older Chinese people. Therefore, the internet penetration rate should be a priority. UR - https://www.jmir.org/2023/1/e40956 UR - http://dx.doi.org/10.2196/40956 UR - http://www.ncbi.nlm.nih.gov/pubmed/36943368 ID - info:doi/10.2196/40956 ER - TY - JOUR AU - Garcia Reyes, Paola Elsy AU - Kelly, Ryan AU - Buchanan, George AU - Waycott, Jenny PY - 2023/3/21 TI - Understanding Older Adults? Experiences With Technologies for Health Self-management: Interview Study JO - JMIR Aging SP - e43197 VL - 6 KW - older adults KW - technology KW - health self-management KW - motivator KW - enabler KW - barrier N2 - Background: Many older adults now use technologies such as wearable devices and telehealth services to support their health and well-being while living independently at home. However, older adults vary in how they use these technologies, and there is a lack of knowledge regarding the motivations that influence their acceptance and use of health-related technologies in home environments. Objective: This study aimed to understand the types of technologies that older adults use to support their health and the factors that motivate them to use their chosen technologies to support their health. In addition, we aimed to understand the factors that enable the effective use of technologies for health self-management and to identify the barriers that can negatively affect the adoption of technologies. Methods: A total of 22 older adults participated in semistructured interviews regarding their experiences of using technologies for health self-management. Interview transcripts were analyzed through an in-depth thematic analysis. Results: The interviews revealed that a range of technologies, such as videoconferencing software, fitness trackers, and other devices, were being used by older adults to support their health. Interviews showed that participants were motivated to use technologies to monitor health issues, to stay active and connected, and to record and change their behavior in the light of foreseen risks related to their future health status. Enablers that facilitated the effective use of technologies include social and organizational influence, convenient access to health care and safety provided by the technology, and easy setup and low cost of the technology. Barriers include information overload and a sense of futility about future health decline; telehealth being an inadequate substitute for in-person consultation; concerns about trust related to privacy and accuracy; and technologies being stigmatizing, uncomfortable to use, expensive, and unfamiliar. Conclusions: This study suggested that older adults were using a variety of technologies to prevent or prepare for future health decline, evidencing a resilient attitude toward health and aging. In addition, older adults were willing to continue using the technology when there was a perceived need. The enabler mentioned by most participants was the social and organizational influence that included health care staff, family, friends, and organizations. This analysis provides a better understanding of how older adults use technologies to support their health and can guide the provision of appropriate health technologies for them. UR - https://aging.jmir.org/2023/1/e43197 UR - http://dx.doi.org/10.2196/43197 UR - http://www.ncbi.nlm.nih.gov/pubmed/36943333 ID - info:doi/10.2196/43197 ER - TY - JOUR AU - Quialheiro, Anna AU - Miranda, André AU - Garcia Jr, Miguel AU - Carvalho, de Adriana Camargo AU - Costa, Patrício AU - Correia-Neves, Margarida AU - Santos, Correia Nadine PY - 2023/2/8 TI - Promoting Digital Proficiency and Health Literacy in Middle-aged and Older Adults Through Mobile Devices With the Workshops for Online Technological Inclusion (OITO) Project: Experimental Study JO - JMIR Form Res SP - e41873 VL - 7 KW - digital proficiency KW - health literacy KW - older adults KW - mobile devices N2 - Background: Digital inclusion and literacy facilitate access to health information and can contribute to self-care behaviors and informed decision-making. However, digital literacy is not an innate skill, but rather requires knowledge acquisition. Objective: The present study aimed to develop, conduct, and measure the impact, on digital and health literacy, of a digital inclusion program aimed at community dwellers. Methods: The program targeted the recruitment of people aged 55 and older that owned mobile devices with an internet connection in 3 cities in northern Portugal (Paredes de Coura, Guimarăes, and Barcelos). The program was titled the Workshops for Online Technological Inclusion (OITO) project and, in each city, was promoted by the coordinator of municipal projects and organized as an in-person 8-workshop program, using mobile devices, smartphones, or tablets. A quasi-experimental design was used with a nonrandomized allocation of participants in each set of 8 workshops. Sociodemographic, health status, and mobile use information were collected at baseline. Digital and health literacy were measured via the Mobile Device Proficiency Questionnaire and the Health Literacy Scale questionnaires, respectively, at baseline (T1), program completion (T2), and a 1-month follow-up (T3). A self-reported measure of autonomy was evaluated at T1 and T2 using a visual scale. Results: Most participants were women with primary schooling (up to 4 years) aged between 65 and 74 years and retired. The intervention had an 81% (97/120) recruitment rate, 53% (43/81) adherence, and 94% (67/71) satisfaction rate, with 81 participants completing the entire 8-workshop program. Most participants had owned their mobile device for more than one year (64/81, 79%), were frequent daily users (70/81, 86%), and had received their mobile device from someone else (33/64, 52%). Over 80% (71/81) of the participants who completed the intervention used Android smartphones. At baseline, participants had low baseline scores in digital literacy, but medium-high baseline scores in health literacy. They showed significant improvement in digital literacy at T2 and T3 compared to T1, but without a significant difference between T2 and T3, regardless of sex, age, or schooling. A significant improvement in self-reported autonomy was observed at T3 compared with baseline. Regarding health literacy, no significant differences were found at T2 or T3 compared to the baseline. Conclusions: The feasibility indicators showed that the OITO project methodology had a substantial rate of recruitment and satisfaction. Program participants had significant improvement in digital literacy after 8 workshops and maintained their score 1 month after completing the intervention. There was no significant change in health literacy during the project period. UR - https://formative.jmir.org/2023/1/e41873 UR - http://dx.doi.org/10.2196/41873 UR - http://www.ncbi.nlm.nih.gov/pubmed/36753331 ID - info:doi/10.2196/41873 ER - TY - JOUR AU - Muńoz Esquivel, Karla AU - Gillespie, James AU - Kelly, Daniel AU - Condell, Joan AU - Davies, Richard AU - McHugh, Catherine AU - Duffy, William AU - Nevala, Elina AU - Alamäki, Antti AU - Jalovaara, Juha AU - Tedesco, Salvatore AU - Barton, John AU - Timmons, Suzanne AU - Nordström, Anna PY - 2023/1/19 TI - Factors Influencing Continued Wearable Device Use in Older Adult Populations: Quantitative Study JO - JMIR Aging SP - e36807 VL - 6 KW - usability KW - older adults KW - remote sensing KW - sensor systems KW - wearable device KW - mobile phone N2 - Background: The increased use of wearable sensor technology has highlighted the potential for remote telehealth services such as rehabilitation. Telehealth services incorporating wearable sensors are most likely to appeal to the older adult population in remote and rural areas, who may struggle with long commutes to clinics. However, the usability of such systems often discourages patients from adopting these services. Objective: This study aimed to understand the usability factors that most influence whether an older adult will decide to continue using a wearable device. Methods: Older adults across 4 different regions (Northern Ireland, Ireland, Sweden, and Finland) wore an activity tracker for 7 days under a free-living environment protocol. In total, 4 surveys were administered, and biometrics were measured by the researchers before the trial began. At the end of the trial period, the researchers administered 2 further surveys to gain insights into the perceived usability of the wearable device. These were the standardized System Usability Scale (SUS) and a custom usability questionnaire designed by the research team. Statistical analyses were performed to identify the key factors that affect participants? intention to continue using the wearable device in the future. Machine learning classifiers were used to provide an early prediction of the intention to continue using the wearable device. Results: The study was conducted with older adult volunteers (N=65; mean age 70.52, SD 5.65 years) wearing a Xiaomi Mi Band 3 activity tracker for 7 days in a free-living environment. The results from the SUS survey showed no notable difference in perceived system usability regardless of region, sex, or age, eliminating the notion that usability perception differs based on geographical location, sex, or deviation in participants? age. There was also no statistically significant difference in SUS score between participants who had previously owned a wearable device and those who wore 1 or 2 devices during the trial. The bespoke usability questionnaire determined that the 2 most important factors that influenced an intention to continue device use in an older adult cohort were device comfort (?=0.34) and whether the device was fit for purpose (?=0.34). A computational model providing an early identifier of intention to continue device use was developed using these 2 features. Random forest classifiers were shown to provide the highest predictive performance (80% accuracy). After including the top 8 ranked questions from the bespoke questionnaire as features of our model, the accuracy increased to 88%. Conclusions: This study concludes that comfort and accuracy are the 2 main influencing factors in sustaining wearable device use. This study suggests that the reported factors influencing usability are transferable to other wearable sensor systems. Future work will aim to test this hypothesis using the same methodology on a cohort using other wearable technologies. UR - https://aging.jmir.org/2023/1/e36807 UR - http://dx.doi.org/10.2196/36807 UR - http://www.ncbi.nlm.nih.gov/pubmed/36656636 ID - info:doi/10.2196/36807 ER - TY - JOUR AU - Savira, Feby AU - Gupta, Adyya AU - Gilbert, Cecily AU - Huggins, E. Catherine AU - Browning, Colette AU - Chapman, Wendy AU - Haines, Terry AU - Peeters, Anna PY - 2023/1/18 TI - Virtual Care Initiatives for Older Adults in Australia: Scoping Review JO - J Med Internet Res SP - e38081 VL - 25 KW - virtual care KW - older adults KW - Australia KW - mobile phone N2 - Background: There has been a rapid shift toward the adoption of virtual health care services in Australia. It is unknown how widely virtual care has been implemented or evaluated for the care of older adults in Australia. Objective: We aimed to review the literature evaluating virtual care initiatives for older adults across a wide range of health conditions and modalities and identify key challenges and opportunities for wider adoption at both patient and system levels in Australia. Methods: A scoping review of the literature was conducted. We searched MEDLINE, Embase, PsycINFO, CINAHL, AgeLine, and gray literature (January 1, 2011, to March 8, 2021) to identify virtual care initiatives for older Australians (aged ?65 years). The results were reported according to the World Health Organization?s digital health evaluation framework. Results: Among the 6296 documents in the search results, we identified 94 that reported 80 unique virtual care initiatives. Most (69/80, 89%) were at the pilot stage and targeted community-dwelling older adults (64/79, 81%) with chronic diseases (52/80, 65%). The modes of delivery included videoconference, telephone, apps, device or monitoring systems, and web-based technologies. Most initiatives showed either similar or better health and behavioral outcomes compared with in-person care. The key barriers for wider adoption were physical, cognitive, or sensory impairment in older adults and staffing issues, legislative issues, and a lack of motivation among providers. Conclusions: Virtual care is a viable model of care to address a wide range of health conditions among older adults in Australia. More embedded and integrative evaluations are needed to ensure that virtually enabled care can be used more widely by older Australians and health care providers. UR - https://www.jmir.org/2023/1/e38081 UR - http://dx.doi.org/10.2196/38081 UR - http://www.ncbi.nlm.nih.gov/pubmed/36652291 ID - info:doi/10.2196/38081 ER - TY - JOUR AU - Fakhfakh, Maya AU - Blanchette, Virginie AU - Plourde, V. Karine AU - Gadio, Souleymane AU - Elf, Marie AU - Jones, Allyson C. AU - Meijering, Louise AU - Gigučre, Anik AU - Légaré, France PY - 2023/1/18 TI - Canadian Older Adults? Intention to Use an Electronic Decision Aid for Housing Decisions: Cross-sectional Web-Based Survey JO - JMIR Aging SP - e43106 VL - 6 KW - aged KW - intention KW - decision aid KW - decision support techniques KW - housing KW - unified theory of acceptance and use of technology KW - UTAUT KW - information technology KW - internet KW - shared decision-making N2 - Background: Older adults with disabilities such as loss of autonomy face the decision of whether to stay at home or move to a health care facility such as a nursing home. Therefore, they may need support for this difficult decision. Objective: We assessed the intention of Canadian older adults to use an electronic decision aid (eDA) to make housing decisions and identified the factors that influenced their intention. Methods: We conducted a cross-sectional study using a web-based survey targeting older adults across 10 Canadian provinces and 3 territories. We included respondents from a web-based panel who were aged ?65 years, understood English or French, had access to an electronic device with an internet connection, and had made a housing decision over the past few months or were planning to make a decision in the coming year. We based the web-based survey on the Unified Theory of Acceptance and Use of Technology (UTAUT). We adapted 17 UTAUT items to measure respondents? intention to use the eDA for housing decisions, as well as items measuring 4 intention constructs (performance expectancy, effort expectancy, social influence, and facilitating conditions). We also assessed eHealth literacy using both subjective and objective scales. We used descriptive statistics and multivariable linear regression analyses to identify the factors influencing the intention to use the eDA. Results: Of the 11,972 invited panelists, 1176 (9.82%) met the eligibility criteria, and 1000 (85.03%) respondents completed the survey. The mean age was 72.5 (SD 5.59) years. Most respondents were male (548/1000, 54.8%), White (906/1000, 90.6%), English speakers (629/1000, 62.9%), and lived in Ontario or Quebec (628/1000, 62.8%) and in urban areas (850/1000, 85%). The mean scores were 27.8 (SD 5.88) out of 40 for subjective eHealth literacy and 3.00 (SD 0.97) out of 5 for objective eHealth literacy. In our sample, the intention score was 4.74 (SD 1.7) out of 7. The mean scores of intention constructs out of 7 were 5.63 (SD 1.28) for facilitating conditions, 4.94 (SD 1.48) for performance expectancy, 5.61 (SD 1.35) for effort expectancy, and 4.76 (SD 1.59) for social influence. In the final model, the factors associated with intention included mother tongue (?=.30; P<.001), objective eHealth literacy (?=?.06; P=.03), performance expectancy (?=.55; P<.001), social influence (?=.37; P<.001), and facilitating conditions (?=.15; P<.001). Conclusions: Findings from this pan-Canadian web-based survey on Canadian older adults suggest that their intention to use the eDA to make housing decisions is similar to the findings in other studies using UTAUT. The factors identified as influencing intention were mother tongue, objective eHealth literacy, performance expectancy, social influence, and facilitating conditions. These will guide future strategies for the implementation of the eDA. UR - https://aging.jmir.org/2023/1/e43106 UR - http://dx.doi.org/10.2196/43106 UR - http://www.ncbi.nlm.nih.gov/pubmed/36566499 ID - info:doi/10.2196/43106 ER - TY - JOUR AU - Young, Ruth Stephanie AU - Lattie, Gardiner Emily AU - Berry, L. Andrew B. AU - Bui, Lynn AU - Byrne, Joseph Greg AU - Yoshino Benavente, Noelani Julia AU - Bass, Michael AU - Gershon, C. Richard AU - Wolf, S. Michael AU - Nowinski, J. Cindy PY - 2023/1/10 TI - Remote Cognitive Screening Of Healthy Older Adults for Primary Care With the MyCog Mobile App: Iterative Design and Usability Evaluation JO - JMIR Form Res SP - e42416 VL - 7 KW - human-centered design KW - mobile health KW - mHealth KW - usability KW - cognitive screening KW - older adults KW - mobile phone N2 - Background: Annual cognitive screening in adults aged >65 years can improve early detection of cognitive impairment, yet less than half of all cases are identified in primary care. Time constraints in primary care settings present a major barrier to routine screening. A remote cognitive screener completed on a patient?s own smartphone before a visit has the potential to save primary care clinics time, encourage broader screening practices, and increase early detection of cognitive decline. Objective: We described the iterative design and proposed the implementation of a remote cognitive screening app, MyCog Mobile, to be completed on a patient?s smartphone before an annual wellness visit. The research questions were as follows: What would motivate primary care clinicians and clinic administrators to implement a remote cognitive screening process? How might we design a remote cognitive screener to fit well with existing primary care workflows? What would motivate an older adult patient to complete a cognitive screener on a smartphone before a primary care visit? How might we optimize the user experience of completing a remote cognitive screener on a smartphone for older adults? Methods: To address research questions 1 and 2, we conducted individual interviews with clinicians (n=5) and clinic administrators (n=3). We also collaborated with clinic administrators to create user journey maps of their existing and proposed MyCog Mobile workflows. To address research questions 3 and 4, we conducted individual semistructured interviews with cognitively healthy older adults (n=5) and solicited feedback from a community stakeholder panel (n=11). We also tested and refined high-fidelity prototypes of the MyCog Mobile app with the older adult interview participants, who rated the usability on the Simplified System Usability Scale and After-Scenario Questionnaire. Results: Clinicians and clinic administrators were motivated to adopt a remote cognitive screening process if it saved time in their workflows. Findings from interviews and user journey mapping informed the proposed implementation and core functionality of MyCog Mobile. Older adult participants were motivated to complete cognitive screeners to ensure that they were cognitively healthy and saw additional benefits to remote screening, such as saving time during their visit and privacy. Older adults also identified potential challenges to remote smartphone screening, which informed the user experience design of the MyCog Mobile app. The average rating across prototype versions was 91 (SD 5.18) on the Simplified System Usability Scale and 6.13 (SD 8.40) on the After-Scenario Questionnaire, indicating above-average usability. Conclusions: Through an iterative, human-centered design process, we developed a viable remote cognitive screening app and proposed an implementation strategy for primary care settings that was optimized for multiple stakeholders. The next steps include validating the cognitive screener in clinical and healthy populations and piloting the finalized app in a community primary care clinic. UR - https://formative.jmir.org/2023/1/e42416 UR - http://dx.doi.org/10.2196/42416 UR - http://www.ncbi.nlm.nih.gov/pubmed/36626223 ID - info:doi/10.2196/42416 ER - TY - JOUR AU - Domingos, Josefa AU - Dean, John AU - Fernandes, Belo Júlio AU - Godinho, Catarina PY - 2022/12/22 TI - An Online Dual-Task Cognitive and Motor Exercise Program for Individuals With Parkinson Disease (PD3 Move Program): Acceptability Study JO - JMIR Aging SP - e40325 VL - 5 IS - 4 KW - Parkinson disease KW - dual-task training KW - exercise KW - digital intervention KW - online intervention KW - physical activity KW - physical therapy KW - elder KW - older adult KW - geriatric KW - neurodegenerative KW - adherence KW - acceptability KW - community based KW - group program KW - online program KW - physiotherapy KW - cognitive training online exercise KW - Parkinson's KW - neuromuscular KW - task training KW - physiotherapist KW - motor KW - movement KW - cognitive KW - cognition KW - vocal KW - voice KW - speech N2 - Background: Dual-task training is an emerging field used for people with Parkinson disease (PD) to improve their physical and cognitive well-being, but the patients? acceptability, safety, and adherence to such training in online settings are unknown. Objective: This study aims to evaluate the acceptability of a dual-task cognitive and motor online training program for people with PD as a group online community program. Methods: People with PD were invited to participate in an online program (PD3 Move) consisting of physical and vocal exercises in response to different cognitive challenges displayed as dynamic backgrounds on Zoom. The program ran twice per week for 16 weeks. Patient acceptability was assessed at 4 months by monitoring attendance rates and feedback from an exit questionnaire emailed to all participants assessing satisfaction, perceived benefit, safety, and willingness to continue and recommend to others. Results: The online program was delivered to 15 participants (n=9, 60%, females) with a diagnosis of PD, a mean age of 69.4 (SD 9.3) years, and Hoehn and Yahr (H&Y) stages I-IV. The attendance rate was high, with participants coming to more than 13 (81%) of the sessions. Participants were very satisfied (n=8, 53%) or satisfied (n=7, 47%) with the program. Participants reported that what they most liked were the new cognitive physical challenges. The 3 main facilitators to participating were perceiving the benefits, instructor?s flexibility and engagement, and the social interaction moments with others. The 3 main difficulties were dealing with motor fluctuations (n=3, 20%), difficulties in using technology (n=2, 13%), and difficulty hearing instructions due to hearing loss (n=2, 13%). Patients had favorable perceived benefits of the program, with 14 (93%) considering it very useful for the current management of health and 1 (7%) moderately useful. No adverse events were reported, and all participants said that they were willing to continue the program and recommend it to others. Conclusions: Our findings suggest that the online cognitive and motor program was well received, safe, and perceived to be of benefit to this group of medically stable people with PD in H&Y stages I-IV. Access to specialized care and enhancement of long-term adherence to regular exercise can be achieved with online community group programs. UR - https://aging.jmir.org/2022/4/e40325 UR - http://dx.doi.org/10.2196/40325 UR - http://www.ncbi.nlm.nih.gov/pubmed/36548037 ID - info:doi/10.2196/40325 ER - TY - JOUR AU - Nunes-Da-Silva, Catarina AU - Victorino, André AU - Lemos, Marta AU - Porojan, Ludmila AU - Costa, Andreia AU - Arriaga, Miguel AU - Gregório, Joăo Maria AU - de Sousa, Dinis Rute AU - Rodrigues, Maria Ana AU - Canhăo, Helena PY - 2022/12/7 TI - A Video-Based Mobile App as a Health Literacy Tool for Older Adults Living at Home: Protocol for a Utility Study JO - JMIR Res Protoc SP - e29675 VL - 11 IS - 12 KW - mobile app KW - technology KW - treatment adherence KW - health literacy KW - seniors KW - older adults N2 - Background: People aged ?65 years are more likely to have health problems related to aging, polypharmacy, and low treatment adherence. Moreover, health literacy levels decrease with increasing age. Objective: The aim of this study is to assess an app?s utility in promoting health-related knowledge in people aged ?65 years. Methods: We developed a simple, intuitive, and video-based app (DigiAdherence) that presents a recipe, nutritional counseling, and content on physical activity, cognitive exercise, motivation to adhere to treatment, fall prevention, and health literacy. A convenience sample of 25 older adults attending the Personalized Health Care Unit of Portimăo or the Family Health Unit of Portas do Arade (ACeS Algarve II ? Barlavento, ARS Algarve, Portugal) will be recruited. Subjects must be aged ?65 years, own a smartphone or tablet, be willing to participate, and consent to participate. Those who do not know how to use or do not have a smartphone/tablet will be excluded. Likewise, people with major cognitive or physical impairment as well as those living in a long-term care center will not be included in this study. Participants will have access to the app for 4 weeks and will be evaluated at 3 different timepoints (V0, before they start using the app; V1, after using it for 30 days; and V2, 60 days after stopping using it). After using the app for 30 days, using a 7-point Likert scale, participants will be asked to score the mobile tool?s utility in encouraging them to take their medications correctly, improving quality of life, increasing their health-related knowledge, and preventing falls. They will also be asked to assess the app?s ease of use and visual esthetics, their motivation to use the app, and their satisfaction with the app. Subjects will be assessed in a clinical interview with a semistructured questionnaire, including questions regarding user experience, satisfaction, the utility of the app, quality of life (EQ-5D-3L instrument), and treatment adherence (Morisky scale). The proportion of participants who considered the app useful for their health at V1 and V2 will be analyzed. Regarding quality of life and treatment adherence perceptions, comparisons will be made between V0 and V1, using the t test for dependent samples. The same comparisons will be made between V0 and V2. Results: This study was funded in December 2019 and authorized by the Executive Board of ACeS Algarve II ? Barlavento and by the Ethics Committee of NOVA Medical School (99/2019/CEFCM, June 2020). This protocol was also approved by the Ethics Committee for Health (16/2020, September 2020) and the Executive Board (December 2020) of the Regional Health Administration of the Algarve, IP (Instituto Público). Recruitment was completed in June 2021. Conclusions: Since the next generation of older adults may have higher digital literacy, information and communication technologies could potentially be used to deliver health-related content to improve lifestyles among older adults. International Registered Report Identifier (IRRID): PRR1-10.2196/29675 UR - https://www.researchprotocols.org/2022/12/e29675 UR - http://dx.doi.org/10.2196/29675 UR - http://www.ncbi.nlm.nih.gov/pubmed/36476754 ID - info:doi/10.2196/29675 ER - TY - JOUR AU - Moxley, Jerad AU - Sharit, Joseph AU - Czaja, J. Sara PY - 2022/11/23 TI - The Factors Influencing Older Adults? Decisions Surrounding Adoption of Technology: Quantitative Experimental Study JO - JMIR Aging SP - e39890 VL - 5 IS - 4 KW - aging KW - technology KW - design KW - older adult KW - application KW - independence KW - relationship KW - adopt KW - transportation KW - leisure KW - health KW - learning KW - adoption KW - cognition KW - cognitive KW - willingness KW - marketing KW - consumer KW - mobile phone N2 - Background: The rapid diffusion of technology apps may support older adults? independence and improve the quality of their lives. Models for predicting technology acceptance in older adults are sparse, based on broad questions related to general technology acceptance, and largely not grounded in theories of aging. Objective: This study aimed to use a mixed methods approach involving 5 technologies to comprehensively assess the causal relationships among factors that influence older adults? willingness to adopt the technologies. Methods: In total, 187 men and women aged 65 to 92 years participated in the study. Participants were given presentations on 5 different technologies spanning domains that included transportation, leisure, health, and new learning and provided ratings of each technology on various measures hypothesized to influence adoption. They were also administered other instruments to collect data on their actual and self-assessed cognitive abilities, rates of discounting of the technologies with respect to willingness to invest time to attain higher skills in the technologies, general technology experience, and attitudes toward technology. We used the machine learning technique of k-fold cross-validated regressions to select variables that predicted participants? willingness to adopt the technologies. Results: Willingness to adopt technologies was most impacted by 3 variables: perceived value of the technologies (?=.54), perceived improvement in quality of life attainable from the technologies (?=.24), and confidence in being able to use the technologies (?=.15). These variables, in turn, were mostly facilitated or inhibited by the perceived effort required to learn to use the technologies, a positive attitude toward technology as reflected in the optimism component of the technology readiness scale, the degree to which technologies were discounted, and the perceived help needed to learn to use the technologies. Conclusions: Our findings demonstrate that participants? willingness to adopt technologies is mainly determined by perceptions of 3 aspects of the technologies; these aspects possibly mediate many relationships with willingness to adopt. We discuss the implications of these findings for the design and marketing of technology products for older consumers. UR - https://aging.jmir.org/2022/4/e39890 UR - http://dx.doi.org/10.2196/39890 UR - http://www.ncbi.nlm.nih.gov/pubmed/36416885 ID - info:doi/10.2196/39890 ER - TY - JOUR AU - Boccardi, Alyssa AU - Wu, Fangzheng AU - Pearlman, Jon AU - Mhatre, Anand PY - 2022/10/18 TI - Older Wheelchair Users Recommend Age-Friendly Design Improvements to a Wheelchair Maintenance App: Mixed Methods Development Study JO - JMIR Aging SP - e39301 VL - 5 IS - 4 KW - aging KW - older adults KW - maintenance KW - mobile phone KW - repair KW - smartphone KW - wheelchair N2 - Background: Wheelchair part failures have doubled over the past decade. Preventative wheelchair maintenance reduces wheelchair failures and prevents user consequences. We are developing a smartphone app called WheelTrak, which alerts users when maintenance is required, to encourage maintenance practices and compliance. Objective: This mixed methods study aimed to develop a wheelchair maintenance app using broad stakeholder advice and investigate older adults? interaction experience with the app and their perceived barriers to and facilitators of maintenance. Methods: Interviews were conducted with stakeholders, including mobility device users, to generate needs statements and app specifications. The app was designed in 2 stages. Stage 1 involved the development of the app according to the specifications and evaluation of the app interface by lead users. Stage 2 included the revision of the app screens and manual functionality testing. Usability testing and semistructured interviews were conducted with older wheelchair and scooter users. The System Usability Scale was used to measure app usability. Results: Interviews with power and manual wheelchair users (37/57, 65%), wheelchair service providers (15/57, 26%), manufacturers (2/57, 4%), seating and mobility researchers (1/57, 2%), and insurance plan providers (2/57, 4%) informed the needs and specifications of the app technology. The 2-stage development process delivered a fully functional app that met the design specifications. In total, 12 older adults (mean age 74.2, SD 9.1 years; n=10, 83% women; and n=2, 17% men) participated in the usability testing study. Of the 12 participants, 9 (75%) agreed to use WheelTrak for preventative maintenance. WheelTrak scored an average System Usability Scale score of 60.25 (SD 16). Four overarching themes were identified: WheelTrak app improvements, barriers to maintenance, consequences related to mobility device failure, and smart technology use and acceptance. Older adults preferred the simplicity, readability, personalization, and availability of educational resources in the app. Barriers to maintenance pertained to health issues and lack of maintenance knowledge among older adults. Facilitators of maintenance included notification for maintenance, app connectivity with the service provider, reporting of device failure, and the presence of a caregiver for maintenance. Conclusions: This study highlighted age-friendly design improvements to the app, making it easy to be used and adopted by older wheelchair users. The WheelTrak app has close to average system usability. Additional usability testing will be conducted following app revision in the future. UR - https://aging.jmir.org/2022/4/e39301 UR - http://dx.doi.org/10.2196/39301 UR - http://www.ncbi.nlm.nih.gov/pubmed/36256830 ID - info:doi/10.2196/39301 ER - TY - JOUR AU - Skirrow, Caroline AU - Meszaros, Marton AU - Meepegama, Udeepa AU - Lenain, Raphael AU - Papp, V. Kathryn AU - Weston, Jack AU - Fristed, Emil PY - 2022/9/30 TI - Validation of a Remote and Fully Automated Story Recall Task to Assess for Early Cognitive Impairment in Older Adults: Longitudinal Case-Control Observational Study JO - JMIR Aging SP - e37090 VL - 5 IS - 3 KW - neurology KW - memory KW - episodic KW - speech KW - psychometrics KW - reliability KW - validity KW - aging KW - elder KW - older adult KW - Alzheimer disease KW - mild cognitive impairment KW - mobile apps KW - mobile health KW - mHealth KW - smartphone KW - cognition KW - cognitive decline KW - cognitive impairment KW - development KW - validation KW - recall KW - story KW - stories KW - observational study KW - acceptability KW - usability KW - semantic KW - cognitive test KW - linguistic KW - mobile phone N2 - Background: Story recall is a simple and sensitive cognitive test that is commonly used to measure changes in episodic memory function in early Alzheimer disease (AD). Recent advances in digital technology and natural language processing methods make this test a candidate for automated administration and scoring. Multiple parallel test stimuli are required for higher-frequency disease monitoring. Objective: This study aims to develop and validate a remote and fully automated story recall task, suitable for longitudinal assessment, in a population of older adults with and without mild cognitive impairment (MCI) or mild AD. Methods: The ?Amyloid Prediction in Early Stage Alzheimer?s disease? (AMYPRED) studies recruited participants in the United Kingdom (AMYPRED-UK: NCT04828122) and the United States (AMYPRED-US: NCT04928976). Participants were asked to complete optional daily self-administered assessments remotely on their smart devices over 7 to 8 days. Assessments included immediate and delayed recall of 3 stories from the Automatic Story Recall Task (ASRT), a test with multiple parallel stimuli (18 short stories and 18 long stories) balanced for key linguistic and discourse metrics. Verbal responses were recorded and securely transferred from participants? personal devices and automatically transcribed and scored using text similarity metrics between the source text and retelling to derive a generalized match score. Group differences in adherence and task performance were examined using logistic and linear mixed models, respectively. Correlational analysis examined parallel-forms reliability of ASRTs and convergent validity with cognitive tests (Logical Memory Test and Preclinical Alzheimer?s Cognitive Composite with semantic processing). Acceptability and usability data were obtained using a remotely administered questionnaire. Results: Of the 200 participants recruited in the AMYPRED studies, 151 (75.5%)?78 cognitively unimpaired (CU) and 73 MCI or mild AD?engaged in optional remote assessments. Adherence to daily assessment was moderate and did not decline over time but was higher in CU participants (ASRTs were completed each day by 73/106, 68.9% participants with MCI or mild AD and 78/94, 83% CU participants). Participants reported favorable task usability: infrequent technical problems, easy use of the app, and a broad interest in the tasks. Task performance improved modestly across the week and was better for immediate recall. The generalized match scores were lower in participants with MCI or mild AD (Cohen d=1.54). Parallel-forms reliability of ASRT stories was moderate to strong for immediate recall (mean rho 0.73, range 0.56-0.88) and delayed recall (mean rho=0.73, range=0.54-0.86). The ASRTs showed moderate convergent validity with established cognitive tests. Conclusions: The unsupervised, self-administered ASRT task is sensitive to cognitive impairments in MCI and mild AD. The task showed good usability, high parallel-forms reliability, and high convergent validity with established cognitive tests. Remote, low-cost, low-burden, and automatically scored speech assessments could support diagnostic screening, health care, and treatment monitoring. UR - https://aging.jmir.org/2022/3/e37090 UR - http://dx.doi.org/10.2196/37090 UR - http://www.ncbi.nlm.nih.gov/pubmed/36178715 ID - info:doi/10.2196/37090 ER - TY - JOUR AU - Chen, Wenwen AU - Flanagan, Ashley AU - Nippak, MD Pria AU - Nicin, Michael AU - Sinha, K. Samir PY - 2022/8/10 TI - Understanding the Experience of Geriatric Care Professionals in Using Telemedicine to Care for Older Patients in Response to the COVID-19 Pandemic: Mixed Methods Study JO - JMIR Aging SP - e34952 VL - 5 IS - 3 KW - telemedicine KW - virtual care visit KW - geriatric care professionals KW - aging population KW - Consolidated Framework for Implementation Research KW - geriatric care KW - older adults KW - elderly care KW - telehealth KW - digital health KW - COVID-19 KW - pandemic KW - technology usability N2 - Background: Geriatric care professionals were forced to rapidly adopt the use of telemedicine technologies to ensure the continuity of care for their older patients in response to the COVID-19 pandemic. However, there is little current literature that describes how telemedicine technologies can best be used to meet the needs of geriatric care professionals in providing care to frail older patients, their caregivers, and their families. Objective: This study aims to identify the benefits and challenges geriatric care professionals face when using telemedicine technologies with frail older patients, their caregivers, and their families and how to maximize the benefits of this method of providing care. Methods: This was a mixed methods study that recruited geriatric care professionals to complete an online survey regarding their personal demographics and experiences with using telemedicine technologies and participate in a semistructured interview. Interview responses were analyzed using the Consolidated Framework for Implementation Research (CFIR). Results: Quantitative and qualitative data were obtained from 30 practicing geriatric care professionals (22, 73%, geriatricians, 5, 17%, geriatric psychiatrists, and 3, 10%, geriatric nurse practitioners) recruited from across the Greater Toronto Area. Analysis of interview data identified 5 CFIR contextual barriers (complexity, design quality and packaging, patient needs and resources, readiness for implementation, and culture) and 13 CFIR contextual facilitators (relative advantage, adaptability, tension for change, available resources, access to knowledge, networks and communications, compatibility, knowledge and beliefs, self-efficacy, champions, external agents, executing, and reflecting and evaluating). The CFIR concept of external policy and incentives was found to be a neutral construct. Conclusions: This is the first known study to use the CFIR to develop a comprehensive narrative to characterize the experiences of Ontario geriatric care professionals using telemedicine technologies in providing care. Overall, telemedicine can significantly enable most of the geriatric care that is traditionally provided in person but is less useful in providing specific aspects of geriatric care to frail older patients, their caregivers, and their families. UR - https://aging.jmir.org/2022/3/e34952 UR - http://dx.doi.org/10.2196/34952 UR - http://www.ncbi.nlm.nih.gov/pubmed/35830331 ID - info:doi/10.2196/34952 ER - TY - JOUR AU - Mehrabi, Samira AU - Muńoz, E. John AU - Basharat, Aysha AU - Boger, Jennifer AU - Cao, Shi AU - Barnett-Cowan, Michael AU - Middleton, E. Laura PY - 2022/6/13 TI - Immersive Virtual Reality Exergames to Promote the Well-being of Community-Dwelling Older Adults: Protocol for a Mixed Methods Pilot Study JO - JMIR Res Protoc SP - e32955 VL - 11 IS - 6 KW - virtual reality KW - exergames KW - community-dwelling older adults KW - pilot protocol KW - feasibility KW - well-being KW - physical activity KW - cognition KW - perception KW - mood KW - COVID-19 N2 - Background: Despite the proven benefits of exercise in older adults, challenges such as access and motivation can deter their engagement. Interactive virtual reality (VR) games combined with exercise (exergames) are a plausible strategy to encourage physical activity among this population. However, there has been little research on the feasibility, acceptability, and potential benefits of deploying at-home VR exergames among community-dwelling older adults. Objective: The objectives of this study are to estimate the feasibility, usability, and acceptability of a co-designed VR exergame in community-dwelling older adults; examine intervention feasibility and assessment protocols for a future large-scale trial; and provide pilot data on outcomes of interest (physical activity, exercise self-efficacy, mood, cognition, perception, and gameplay metrics). Methods: The study will be a remote, 6-week intervention comprising an experimental and a control group. A sample of at least 12 community-dwelling older adults (with no or mild cognitive impairment) will be recruited for each group. Both groups will follow the same study procedures and assessment methods. However, the experimental group will engage with a co-designed VR exergame (Seas The Day) thrice weekly for approximately 20 minutes using the Oculus Quest 2 (Facebook Reality Labs) VR headset. The control group will read (instead of playing Seas The Day) thrice weekly for approximately 20 minutes over the 6-week period. A mixed methods evaluation will be used. Changes in physical activity, exercise self-efficacy, mood, cognition, and perception will be compared before and after acute data as well as before and after the 6 weeks between the experimental (exergaming) and control (reading) groups. Qualitative data from postintervention focus groups or interviews and informal notes and reports from all participants will be analyzed to assess the feasibility of the study protocol. Qualitative data from the experimental group will also be analyzed to assess the feasibility, usability, and acceptability of at-home VR exergames and explore perceived facilitators of and barriers to uptaking VR systems among community-dwelling older adults. Results: The screening and recruitment process for the experimental group started in May 2021, and the data collection process will be completed by September 2021. The timeline of the recruitment process for the control group is September 2021 to December 2021. We anticipate an estimated adherence rate of ?80%. Challenges associated with VR technology and the complexity of remote assessments are expected. Conclusions: This pilot study will provide important information on the feasibility, acceptability, and usability of a custom-made VR exergaming intervention to promote older adults? well-being. Findings from this study will be useful to inform the methodology, design, study procedures, and assessment protocol for future large-scale trials of VR exergames with older adults as well as deepen the understanding of remote deployment and at-home use of VR for exercise in older adults. International Registered Report Identifier (IRRID): DERR1-10.2196/32955 UR - https://www.researchprotocols.org/2022/6/e32955 UR - http://dx.doi.org/10.2196/32955 UR - http://www.ncbi.nlm.nih.gov/pubmed/35700014 ID - info:doi/10.2196/32955 ER - TY - JOUR AU - Provencher, Veronique AU - Baillargeon, Dany AU - Abdulrazak, Bessam AU - Boissy, Patrick AU - Levasseur, Mélanie AU - Delli-Colli, Nathalie AU - Pigot, Hélčne AU - Audet, Mélisa AU - Bahrampoor Givi, Sara AU - Girard, Catherine PY - 2022/6/9 TI - Developing a One-Stop Platform Transportation Planning Service to Help Older Adults Move Around in Their Community Where, When, and How They Wish: Protocol for a Living Lab Study JO - JMIR Res Protoc SP - e33894 VL - 11 IS - 6 KW - aged KW - mobility limitation KW - transportation KW - community-based KW - participatory research KW - information system KW - mobility KW - older adults N2 - Background:  Multiple mobility-related challenges frequently appear with aging. As a result, many older adults have difficulty getting around, to go, for example, to doctors? appointments or leisure activities. Although various means of transportation are currently available, older adults do not necessarily use them, partly because they do not know which ones are adapted to their needs and preferences. To foster older adults? autonomy and freedom in their decision-making about transportation, it is crucial to help them make informed decisions about the means that suit them best. Objective: Our aim is to develop Mobilainés, a one-stop platform transportation planning service combining different transport modes and services to help older adults move around in their community where, when, and how they wish. More specifically, we aim to (1) define older adults? mobility needs and preferences in order to conceptualize a one-stop platform; (2) cocreate a prototype of the one-stop platform; and (3) test the prototype with users in a real-life context. Methods: This ongoing study uses a ?Living Lab? co-design approach. This approach differs from traditional research on aging by facilitating intersectoral knowledge sharing and innovative solutions by and with older adults themselves. A steering committee of 8 stakeholders from the public, scientific, and private sectors, as well as older citizens, will meet quarterly throughout the study. The design comprises three phases, each with several iterative subphases. Phase 1 is exploration: through co-design workshops and literature reviews, members of the intersectoral committee will define older adults? mobility needs and preferences to support the conceptualization of the one-stop platform. Phase 2 is experimentation: 4 personas will be produced that reflect the different needs and preferences of typical older adult end users of the platform; for development of a prototype, scenarios and mockups (static designs of the web application) will be created through co-design sessions with older adults (N=12) embodying these personas. Phase 3 is evaluation: we will test the usability of the prototype and document changes in mobility, such as the ability to move around satisfactorily and to participate in meaningful activities, by and with older adults (N=30) who use the prototype. The steering committee will identify ways to support the adoption, implementation, and scaling up of Mobilainés to ensure its sustainability. Qualitative and quantitative data will be triangulated according to each subphase objective. Results:  The first phase began in September 2019. The study is scheduled for completion by mid-2023. Conclusions:  This innovative transportation planning service will merge existing transportation options in one place. By meeting a wide variety of older adults? needs and preferences, Mobilainés will help them feel comfortable and safe when moving around, which should increase their participation in meaningful activities and reduce the risk of social isolation. International Registered Report Identifier (IRRID): DERR1-10.2196/33894 UR - https://www.researchprotocols.org/2022/6/e33894 UR - http://dx.doi.org/10.2196/33894 UR - http://www.ncbi.nlm.nih.gov/pubmed/35679116 ID - info:doi/10.2196/33894 ER - TY - JOUR AU - Miguel Cruz, Antonio AU - Lopez Portillo, Perez Hector AU - Daum, Christine AU - Rutledge, Emily AU - King, Sharla AU - Liu, Lili PY - 2022/5/18 TI - 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 JO - JMIR Aging SP - e37521 VL - 5 IS - 2 KW - usability KW - technology acceptance KW - Unified Theory of Acceptance and Use of Technology KW - UTAUT KW - older adults KW - caregivers KW - health care aides KW - mobile phone N2 - 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 ? 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. UR - https://aging.jmir.org/2022/2/e37521 UR - http://dx.doi.org/10.2196/37521 UR - http://www.ncbi.nlm.nih.gov/pubmed/35583930 ID - info:doi/10.2196/37521 ER - TY - JOUR AU - McCloud, Rachel AU - Perez, Carly AU - Bekalu, Awoke Mesfin AU - Viswanath, K. PY - 2022/5/9 TI - Using Smart Speaker Technology for Health and Well-being in an Older Adult Population: Pre-Post Feasibility Study JO - JMIR Aging SP - e33498 VL - 5 IS - 2 KW - technology KW - older adults KW - communication inequalities KW - digital health KW - elderly population KW - smart technology KW - smart speaker KW - well-being KW - health technology KW - mobile phone N2 - 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. UR - https://aging.jmir.org/2022/2/e33498 UR - http://dx.doi.org/10.2196/33498 UR - http://www.ncbi.nlm.nih.gov/pubmed/35532979 ID - info:doi/10.2196/33498 ER - TY - JOUR AU - Camp, Nicola AU - Johnston, Julie AU - Lewis, C. Martin G. AU - Zecca, Massimiliano AU - Di Nuovo, Alessandro AU - Hunter, Kirsty AU - Magistro, Daniele PY - 2022/5/5 TI - Perceptions of In-home Monitoring Technology for Activities of Daily Living: Semistructured Interview Study With Community-Dwelling Older Adults JO - JMIR Aging SP - e33714 VL - 5 IS - 2 KW - aging KW - wearable sensors KW - environmental sensors KW - social robots KW - activities of daily living KW - older adults KW - elderly KW - robots KW - wearables N2 - 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. UR - https://aging.jmir.org/2022/2/e33714 UR - http://dx.doi.org/10.2196/33714 UR - http://www.ncbi.nlm.nih.gov/pubmed/35511248 ID - info:doi/10.2196/33714 ER - TY - JOUR AU - Timon, M. Claire AU - Heffernan, Emma AU - Kilcullen, M. Sophia AU - Lee, Hyowon AU - Hopper, Louise AU - Quinn, Joe AU - McDonald, David AU - Gallagher, Pamela AU - Smeaton, F. Alan AU - Moran, Kieran AU - Hussey, Pamela AU - Murphy, Catriona PY - 2022/5/5 TI - Development of an Internet of Things Technology Platform (the NEX System) to Support Older Adults to Live Independently: Protocol for a Development and Usability Study JO - JMIR Res Protoc SP - e35277 VL - 11 IS - 5 KW - independent living KW - older adults KW - Internet of Things KW - wearable electronic devices KW - activities of daily living KW - mobile phone N2 - Background: In a rapidly aging population, new and efficient ways of providing health and social support to older adults are required that not only preserve independence but also maintain quality of life and safety. Objective: The NEX project aims to develop an integrated Internet of Things system coupled with artificial intelligence to offer unobtrusive health and wellness monitoring to support older adults living independently in their home environment. The primary objective of this study is to develop and evaluate the technical performance and user acceptability of the NEX system. The secondary objective is to apply machine learning algorithms to the data collected via the NEX system to identify and eventually predict changes in the routines of older adults in their own home environment. Methods: The NEX project commenced in December 2019 and is expected to be completed by August 2022. Mixed methods research (web-based surveys and focus groups) was conducted with 426 participants, including older adults (aged ?60 years), family caregivers, health care professionals, and home care workers, to inform the development of the NEX system (phase 1). The primary outcome will be evaluated in 2 successive trials (the Friendly trial [phase 2] and the Action Research Cycle trial [phase 3]). The secondary objective will be explored in the Action Research Cycle trial (phase 3). For the Friendly trial, 7 older adult participants aged ?60 years and living alone in their own homes for a 10-week period were enrolled. A total of 30 older adult participants aged ?60 years and living alone in their own homes will be recruited for a 10-week data collection period (phase 3). Results: Phase 1 of the project (n=426) was completed in December 2020, and phase 2 (n=7 participants for a 10-week pilot study) was completed in September 2021. The expected completion date for the third project phase (30 participants for the 10-week usability study) is June 2022. Conclusions: The NEX project has considered the specific everyday needs of older adults and other stakeholders, which have contributed to the design of the integrated system. The innovation of the NEX system lies in the use of Internet of Things technologies and artificial intelligence to identify and predict changes in the routines of older adults. The findings of this project will contribute to the eHealth research agenda, focusing on the improvement of health care provision and patient support in home and community environments. International Registered Report Identifier (IRRID): DERR1-10.2196/35277 UR - https://www.researchprotocols.org/2022/5/e35277 UR - http://dx.doi.org/10.2196/35277 UR - http://www.ncbi.nlm.nih.gov/pubmed/35511224 ID - info:doi/10.2196/35277 ER - TY - JOUR AU - Gudala, Meghana AU - Ross, Trail Mary Ellen AU - Mogalla, Sunitha AU - Lyons, Mandi AU - Ramaswamy, Padmavathy AU - Roberts, Kirk PY - 2022/4/28 TI - Benefits of, Barriers to, and Needs for an Artificial Intelligence?Powered Medication Information Voice Chatbot for Older Adults: Interview Study With Geriatrics Experts JO - JMIR Aging SP - e32169 VL - 5 IS - 2 KW - medication information KW - chatbot KW - older adults KW - technology capabilities KW - mobile phone N2 - 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. UR - https://aging.jmir.org/2022/2/e32169 UR - http://dx.doi.org/10.2196/32169 UR - http://www.ncbi.nlm.nih.gov/pubmed/35482367 ID - info:doi/10.2196/32169 ER - TY - JOUR AU - Gooch, Daniel AU - Mehta, Vikram AU - Stuart, Avelie AU - Katz, Dmitri AU - Bennasar, Mohamed AU - Levine, Mark AU - Bandara, Arosha AU - Nuseibeh, Bashar AU - Bennaceur, Amel AU - Price, Blaine PY - 2022/4/27 TI - Designing Tangibles to Support Emotion Logging for Older Adults: Development and Usability Study JO - JMIR Hum Factors SP - e34606 VL - 9 IS - 2 KW - older adults KW - health KW - emotion KW - affect KW - well-being KW - tangible interaction KW - TUI N2 - Background: The global population is aging, leading to shifts in health care needs. In addition to developing technology to support physical health, there is an increasing recognition of the need to consider how technology can support emotional health. This raises the question of how to design devices that older adults can interact with to log their emotions. Objective: We designed and developed 2 novel tangible devices, inspired by existing paper-based scales of emotions. The findings from a field trial of these devices with older adults are reported. Methods: Using interviews, field deployment, and fixed logging tasks, we assessed the developed devices. Results: Our results demonstrate that the tangible devices provided data comparable with standardized psychological scales of emotion. The participants developed their own patterns of use around the devices, and their experience of using the devices uncovered a variety of design considerations. We discuss the difficulty of customizing devices for specific user needs while logging data comparable to psychological scales of emotion. We also highlight the value of reflecting on sparse emotional data. Conclusions: Our work demonstrates the potential for tangible emotional logging devices. It also supports further research on whether such devices can support the emotional health of older adults by encouraging reflection of their emotional state. UR - https://humanfactors.jmir.org/2022/2/e34606 UR - http://dx.doi.org/10.2196/34606 UR - http://www.ncbi.nlm.nih.gov/pubmed/35475781 ID - info:doi/10.2196/34606 ER - TY - JOUR AU - Mao, Alice AU - Tam, Lydia AU - Xu, Audrey AU - Osborn, Kim AU - Sheffrin, Meera AU - Gould, Christine AU - Schillinger, Erika AU - Martin, Marina AU - Mesias, Matthew PY - 2022/4/19 TI - Barriers to Telemedicine Video Visits for Older Adults in Independent Living Facilities: Mixed Methods Cross-sectional Needs Assessment JO - JMIR Aging SP - e34326 VL - 5 IS - 2 KW - telemedicine KW - barriers to access to care KW - older adults KW - eHealth KW - e-visit KW - access KW - accessibility KW - barrier KW - elder KW - gerontology KW - geriatric KW - need assessment KW - mixed method KW - cross-sectional KW - telehealth KW - community care KW - independent living N2 - 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. UR - https://aging.jmir.org/2022/2/e34326 UR - http://dx.doi.org/10.2196/34326 UR - http://www.ncbi.nlm.nih.gov/pubmed/35438648 ID - info:doi/10.2196/34326 ER - TY - JOUR AU - Pang, Ning-Qi AU - Lau, Jerrald AU - Fong, Si-Ying AU - Wong, Yu-Hui Celine AU - Tan, Ker-Kan PY - 2022/3/29 TI - Telemedicine Acceptance Among Older Adult Patients With Cancer: Scoping Review JO - J Med Internet Res SP - e28724 VL - 24 IS - 3 KW - older adult patients KW - cancer KW - telemedicine KW - acceptability KW - satisfaction N2 - Background: Cancer is likely to remain the most prevalent noncommunicable disease in high-income countries with an older population. Interestingly, no review of attitudes toward telemedicine among older adults has been performed. This is likely to be the group most affected by both cancer and the increasing use of technology in health care. Objective: We aimed to map research on the acceptance of telemedicine among older adults who are cancer patients. Methods: We conducted a scoping review. PubMed, EMBASE, PsycINFO, CINAHL, and the Cochrane Central Register of Controlled Trials were systematically searched from inception to September 2020. Articles were included if the study population had a mean or median age ?65 years, with cancer diagnoses and if the study assessed patients? acceptance of a telemedicine intervention. Quantitative, qualitative, and mixed method studies were included. Results: Out of a total of 887 articles that were identified, 19 were included in the review. Interventions were delivered via telephone, videoconference, web portal, mobile app, wearable technology, and text messaging and included teleconsultation, monitoring and follow-up, psychosocial support and nursing care, and prompts. The most often cited facilitating factor was convenience. Other facilitators included an increase in telemedicine care accessibility, previous positive experiences of telemedicine, appropriate technical knowledge and support, decreased cost, physician recommendations, and privacy conferred by the telemedicine intervention. Barriers include a preference for conventional care along with negative perceptions of telemedicine, concerns about technical difficulties, and confidentiality concerns in the adoption of telemedicine. Conclusions: None of the studies explored the ability of tailored interventions to address facilitators and barriers of the acceptance of telemedicine in order to increase its adoption by older adults. Facilitators and barriers will likely differ across different cultural contexts and by type of telemedicine; however, this is a gap in current knowledge. In-depth studies are necessary to determine if interventions could potentially address the barriers identified in this review, to increase acceptability. UR - https://www.jmir.org/2022/3/e28724 UR - http://dx.doi.org/10.2196/28724 UR - http://www.ncbi.nlm.nih.gov/pubmed/35348462 ID - info:doi/10.2196/28724 ER - TY - JOUR AU - Albers, A. Elizabeth AU - Mikal, Jude AU - Millenbah, Ashley AU - Finlay, Jessica AU - Jutkowitz, Eric AU - Mitchell, Lauren AU - Horn, Brenna AU - Gaugler, E. Joseph PY - 2022/3/17 TI - The Use of Technology Among Persons With Memory Concerns and Their Caregivers in the United States During the COVID-19 Pandemic: Qualitative Study JO - JMIR Aging SP - e31552 VL - 5 IS - 1 KW - social isolation KW - dementia KW - caregiving - informal KW - aging in place KW - caregivers KW - aging KW - elderly KW - pandemic KW - COVID-19 KW - mental health KW - technology use KW - health technology N2 - Background: Stay-at-home orders and other public health measures designed to mitigate the spread of COVID-19 have increased isolation among persons with memory concerns (PWMCs: individuals diagnosed with cognitive impairment or Alzheimer disease or related dementias). The pandemic has also exacerbated challenges for family members who care for PWMCs. Although technology has demonstrated the potential to improve the social connections and mental health of PWMCs and their family caregivers (CGs), previous research shows that older adults may be reluctant to adopt new technologies. Objective: We aimed to understand why and how some PWMCs and their CGs altered their use of mainstream technology, such as smartphones and fitness trackers, and assistive technology to adapt to lifestyle changes (eg, increased isolation) during the COVID-19 pandemic. Methods: Using data collected in 20 qualitative interviews from June to August 2020 with 20 PWMCs and family CG dyads, we assessed changes in and barriers to everyday technology use following the implementation of COVID-19 mitigation strategies in the United States. Zoom videoconferencing was utilized to conduct the interviews to protect the health of the participants who were primarily older adults. Results: Using qualitative thematic analysis, we identified 3 themes that explained motivations for using technology during a pandemic: (1) maintaining social connections, (2) alleviating boredom, and (3) increasing CG respite. Results further revealed lingering barriers to PWMC and CG adoption of technologies, including: (1) PWMC dependence upon CGs, (2) low technological literacy, and (3) limitations of existing technology. Conclusions: This in-depth investigation suggests that technology can provide PWMCs with more independence and offer CGs relief from CG burden during periods of prolonged isolation. UR - https://aging.jmir.org/2022/1/e31552 UR - http://dx.doi.org/10.2196/31552 UR - http://www.ncbi.nlm.nih.gov/pubmed/35134748 ID - info:doi/10.2196/31552 ER - TY - JOUR AU - Happe, Lisa AU - Sgraja, Marie AU - Hein, Andreas AU - Diekmann, Rebecca PY - 2022/3/16 TI - Iterative Development and Applicability of a Tablet-Based e-Coach for Older Adults in Rehabilitation Units to Improve Nutrition and Physical Activity: Usability Study JO - JMIR Hum Factors SP - e31823 VL - 9 IS - 1 KW - older adults KW - rehabilitation KW - physical activity KW - nutrition KW - e-coach KW - usability testing KW - tablet computers KW - health behavior KW - mobile phone N2 - Background: Maintaining nutrition and exercise strategies after rehabilitation can be difficult for older people with malnutrition or limited mobility. A technical assistance system such as an e-coach could help to positively influence changes in dietary and exercise behavior and contribute to a sustainable improvement in one?s nutrition and mobility status. Most apps do not provide a combination of nutrition and exercise content. In most cases, these apps were evaluated with healthy individuals aged <70 years, making transferability to vulnerable patients, with functional limitations and an assumed lower affinity for technology, in geriatric rehabilitation unlikely. Objective: This study aims to identify the potential for optimization and enhance usability through iterative test phases to develop a nutrition and mobility e-coach suitable for older adults (?65 years) based on individual health behavior change stages in a rehabilitation setting. Methods: Iterative testing was performed with patients aged ?65 years in a rehabilitation center. During testing, participants used an e-coach prototype with educational elements and active input options on nutrition and mobility as a 1-time application test. The participants performed navigation and comprehension tasks and subsequently provided feedback on the design aspects. Hints were provided by the study team when required, documented, and used for improvements. After testing, the participants were asked to rate the usability of the prototype using the System Usability Scale (SUS). Results: In all, 3 iterative test phases (T1-T3) were conducted with 49 participants (24/49, 49% female; mean 77.8, SD 6.2 years). Improvements were made after each test phase, such as adding explanatory notes on overview screens or using consistent chart types. The use of the user-centered design in this specific target group facilitated an increase in the average SUS score from 69.3 (SD 16.3; median 65) at T1 to 78.1 (SD 11.8; median 82.5) at T3. Fewer hints were required for navigation tasks (T1: 14.1%; T2: 26.5%; T3: 17.2%) than for comprehension questions (T1: 30.5%; T2: 21.6%; T3: 20%). However, the proportion of unsolved tasks, calculated across all participants in all tasks, was higher for navigation tasks (T1: 0%, T2: 15.2%, T3: 4.3%) than for comprehension tasks (T1: 1.9%, T2: 0%, T3: 2.5%). Conclusions: The extensive addition of explanatory sentences and terms, instead of shorter keywords, to make it easier for users to navigate and comprehend the content was a major adjustment. Thus, good usability (SUS: 80th-84th percentile) was achieved using iterative optimizations within the user-centered design. Long-term usability and any possible effects on nutritional and physical activity behavior need to be evaluated in an additional study in which patients should be able to use the e-coach with increasing independence, thereby helping them to gain access to content that could support their long-term behavior change. UR - https://humanfactors.jmir.org/2022/1/e31823 UR - http://dx.doi.org/10.2196/31823 UR - http://www.ncbi.nlm.nih.gov/pubmed/35293874 ID - info:doi/10.2196/31823 ER - TY - JOUR AU - Kim, Sunyoung AU - Yao, Willow AU - Du, Xiaotong PY - 2022/3/8 TI - Exploring Older Adults? Adoption and Use of a Tablet Computer During COVID-19: Longitudinal Qualitative Study JO - JMIR Aging SP - e32957 VL - 5 IS - 1 KW - older adults KW - tablet computer KW - technology acceptance KW - mental model KW - longitudinal study KW - COVID-19 N2 - Background: As mobile computing technology evolves, such as smartphones and tablet computers, it increasingly offers features that may be particularly beneficial to older adults. However, the digital divide exists, and many older adults have been shown to have difficulty using these devices. The COVID-19 pandemic has magnified how much older adults need but are excluded from having access to technologies to meet essential daily needs and overcome physical distancing restrictions. Objective: This study sought to understand how older adults who had never used a tablet computer learn to use it, what they want to use it for, and what barriers they experience as they continue to use it during social isolation caused by the COVID-19 pandemic. Methods: We conducted a series of semistructured interviews with eight people aged 65 years and older for 16 weeks, investigating older novice users? adoption and use of a tablet computer during the nationwide lockdown due to COVID-19. Results: Participants were gradually yet successfully accustomed to using a tablet computer to serve various daily needs, including entertainment, social connectedness, and information-seeking. However, this success was not achieved through developing sufficient digital skills but rather by applying the methods they were already familiar with in its operation, such as taking and referring to instruction notes. Conclusions: Our findings imply that older adults without digital literacy can still benefit from a digital device for quality of later life if proper traditional methods they are already familiar with are offered in its use. UR - https://aging.jmir.org/2022/1/e32957 UR - http://dx.doi.org/10.2196/32957 UR - http://www.ncbi.nlm.nih.gov/pubmed/35134747 ID - info:doi/10.2196/32957 ER - TY - JOUR AU - Thangavel, Gomathi AU - Memedi, Mevludin AU - Hedström, Karin PY - 2022/3/7 TI - Customized Information and Communication Technology for Reducing Social Isolation and Loneliness Among Older Adults: Scoping Review JO - JMIR Ment Health SP - e34221 VL - 9 IS - 3 KW - social isolation KW - loneliness KW - review KW - ICT KW - older adults KW - customization KW - mobile phone N2 - Background: Advancements in science and various technologies have resulted in people having access to better health care, a good quality of life, and better economic situations, enabling humans to live longer than ever before. Research shows that the problems of loneliness and social isolation are common among older adults, affecting psychological and physical health. Information and communication technology (ICT) plays an important role in alleviating social isolation and loneliness. Objective: The aim of this review is to explore ICT solutions for reducing social isolation or loneliness among older adults, the purpose of ICT solutions, and the evaluation focus of these solutions. This study particularly focuses on customized ICT solutions that either are designed from scratch or are modifications of existing off-the-shelf products that cater to the needs of older adults. Methods: A scoping literature review was conducted. A search across 7 databases, including ScienceDirect, Association for Computing Machinery, PubMed, IEEE Xplore, PsycINFO, Scopus, and Web of Science, was performed, targeting ICT solutions for reducing and managing social isolation and loneliness among older adults. Articles published in English from 2010 to 2020 were extracted and analyzed. Results: From the review of 39 articles, we identified 5 different purposes of customized ICT solutions focusing on reducing social isolation and loneliness. These were social communication, social participation, a sense of belonging, companionship, and feelings of being seen. The mapping of purposes of ICT solutions with problems found among older adults indicates that increasing social communication and social participation can help reduce social isolation problems, whereas fulfilling emotional relationships and feeling valued can reduce feelings of loneliness. In terms of customized ICT solution types, we found the following seven different categories: social network, messaging services, video chat, virtual spaces or classrooms with messaging capabilities, robotics, games, and content creation and management. Most of the included studies (30/39, 77%) evaluated the usability and acceptance aspects, and few studies (11/39, 28%) focused on loneliness or social isolation outcomes. Conclusions: This review highlights the importance of discussing and managing social isolation and loneliness as different but related concepts and emphasizes the need for future research to use suitable outcome measures for evaluating ICT solutions based on the problem. Even though a wide range of customized ICT solutions have been developed, future studies need to explore the recent emerging technologies, such as the Internet of Things and augmented or virtual reality, to tackle social isolation and loneliness among older adults. Furthermore, future studies should consider evaluating social isolation or loneliness while developing customized ICT solutions to provide more robust data on the effectiveness of the solutions. UR - https://mental.jmir.org/2022/3/e34221 UR - http://dx.doi.org/10.2196/34221 UR - http://www.ncbi.nlm.nih.gov/pubmed/35254273 ID - info:doi/10.2196/34221 ER - TY - JOUR AU - Koh, Qi Wei AU - Whelan, Sally AU - Heins, Pascale AU - Casey, Dympna AU - Toomey, Elaine AU - Dröes, Rose-Marie PY - 2022/2/22 TI - The Usability and Impact of a Low-Cost Pet Robot for Older Adults and People With Dementia: Qualitative Content Analysis of User Experiences and Perceptions on Consumer Websites JO - JMIR Aging SP - e29224 VL - 5 IS - 1 KW - social robot KW - pet robots KW - low-cost robot KW - dementia KW - older adults KW - qualitative research KW - qualitative content analysis N2 - Background: Worldwide, populations are aging exponentially. Older adults and people with dementia are especially at risk of social isolation and loneliness. Social robots, including robotic pets, have had positive impacts on older adults and people with dementia by providing companionship, improving mood, reducing agitation, and facilitating social interaction. Nevertheless, the issue of affordability can hinder technology access. The Joy for All (JfA) robotic pets have showed promise as examples of low-cost alternatives. However, there has been no research that investigated the usability and impact of such low-cost robotic pets based on perceptions and experiences of its use with older adults and people with dementia. Objective: The aim of our study was to explore the usability and impact of the JfA robotic cat, as an example of a low-cost robot, based on perceptions and experiences of using the JfA cat for older adults and people with dementia. Methods: We used a novel methodology of analyzing a large volume of information that was uploaded by reviewers of the JfA cat onto online consumer review sites. Data were collected from 15 consumer websites. This provided a total of 2445 reviews. Next, all reviews were screened. A total of 1327 reviews that contained information about use of the JfA cat for older adults or people with dementia were included for analysis. These were reviews that contained terms relating to ?older adults,? ?dementia,? and ?institutional care? and were published in the English language. Descriptive statistics was used to characterize available demographic information, and textual data were qualitatively analyzed using inductive content analysis. Results: Most reviews were derived from consumer sites in the United States, and most reviewers were family members of users (ie, older adults and people with dementia). Based on the qualitative content analysis, 5 key themes were generated: prior expectations, perceptions, meaningful activities, impacts, and practicalities. Reviewers had prior expectations of the JfA cat, which included circumstantial reasons that prompted them to purchase this technology. Their perceptions evolved after using the technology, where most reported positive perceptions about their appearance and interactivity. The use of the robot provided opportunities for users to care for it and incorporate it into their routine. Finally, reviewers also shared information about the impacts of device and practicalities related to its use. Conclusions: This study provides useful knowledge about the usability and impact of a low-cost pet robot, based on experiences and perceptions of its use. These findings can help researchers, robot developers, and clinicians understand the viability of using low-cost robotic pets to benefit older adults and people with dementia. Future research should consider evaluating design preferences for robotic pets, and compare the effects of low-cost robotic pets with other more technologically advanced robotic pets. UR - https://aging.jmir.org/2022/1/e29224 UR - http://dx.doi.org/10.2196/29224 UR - http://www.ncbi.nlm.nih.gov/pubmed/35191844 ID - info:doi/10.2196/29224 ER - TY - JOUR AU - Garcia, P. Angely AU - De La Vega, F. Shelley AU - Mercado, P. Susan PY - 2022/2/14 TI - Health Information Systems for Older Persons in Select Government Tertiary Hospitals and Health Centers in the Philippines: Cross-sectional Study JO - J Med Internet Res SP - e29541 VL - 24 IS - 2 KW - health information systems KW - the Philippines KW - aged KW - hospitals KW - community health centers KW - database KW - geriatric assessment KW - elderly KW - digital health KW - medical records KW - health policy N2 - Background: The rapid aging of the world?s population requires systems that support health facilities? provision of integrated care at multiple levels of the health care system. The use of health information systems (HISs) at the point of care has shown positive effects on clinical processes and patient health in several settings of care. Objective: We sought to describe HISs for older persons (OPs) in select government tertiary hospitals and health centers in the Philippines. Specifically, we aimed to review the existing policies and guidelines related to HISs for OPs in the country, determine the proportion of select government hospitals and health centers with existing health information specific for OPs, and describe the challenges related to HISs in select health facilities. Methods: We utilized the data derived from the findings of the Focused Interventions for Frail Older Adults Research and Development Project (FITforFrail), a cross-sectional and ethics committee?approved study. A facility-based listing of services and human resources specific to geriatric patients was conducted in purposively sampled 27 tertiary government hospitals identified as geriatric centers and 16 health centers across all regions in the Philippines. We also reviewed the existing policies and guidelines related to HISs for OPs in the country. Results: Based on the existing guidelines, multiple agencies were involved in the provision of services for OPs, with several records containing health information of OPs. However, there is no existing HIS specific for OPs in the country. Only 14 (52%) of the 27 hospitals and 4 (25%) of the 16 health centers conduct comprehensive geriatric assessment (CGA). All tertiary hospitals and health centers are able to maintain medical records of their patients, and almost all (26/27, 96%) hospitals and all (16/16, 100%) health centers have data on top causes of morbidity and mortality. Meanwhile, the presence of specific disease registries varied per hospitals and health centers. Challenges to HISs include the inability to update databases due to inadequately trained personnel, use of an offline facility?based HIS, an unstable internet connection, and technical issues and nonuniform reporting of categories for age group classification. Conclusions: Current HISs for OPs are characterized by fragmentation, multiple sources, and inaccessibility. Barriers to achieving appropriate HISs for OPs include the inability to update HISs in hospitals and health centers and a lack of standardization by age group and disease classification. Thus, we recommend a 1-person, 1-record electronic medical record system for OPs and the disaggregation and analysis across demographic and socioeconomic parameters to inform policies and programs that address the complex needs of OPs. CGA as a required routine procedure for all OPs and its integration with the existing HISs in the country are also recommended. UR - https://www.jmir.org/2022/2/e29541 UR - http://dx.doi.org/10.2196/29541 UR - http://www.ncbi.nlm.nih.gov/pubmed/35156927 ID - info:doi/10.2196/29541 ER - TY - JOUR AU - Stargatt, Jennifer AU - Bhar, Sunil AU - Bhowmik, Jahar AU - Al Mahmud, Abdullah PY - 2022/1/12 TI - Digital Storytelling for Health-Related Outcomes in Older Adults: Systematic Review JO - J Med Internet Res SP - e28113 VL - 24 IS - 1 KW - digital storytelling KW - mental health KW - aging KW - dementia KW - reminiscence KW - memory KW - systematic review KW - older adults N2 - Background: Older adults face a unique set of challenges and may experience a range of psychological comorbidities. Digital storytelling is an emerging tool for sharing and recording lived experiences and may have the potential to support well-being but is yet to be systematically reviewed for use among older adults. Objective: The aim of this review is to examine the methods for creating digital stories, the health-related outcomes associated with creating digital stories, and the potential for implementing digital storytelling with older adults. Methods: We systematically searched electronic databases to identify articles published in English that reported on at least one health-related outcome of digital storytelling for participants aged ?60 years. Data were extracted and synthesized using qualitative content analysis and summarized in tables. The methodological quality of the studies was assessed using the Mixed Methods Appraisal Tool. Results: A total of 8 studies were included in the review. Participants were primarily community-dwelling older adults living with dementia, involving family caregivers and professional care staff. Studies have taken various approaches to digital storytelling and reported diverse benefits associated with digital storytelling, including improvements in mood, memory, social engagement, and quality of relationships. Although the potential for implementation was not widely examined, some studies have presented evidence for acceptability and feasibility. Generally, studies were of high quality, despite the absence of comparator groups and confounder analyses. Conclusions: The evidence reviewed suggests that despite the various approaches taken, digital storytelling shows promise as an effective approach for supporting well-being in older adults. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42019145922; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019145922 International Registered Report Identifier (IRRID): RR2-10.2196/15512 UR - https://www.jmir.org/2022/1/e28113 UR - http://dx.doi.org/10.2196/28113 UR - http://www.ncbi.nlm.nih.gov/pubmed/35019845 ID - info:doi/10.2196/28113 ER - TY - JOUR AU - Zaman, Bin Sojib AU - Khan, Kabir Raihan AU - Evans, G. Roger AU - Thrift, G. Amanda AU - Maddison, Ralph AU - Islam, Shariful Sheikh Mohammed PY - 2022/1/7 TI - Exploring Barriers to and Enablers of the Adoption of Information and Communication Technology for the Care of Older Adults With Chronic Diseases: Scoping Review JO - JMIR Aging SP - e25251 VL - 5 IS - 1 KW - older adults KW - gerontechnology KW - usability challenges KW - chronic disease KW - information technology KW - mobile phone N2 - Background: Information and communication technology (ICT) offers considerable potential for supporting older adults in managing their health, including chronic diseases. However, there are mixed opinions about the benefits and effectiveness of ICT interventions for older adults with chronic diseases. Objective: We aim to map the use of ICT interventions in health care and identified barriers to and enablers of its use among older adults with chronic disease. Methods: A scoping review was conducted using 5 databases (Ovid MEDLINE, Embase, Scopus, PsycINFO, and ProQuest) to identify eligible articles from January 2000 to July 2020. Publications incorporating the use of ICT interventions, otherwise known as eHealth, such as mobile health, telehealth and telemedicine, decision support systems, electronic health records, and remote monitoring in people aged ?55 years with chronic diseases were included. We conducted a strengths, weaknesses, opportunities, and threats framework analysis to explore the implied enablers of and barriers to the use of ICT interventions. Results: Of the 1149 identified articles, 31 (2.7%; n=4185 participants) met the inclusion criteria. Of the 31 articles, 5 (16%) mentioned the use of various eHealth interventions. A range of technologies was reported, including mobile health (8/31, 26%), telehealth (7/31, 23%), electronic health record (2/31, 6%), and mixed ICT interventions (14/31, 45%). Various chronic diseases affecting older adults were identified, including congestive heart failure (9/31, 29%), diabetes (7/31, 23%), chronic respiratory disease (6/31, 19%), and mental health disorders (8/31, 26%). ICT interventions were all designed to help people self-manage chronic diseases and demonstrated positive effects. However, patient-related and health care provider?related challenges, in integrating ICT interventions in routine practice, were identified. Barriers to using ICT interventions in older adults included knowledge gaps, a lack of willingness to adopt new skills, and reluctance to use technologies. Implementation challenges related to ICT interventions such as slow internet connectivity and lack of an appropriate reimbursement policy were reported. Advantages of using ICT interventions include their nonpharmacological nature, provision of health education, encouragement for continued physical activity, and maintenance of a healthy diet. Participants reported that the use of ICT was a fun and effective way of increasing their motivation and supporting self-management tasks. It gave them reassurance and peace of mind by promoting a sense of security and reducing anxiety. Conclusions: ICT interventions have the potential to support the care of older adults with chronic diseases. However, they have not been effectively integrated with routine health care. There is a need to improve awareness and education about ICT interventions among those who could benefit from them, including older adults, caregivers, and health care providers. More sustainable funding is required to promote the adoption of ICT interventions. We recommend involving clinicians and caregivers at the time of designing ICT interventions. UR - https://aging.jmir.org/2022/1/e25251 UR - http://dx.doi.org/10.2196/25251 UR - http://www.ncbi.nlm.nih.gov/pubmed/34994695 ID - info:doi/10.2196/25251 ER - TY - JOUR AU - Jacobson, L. Claire AU - Foster, C. Lauren AU - Arul, Hari AU - Rees, Amanda AU - Stafford, S. Randall PY - 2021/12/23 TI - A Digital Health Fall Prevention Program for Older Adults: Feasibility Study JO - JMIR Form Res SP - e30558 VL - 5 IS - 12 KW - older adults KW - accidental falls KW - fall prevention KW - digital health KW - technology KW - exercise KW - longevity and healthy aging KW - program evaluation KW - aging KW - elderly KW - health strategy N2 - Background: About 1 in 3 adults aged 65 and older falls annually. Exercise interventions are effective in reducing the fall risk and fall rate among older adults. In 2020, startup company Age Bold Inc. disseminated the Bold Fall Prevention Program, aiming to reduce falls among older adults through a remotely delivered, digital exercise program. Objective: We conducted a feasibility study to assess the delivery of the Bold Fall Prevention Program remotely and evaluate the program's impact on 2 primary outcomes?annualized fall rate and weekly minutes of physical activity (PA)?over 6 months of follow-up. Methods: Older adults at high risk of falling were screened and recruited for the feasibility study via nationwide digital advertising strategies. Self-reported outcomes were collected via surveys administered at the time of enrollment and after 3 and 6 months. Responses were used to calculate changes in the annualized fall rate and minutes of PA per week. Results: The remote delivery of a progressive digital fall prevention program and associated research study, including remote recruitment, enrollment, and data collection, was deemed feasible. Participants successfully engaged at home with on-demand video exercise classes, self-assessments, and online surveys. We enrolled 65 participants, of whom 48 (74%) were women, and the average participant age was 72.6 years. Of the 65 participants, 54 (83%) took at least 1 exercise class, 40 (62%) responded to at least 1 follow-up survey at either 3 or 6 months, 20 (31%) responded to both follow-up surveys, and 25 (39%) were lost to follow-up. Among all participants who completed at least 1 follow-up survey, weekly minutes of PA increased by 182% (ratio change=2.82, 95% CI 1.26-6.37, n=35) from baseline and annualized falls per year decreased by 46% (incidence rate ratio [IRR]=0.54, 95% CI 0.32-0.90, n=40). Among only 6-month survey responders (n=31, 48%), weekly minutes of PA increased by 206% (ratio change=3.06, 95% CI 1.43-6.55) from baseline to 6 months (n=30, 46%) and the annualized fall rate decreased by 28% (IRR=0.72, 95% CI 0.42-1.23) from baseline to 6 months. Conclusions: The Bold Fall Prevention Program provides a feasible strategy to increase PA and reduce the burden of falls among older adults. UR - https://formative.jmir.org/2021/12/e30558 UR - http://dx.doi.org/10.2196/30558 UR - http://www.ncbi.nlm.nih.gov/pubmed/34837492 ID - info:doi/10.2196/30558 ER - TY - JOUR AU - Davies, Karen AU - Cheraghi-Sohi, Sudeh AU - Ong, Nio Bie AU - Perryman, Katherine AU - Sanders, Caroline PY - 2021/12/20 TI - Co-designing an Adaption of a Mobile App to Enhance Communication, Safety, and Well-being Among People Living at Home With Early-Stage Dementia: Protocol for an Exploratory Multiple Case Study JO - JMIR Res Protoc SP - e19543 VL - 10 IS - 12 KW - design research KW - co-design KW - dementia KW - mobile app KW - communication KW - safety KW - mobile phone N2 - Background: There is a growing interest in using mobile apps to support communication, safety, and well-being. Evidence directly from people with dementia regarding the usability, usefulness, and relevance of mobile apps is limited. Objective: This paper describes the protocol of a study that will evaluate an app designed for supporting communication, safety, and well-being among people living with dementia. The study aims to understand if the app can enhance safety through improved communication among users. Methods: The study will use participatory qualitative methods over 3 cycles of evaluation with co-designers (service users, their families, and care practitioners). The study will be developed in partnership with a specialist home care service in England. Purposive case selection will be performed to ensure that the cases exemplify differences in experiences. The app will be evaluated in a walk-through workshop by people living with early-stage dementia and then trialed at home by up to 12 families in a try-out cycle. An amended version will be evaluated in a final walk-through workshop during cycle 3. Data will be collected from at least 4 data sources during the try-out phase and analyzed thematically. An explanatory multiple case study design will be used to synthesize and present the evidence from the three cycles, drawing on the Normalization Process Theory to support the interpretation of the findings. Results: The study is ready to be implemented, but it was paused to protect vulnerable individuals during the COVID-19 pandemic in 2020. The findings will be particularly relevant for understanding how to support vulnerable people living in the community during social distancing and the period following the pandemic as well as for providing insight into the challenges of social isolation that arise from living with dementia. Conclusions: Evaluating a mobile app for enhancing communication, safety, and well-being among people living with dementia contributes to the key ambitions enshrined in policy and practice?championing the use of digital technology and supporting people with dementia to live safely in their own homes. The study will involve co-designers living with dementia, so that the voices of service users can be used to highlight the benefits and challenges of assistive technology and shape the future development of apps that enhance safety by improving communication. International Registered Report Identifier (IRRID): PRR1-10.2196/19543 UR - https://www.researchprotocols.org/2021/12/e19543 UR - http://dx.doi.org/10.2196/19543 UR - http://www.ncbi.nlm.nih.gov/pubmed/34932011 ID - info:doi/10.2196/19543 ER - TY - JOUR AU - Doyle, Julie AU - Murphy, Emma AU - Gavin, Shane AU - Pascale, Alessandra AU - Deparis, Stéphane AU - Tommasi, Pierpaolo AU - Smith, Suzanne AU - Hannigan, Caoimhe AU - Sillevis Smitt, Myriam AU - van Leeuwen, Cora AU - Lastra, Julia AU - Galvin, Mary AU - McAleer, Patricia AU - Tompkins, Lorraine AU - Jacobs, An AU - M Marques, Marta AU - Medina Maestro, Jaime AU - Boyle, Gordon AU - Dinsmore, John PY - 2021/12/15 TI - A Digital Platform to Support Self-management of Multiple Chronic Conditions (ProACT): Findings in Relation to Engagement During a One-Year Proof-of-Concept Trial JO - J Med Internet Res SP - e22672 VL - 23 IS - 12 KW - digital health KW - aging KW - multimorbidity KW - chronic disease KW - self-management KW - integrated care KW - longitudinal study KW - engagement KW - usability KW - mobile phone N2 - Background: Populations globally are ageing, resulting in higher incidence rates of chronic diseases. Digital health platforms, designed to support those with chronic conditions to self-manage at home, offer a promising solution to help people monitor their conditions and lifestyle, maintain good health, and reduce unscheduled clinical visits. However, despite high prevalence rates of multimorbidity or multiple chronic conditions, most platforms tend to focus on a single disease. A further challenge is that despite the importance of users actively engaging with such systems, little research has explored engagement. Objective: The objectives of this study are to design and develop a digital health platform, ProACT, for facilitating older adults self-managing multimorbidity, with support from their care network, and evaluate end user engagement and experiences with this platform through a 12-month trial. Methods: The ProACT digital health platform is presented in this paper. The platform was evaluated in a year-long proof-of-concept action research trial with 120 older persons with multimorbidity in Ireland and Belgium. Alongside the technology, participants had access to a clinical triage service responding to symptom alerts and a technical helpdesk. Interactions with the platform during the trial were logged to determine engagement. Semistructured interviews were conducted with participants and analyzed using inductive thematic analysis, whereas usability and user burden were examined using validated questionnaires. Results: This paper presents the ProACT platform and its components, along with findings on engagement with the platform and its usability. Of the 120 participants who participated, 24 (20%) withdrew before the end of the study, whereas 3 (2.5%) died. The remaining 93 participants actively used the platform until the end of the trial, on average, taking 2 or 3 health readings daily over the course of the trial in Ireland and Belgium, respectively. The participants reported ProACT to be usable and of low burden. Findings from interviews revealed that participants experienced multiple benefits as a result of using ProACT, including improved self-management, health, and well-being and support from the triage service. For those who withdrew, barriers to engagement were poor health and frustration when technology, in particular sensing devices, did not work as expected. Conclusions: This is the first study to present findings from a longitudinal study of older adults using digital health technology to self-manage multimorbidity. Our findings show that older adults sustained engagement with the technology and found it usable. Potential reasons for these results include a strong focus on user-centered design and engagement throughout the project lifecycle, resulting in a platform that meets user needs, as well as the integration of behavior change techniques and personal analytics into the platform. The provision of triage and technical support services alongside the platform during the trial were also important facilitators of engagement. International Registered Report Identifier (IRRID): RR2-10.2196/22125 UR - https://www.jmir.org/2021/12/e22672 UR - http://dx.doi.org/10.2196/22672 UR - http://www.ncbi.nlm.nih.gov/pubmed/34914612 ID - info:doi/10.2196/22672 ER - TY - JOUR AU - Dinsmore, John AU - Hannigan, Caoimhe AU - Smith, Suzanne AU - Murphy, Emma AU - Kuiper, L. Janneke M. AU - O'Byrne, Emma AU - Galvin, Mary AU - Jacobs, An AU - Sillevis Smitt, Myriam AU - van Leeuwen, Cora AU - McAleer, Patricia AU - Tompkins, Lorraine AU - Brady, Anne-Marie AU - McCarron, Mary AU - Doyle, Julie PY - 2021/12/15 TI - A Digital Health Platform for Integrated and Proactive Patient-Centered Multimorbidity Self-management and Care (ProACT): Protocol for an Action Research Proof-of-Concept Trial JO - JMIR Res Protoc SP - e22125 VL - 10 IS - 12 KW - multimorbidity KW - digital health KW - chronic disease KW - self-management KW - older adults KW - integrated care KW - behaviour change KW - mobile phone KW - smart phone KW - smart device N2 - Background: Multimorbidity is defined as the presence of two or more chronic diseases and associated comorbidities. There is a need to improve best practices around the provision of well-coordinated, person-centered care for persons with multimorbidities. Present health systems across the European Union (EU) focus on supporting a single-disease framework of care; the primary challenge is to create a patient-centric, integrated care ecosystem to understand and manage multimorbidity. ProACT is a large-scale project funded by the European Commission under the Horizon 2020 programme, that involved the design, development, and evaluation of a digital health platform to improve and advance home-based integrated care, and supported self-management, for older adults (aged ?65 years) living with multimorbidity. Objective: This paper describes the trial implementation protocol of a proof-of-concept digital health platform (ProACT) in 2 EU member states (Ireland and Belgium) to support older persons with multimorbidities self-managing at home, supported by their care network (CN). Methods: Research was conducted across 2 EU member states, Ireland and Belgium. A 12-month action research trial design, divided into 3 evaluation cycles and lasting 3 months each, with a reflective redesign and development phase of 1 month after cycles 1 and 2 was conducted. Participants were 120 (60/120, 50% in Ireland and 60/120, 50% in Belgium) older persons with multimorbidities diagnosed with two or more of the following chronic conditions: diabetes, chronic obstructive pulmonary disease, chronic heart failure, and cardiovascular diseases. With permission from persons with multimorbidities, members of their CN were invited to participate in the study. Persons with multimorbidities were provided with ProACT technologies (tablet, devices, or sensors) to support them in self-managing their conditions. CN members also received access to an app to remotely support their persons with multimorbidity. Qualitative and quantitative feedback and evaluation data from persons with multimorbidity and CN participants were collected across four time points: baseline (T1), at the end of each 3-month action research cycle (T2 and T3), and in a final posttrial interview (T4). Thematic analysis was used to analyze the qualitative interview data. Quantitative data were analyzed via platform use statistics (to assess engagement) and standardized questionnaires (using descriptive and inferential statistics). This study is approved by the ethics committees of Ireland and Belgium. Results: The trial implementation phase for this 44-month (2016-2019) funded study was April 2018 to June 2019. The trial outcomes are at various stages of publication since 2021. Conclusions: ProACT aims to co-design and develop a digital intervention with persons with multimorbidities and their CN, incorporating clinical guidelines with the state of the art in human-computer interaction, behavioral science, health psychology, and data analytic methods to deliver a digital health platform to advance self-management of multimorbidity at home, as part of a proactive, integrated model of supported person-centered care. International Registered Report Identifier (IRRID): RR1-10.2196/22125 UR - https://www.researchprotocols.org/2021/12/e22125 UR - http://dx.doi.org/10.2196/22125 UR - http://www.ncbi.nlm.nih.gov/pubmed/34914613 ID - info:doi/10.2196/22125 ER - TY - JOUR AU - Gell, Nancy AU - Hoffman, Elise AU - Patel, Kushang PY - 2021/12/9 TI - Technology Support Challenges and Recommendations for Adapting an Evidence-Based Exercise Program for Remote Delivery to Older Adults: Exploratory Mixed Methods Study JO - JMIR Aging SP - e27645 VL - 4 IS - 4 KW - tele-exercise KW - technology KW - older adults KW - adult learning theory KW - knee osteoarthritis KW - mobile phone N2 - Background: Tele-exercise has emerged as a means for older adults to participate in group exercise during the COVID-19 pandemic. However, little is known about the technology support needs of older adults for accessing tele-exercise. Objective: This study aims to examine the needs of older adults for transition to tele-exercise, identify barriers to and facilitators of tele-exercise uptake and continued participation, and describe technology support challenges and successes encountered by older adults starting tele-exercise. Methods: We used an exploratory, sequential mixed methods study design. Participants were older adults with symptomatic knee osteoarthritis (N=44) who started participating in a remotely delivered program called Enhance Fitness. Before the start of the classes, a subsample of the participants (n=10) completed semistructured phone interviews about their technology support needs and the barriers to and facilitators for technology adoption. All of the participants completed the surveys including the Senior Technology Acceptance Model scale and a technology needs assessment. The study team recorded the technology challenges encountered and the attendance rates for 48 sessions delivered over 16 weeks. Results: Four themes emerged from the interviews: participants desire features in a tele-exercise program that foster accountability, direct access to helpful people who can troubleshoot and provide guidance with technology is important, opportunities to participate in high-value activities motivate willingness to persevere through the technology concerns, and belief in the ability to learn new things supersedes technology-related frustration. Among the participants in the tele-exercise classes (mean age 74, SD 6.3 years; 38/44, 86% female; mean 2.5, SD 0.9 chronic conditions), 71% (31/44) had a computer with a webcam, but 41% (18/44) had little or no experience with videoconferencing. The initial technology orientation sessions lasted on average 19.3 (SD 10.3) minutes, and 24% (11/44) required a follow-up assistance call. During the first 2 weeks of tele-exercise, 47% of participants (21/44) required technical assistance, which decreased to 12% (5/44) during weeks 3 to 16. The median attendance was 100% for the first 6 sessions and 93% for the subsequent 42 sessions. Conclusions: With appropriate support, older adults can successfully participate in tele-exercise. Recommendations include individualized technology orientation sessions, experiential learning, and availability of standby technical assistance, particularly during the first 2 weeks of classes. Continued development of best practices in this area may allow previously hard-to-reach populations of older adults to participate in health-enhancing, evidence-based exercise programs. UR - https://aging.jmir.org/2021/4/e27645 UR - http://dx.doi.org/10.2196/27645 UR - http://www.ncbi.nlm.nih.gov/pubmed/34889743 ID - info:doi/10.2196/27645 ER - TY - JOUR AU - Steele Gray, Carolyn AU - Chau, Edward AU - Tahsin, Farah AU - Harvey, Sarah AU - Loganathan, Mayura AU - McKinstry, Brian AU - Mercer, W. Stewart AU - Nie, Xin Jason AU - Palen, E. Ted AU - Ramsay, Tim AU - Thavorn, Kednapa AU - Upshur, Ross AU - Wodchis, P. Walter PY - 2021/12/2 TI - Assessing the Implementation and Effectiveness of the Electronic Patient-Reported Outcome Tool for Older Adults With Complex Care Needs: Mixed Methods Study JO - J Med Internet Res SP - e29071 VL - 23 IS - 12 KW - older adults KW - goal-oriented care KW - quality of life KW - self-management KW - primary care KW - eHealth KW - pragmatic trial KW - mobile phone N2 - Background: Goal-oriented care is being adopted to deliver person-centered primary care to older adults with multimorbidity and complex care needs. Although this model holds promise, its implementation remains a challenge. Digital health solutions may enable processes to improve adoption; however, they require evaluation to determine feasibility and impact. Objective: This study aims to evaluate the implementation and effectiveness of the electronic Patient-Reported Outcome (ePRO) mobile app and portal system, designed to enable goal-oriented care delivery in interprofessional primary care practices. The research questions driving this study are as follows: Does ePRO improve quality of life and self-management in older adults with complex needs? What mechanisms are likely driving observed outcomes? Methods: A multimethod, pragmatic randomized controlled trial using a stepped-wedge design and ethnographic case studies was conducted over a 15-month period in 6 comprehensive primary care practices across Ontario with a target enrollment of 176 patients. The 6 practices were randomized into either early (3-month control period; 12-month intervention) or late (6-month control period; 9-month intervention) groups. The primary outcome measure of interest was the Assessment of Quality of Life-4D (AQoL-4D). Data were collected at baseline and at 3 monthly intervals for the duration of the trial. Ethnographic data included observations and interviews with patients and providers at the midpoint and end of the intervention. Outcome data were analyzed using linear models conducted at the individual level, accounting for cluster effects at the practice level, and ethnographic data were analyzed using qualitative description and framework analysis methods. Results: Recruitment challenges resulted in fewer sites and participants than expected; of the 176 target, only 142 (80.6%) patients were identified as eligible to participate because of lower-than-expected provider participation and fewer-than-expected patients willing to participate or perceived as ready to engage in goal-setting. Of the 142 patients approached, 45 (32%) participated. Patients set a variety of goals related to self-management, mental health, social health, and overall well-being. Owing to underpowering, the impact of ePRO on quality of life could not be definitively assessed; however, the intervention group, ePRO plus usual care (mean 15.28, SD 18.60) demonstrated a nonsignificant decrease in quality of life (t24=?1.20; P=.24) when compared with usual care only (mean 21.76, SD 2.17). The ethnographic data reveal a complex implementation process in which the meaningfulness (or coherence) of the technology to individuals? lives and work acted as a key driver of adoption and tool appraisal. Conclusions: This trial experienced many unexpected and significant implementation challenges related to recruitment and engagement. Future studies could be improved through better alignment of the research methods and intervention to the complex and diverse clinical settings, dynamic goal-oriented care process, and readiness of provider and patient participants. Trial Registration: ClinicalTrials.gov NCT02917954; https://clinicaltrials.gov/ct2/show/NCT02917954 UR - https://www.jmir.org/2021/12/e29071 UR - http://dx.doi.org/10.2196/29071 UR - http://www.ncbi.nlm.nih.gov/pubmed/34860675 ID - info:doi/10.2196/29071 ER - TY - JOUR AU - Kunonga, Patience Tafadzwa AU - Spiers, Frances Gemma AU - Beyer, R. Fiona AU - Hanratty, Barbara AU - Boulton, Elisabeth AU - Hall, Alex AU - Bower, Peter AU - Todd, Chris AU - Craig, Dawn PY - 2021/11/24 TI - Effects of Digital Technologies on Older People?s Access to Health and Social Care: Umbrella Review JO - J Med Internet Res SP - e25887 VL - 23 IS - 11 KW - digital health KW - social care KW - access KW - older adults KW - review of reviews KW - umbrella review N2 - Background: The 2020 COVID-19 pandemic prompted the rapid implementation of new and existing digital technologies to facilitate access to health and care services during physical distancing. Older people may be disadvantaged in that regard if they are unable to use or have access to smartphones, tablets, computers, or other technologies. Objective: In this study, we synthesized evidence on the impact of digital technologies on older adults? access to health and social services. Methods: We conducted an umbrella review of systematic reviews published from January 2000 to October 2019 using comprehensive searches of 6 databases. We looked for reviews in a population of adults aged ?65 years in any setting, reporting outcomes related to the impact of technologies on access to health and social care services. Results: A total of 7 systematic reviews met the inclusion criteria, providing data from 77 randomized controlled trials and 50 observational studies. All of them synthesized findings from low-quality primary studies, 2 of which used robust review methods. Most of the reviews focused on digital technologies to facilitate remote delivery of care, including consultations and therapy. No studies examined technologies used for first contact access to care, such as online appointment scheduling. Overall, we found no reviews of technology to facilitate first contact access to health and social care such as online appointment booking systems for older populations. Conclusions: The impact of digital technologies on equitable access to services for older people is unclear. Research is urgently needed in order to understand the positive and negative consequences of digital technologies on health care access and to identify the groups most vulnerable to exclusion. UR - https://www.jmir.org/2021/11/e25887 UR - http://dx.doi.org/10.2196/25887 UR - http://www.ncbi.nlm.nih.gov/pubmed/34821564 ID - info:doi/10.2196/25887 ER - TY - JOUR AU - Pan, Jing AU - Dong, Hua AU - Bryan-Kinns, Nick PY - 2021/11/19 TI - Perception and Initial Adoption of Mobile Health Services of Older Adults in London: Mixed Methods Investigation JO - JMIR Aging SP - e30420 VL - 4 IS - 4 KW - older adults KW - mHealth KW - initial adoption KW - technology acceptance KW - design KW - mobile phone N2 - Background: Advances in mobile technology and public needs have resulted in the emergence of mobile health (mHealth) services. Despite the potential benefits of mHealth apps, older adults face challenges and barriers in adopting them. Objective: The aims of this study are to understand older adults? perception of mHealth services and to discover the barriers that older adults face in the initial adoption of mHealth apps. Methods: This paper systematically analyzed main determinants related to mHealth services and investigated them through questionnaires, interviews, and a workshop. Two studies were carried out in London. In study 1, the questionnaires with follow-up interviews were conducted based on the literature review to uncover older adults? perception (including perceived usefulness, perceived ease of use, and perceived behavioral control) of mHealth services. Study 2 was a workshop helping older adults to trial selected mHealth apps. The workshop was conducted by the first author (JP) with assistance from 5 research students. The barriers that older adults faced in the initial adoption period were observed. The interviews and workshop were audiotaped and transcribed. Descriptive statistics and the thematic analysis technique were used for data analysis. Results: In total, 30 older adults in London completed the questionnaires and interviews in study 1. The results of study 1 show that the lack of obvious advantage, low reliability, scary information, and the risk of privacy leakage would decrease older adults? perceived usefulness of mHealth services; the design of app interface would directly affect the perceived ease of use; and aging factors, especially the generation gap, would create barriers for older users. In total, 12 participants took part in the workshop of study 2, including 8 who took part in study 1. The results of study 2 identified that access to technology, the way of interaction, the risk of money loss, heavy workload of using an mHealth app, and different lifestyle are influential factors to older adults? adoption of mHealth services. Conclusions: The perceptions of mHealth services of older adults were investigated; the barriers that older adults may face in the initial adoption stage were identified. On the basis of the synthesis of these results, design suggestions were proposed, including technical improvement, free trial, information clarification, and participatory design. They will help inform the design of mHealth services to benefit older adults. UR - https://aging.jmir.org/2021/4/e30420 UR - http://dx.doi.org/10.2196/30420 UR - http://www.ncbi.nlm.nih.gov/pubmed/34807836 ID - info:doi/10.2196/30420 ER - TY - JOUR AU - Hill, R. Jordan AU - Brown, C. Janetta AU - Campbell, L. Noll AU - Holden, J. Richard PY - 2021/11/2 TI - Usability-In-Place?Remote Usability Testing Methods for Homebound Older Adults: Rapid Literature Review JO - JMIR Form Res SP - e26181 VL - 5 IS - 11 KW - mobile usability testing KW - usability inspection KW - methods KW - aging KW - literature synthesis KW - usability study KW - mobile usability KW - elderly KW - older adults KW - remote usability KW - mobility restriction N2 - Background: Technology can benefit older adults in many ways, including by facilitating remote access to services, communication, and socialization for convenience or out of necessity when individuals are homebound. As people, especially older adults, self-quarantined and sheltered in place during the COVID-19 pandemic, the importance of usability-in-place became clear. To understand the remote use of technology in an ecologically valid manner, researchers and others must be able to test usability remotely. Objective: Our objective was to review practical approaches for and findings about remote usability testing, particularly remote usability testing with older adults. Methods: We performed a rapid review of the literature and reported on available methods, their advantages and disadvantages, and practical recommendations. This review also reported recommendations for usability testing with older adults from the literature. Results: Critically, we identified a gap in the literature?a lack of remote usability testing methods, tools, and strategies for older adults, despite this population?s increased remote technology use and needs (eg, due to disability or technology experience). We summarized existing remote usability methods that were found in the literature as well as guidelines that are available for conducting in-person usability testing with older adults. Conclusions: We call on the human factors research and practice community to address this gap to better support older adults and other homebound or mobility-restricted individuals. UR - https://formative.jmir.org/2021/11/e26181 UR - http://dx.doi.org/10.2196/26181 UR - http://www.ncbi.nlm.nih.gov/pubmed/34726604 ID - info:doi/10.2196/26181 ER - TY - JOUR AU - Kelleher, Jessica AU - Zola, Stuart AU - Cui, Xiangqin AU - Chen, Shiyu AU - Gerber, Caroline AU - Parker, Willis Monica AU - Davis, Crystal AU - Law, Sidney AU - Golden, Matthew AU - Vaughan, P. Camille PY - 2021/10/19 TI - Personalized Visual Mapping Assistive Technology to Improve Functional Ability in Persons With Dementia: Feasibility Cohort Study JO - JMIR Aging SP - e28165 VL - 4 IS - 4 KW - aging KW - ageing KW - impaired memory KW - assistive technology KW - assistive technologies KW - function KW - assistive devices KW - cognition KW - cognitive KW - activities of daily living KW - mobile technology KW - mobile technologies KW - dementia KW - Alzheimer N2 - Background: Mobile health (mHealth) apps using novel visual mapping assistive technology can allow users to develop personalized maps that aid people living with cognitive impairment in the recall of steps needed to independently complete activities of daily living (ADLs), such as bathing, toileting, and dressing. Objective: This study aims to determine the feasibility and preliminary impact of an mHealth assistive technology app providing guidance to aid individuals living with cognitive impairment in the recall of steps to independently complete ADLs. Methods: A total of 14 Veterans (mean age 65 SD 9.5 years; 14/14, 100% male; 10/14, 71.4% Black) and 8 non-Veterans (mean age 78, SD 10.3 years; 5/8, 62.5% male; 8/8, 100% Black) were recruited and enrolled from the Department of Veterans Affairs (VA) and non-VA cognitive care clinics. A visual mapping software program, MapHabit, was used to generate a series of personalized visual map templates focused on ADLs created within the MapHabit app. The visual maps were accessed through a tablet device. A 19-item exit questionnaire was administered to the participants to assess perceived improvement in their functional ability after using the MapHabit system for 3 months. Results: A total of 13 (93%) VA clinic participants and 8 (100%) non-VA clinic participants completed the 3-month study. Baseline cognitive testing indicated impaired to significantly impaired cognitive function. After 3 months of using the MapHabit system, VA clinic participants reported perceived improvement in social engagement (P=.01) and performance of ADLs (P=.05) compared to the baseline, whereas non-VA clinic participants reported improvements in the performance of ADLs (P=.02), mood (P=.04), social engagement (P=.02), and memory (P=.02). All study participants reported they would recommend the MapHabit system to a colleague, and 85% (11/14) of VA and 100% (8/8) of non-VA clinic participants reported a willingness to participate in a future study. Conclusions: Older VA and non-VA clinic participants with cognitive impairment were willing to use an mHealth app to assist with the completion of ADLs, and they reported positive preliminary effects. A larger study is warranted to assess the efficacy in the setting of a randomized controlled trial. UR - https://aging.jmir.org/2021/4/e28165 UR - http://dx.doi.org/10.2196/28165 UR - http://www.ncbi.nlm.nih.gov/pubmed/34269690 ID - info:doi/10.2196/28165 ER - TY - JOUR AU - Henrique, Bazzanello Patrícia Paula AU - Perez, Pelle Fabrízzio Martin AU - Becker, Cemin Osvaldo Henrique AU - Bellei, Andrei Ericles AU - Biduski, Daiana AU - Korb, Arthiese AU - Pochmann, Daniela AU - Dani, Caroline AU - Elsner, Rostirola Viviane AU - De Marchi, Bertoletti Ana Carolina PY - 2021/10/13 TI - Kinesiotherapy With Exergaming as a Potential Modulator of Epigenetic Marks and Clinical Functional Variables of Older Women: Protocol for a Mixed Methods Study JO - JMIR Res Protoc SP - e32729 VL - 10 IS - 10 KW - elderly women KW - exergame KW - epigenome KW - cognition KW - kinesiotherapy N2 - Background: Kinesiotherapy is an option to mitigate worsening neuropsychomotor function due to human aging. Moreover, exergames are beneficial for the practice of physical therapy by older patients. Physical exercise interventions are known to alter the epigenome, but little is known about their association with exergames. Objective: We aim to evaluate the effects of kinesiotherapy with exergaming on older women?s epigenetic marks and cognitive ability, as well as on their clinical functional variables. Our hypothesis states that this kind of therapy can elicit equal or even better outcomes than conventional therapy. Methods: We will develop a virtual clinic exergame with 8 types of kinesiotherapy exercises. Afterward, we will conduct a 1:1 randomized clinical trial to compare the practice of kinesiotherapy with exergames (intervention group) against conventional kinesiotherapy (control group). A total of 24 older women will be enrolled for 1-hour sessions performed twice a week, for 6 weeks, totaling 12 sessions. We will assess outcomes using epigenetic blood tests, the Montreal Cognitive Assessment test, the Timed Up and Go test, muscle strength grading in a hydraulic dynamometer, and the Game Experience Questionnaire at various stages. Results: The project was funded in October 2019. Game development took place in 2020. Patient recruitment and a clinical trial are planned for 2021. Conclusions: Research on this topic is likely to significantly expand the understanding of kinesiotherapy and the impact of exergames. To the best of our knowledge, this may be one of the first studies exploring epigenetic outcomes of exergaming interventions. Trial Registration: Brazilian Clinical Trials Registry/Registro Brasileiro de Ensaios Clínicos (ReBEC) RBR-9tdrmw; https://ensaiosclinicos.gov.br/rg/RBR-9tdrmw. International Registered Report Identifier (IRRID): DERR1-10.2196/32729 UR - https://www.researchprotocols.org/2021/10/e32729 UR - http://dx.doi.org/10.2196/32729 UR - http://www.ncbi.nlm.nih.gov/pubmed/34643543 ID - info:doi/10.2196/32729 ER - TY - JOUR AU - Kang, Min-gu AU - Kang, Seong-Ji AU - Roh, Hye-Kang AU - Jung, Hwa-Young AU - Kim, Sun?wook AU - Choi, Jung-Yeon AU - Kim, Kwang-il PY - 2021/10/11 TI - Accuracy and Diversity of Wearable Device?Based Gait Speed Measurement Among Older Men: Observational Study JO - J Med Internet Res SP - e29884 VL - 23 IS - 10 KW - gait speed KW - sarcopenia KW - skeletal muscle mass KW - wearable device N2 - Background: Gait speed measurements are widely used in clinical practice, as slow gait is a major predictor of frailty and a diagnostic criterion for sarcopenia. With the development of wearable devices, it is possible to estimate the gait speed in daily life by simply wearing the device. Objective: This study aims to accurately determine the characteristics of daily life gait speed and analyze their association with sarcopenia. Methods: We invited community-dwelling men aged >50 years who had visited the outpatient clinic at a tertiary university hospital to participate in the study. Daily life gait speed was assessed using a wearable smart belt (WELT) for a period of 4 weeks. Data from participants who wore the smart belt for at least 10 days during this period were included. After 4 weeks, data from a survey about medical and social history, usual gait speed measurements, handgrip strength measurements, and dual-energy x-ray absorptiometry were analyzed. Results: A total of 217,578 daily life gait speed measurements from 106 participants (mean age 71.1, SD 7.6 years) were analyzed. The mean daily life gait speed was 1.23 (SD 0.26) m/s. The daily life gait speed of the participants varied according to the time of the day and day of the week. Daily life gait speed significantly slowed down with age (P<.001). Participants with sarcopenia had significantly lower mean daily life gait speed (mean 1.12, SD 0.11 m/s) than participants without sarcopenia (mean 1.23, SD 0.08 m/s; P<.001). Analysis of factors related to mean daily life gait speed showed that age and skeletal muscle mass of the lower limbs were significantly associated characteristics. Conclusions: More diverse and accurate information about gait speed can be obtained by measuring daily life gait speed using a wearable device over an appropriate period, compared with one-time measurements performed in a laboratory setting. Importantly, in addition to age, daily life gait speed is significantly associated with skeletal muscle mass of the lower limbs. UR - https://www.jmir.org/2021/10/e29884 UR - http://dx.doi.org/10.2196/29884 UR - http://www.ncbi.nlm.nih.gov/pubmed/34633293 ID - info:doi/10.2196/29884 ER - TY - JOUR AU - Ehn, Maria AU - Richardson, X. Matt AU - Landerdahl Stridsberg, Sara AU - Redekop, Ken AU - Wamala-Andersson, Sarah PY - 2021/10/11 TI - Mobile Safety Alarms Based on GPS Technology in the Care of Older Adults: Systematic Review of Evidence Based on a General Evidence Framework for Digital Health Technologies JO - J Med Internet Res SP - e27267 VL - 23 IS - 10 KW - GPS KW - older adults KW - dementia KW - evidence KW - digital health KW - NICE KW - mobile phone N2 - Background: GPS alarms aim to support users in independent activities. Previous systematic reviews have reported a lack of clear evidence of the effectiveness of GPS alarms for the health and welfare of users and their families and for social care provision. As GPS devices are currently being implemented in social care, it is important to investigate whether the evidence of their clinical effectiveness remains insufficient. Standardized evidence frameworks have been developed to ensure that new technologies are clinically effective and offer economic value. The frameworks for analyzing existing evidence of the clinical effectiveness of GPS devices can be used to identify the risks associated with their implementation and demonstrate key aspects of successful piloting or implementation. Objective: The principal aim of this study is to provide an up-to-date systematic review of evidence based on existing studies of the effects of GPS alarms on health, welfare, and social provision in the care of older adults compared with non?GPS-based standard care. In addition, the study findings were assessed by using the evidence standards framework for digital health technologies (DHTs) established by the National Institute for Health and Care Excellence (NICE) in the United Kingdom. Methods: This review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Primary studies published in peer-reviewed journals and gray literature from January 2005 to August 2020 were identified through searches in 13 databases and several sources of gray literature. Included studies had individuals (aged ?50 years) who were receiving social care for older adults or for persons with dementia; used GPS devices as an intervention; were performed in Canada, the United States, European Union, Singapore, Australia, New Zealand, Hong Kong, South Korea, or Japan; and addressed quantitative outcomes related to health, welfare, and social care. The study findings were analyzed by using the NICE framework requirements for active monitoring DHTs. Results: Of the screened records, 1.6% (16/986) were included. Following the standards of the NICE framework, practice evidence was identified for the tier 1 categories Relevance to current pathways in health/social care system and Acceptability with users, and minimum evidence was identified for the tier 1 category Credibility with health, social care professionals. However, several evidence categories for tiers 1 and 2 could not be assessed, and no clear evidence demonstrating effectiveness could be identified. Thus, the evidence required for using DHTs to track patient location according to the NICE framework was insufficient. Conclusions: Evidence of the beneficial effects of GPS alarms on the health and welfare of older adults and social care provision remains insufficient. This review illustrated the application of the NICE framework in analyses of evidence, demonstrated successful piloting and acceptability with users of GPS devices, and identified implications for future research. UR - https://www.jmir.org/2021/10/e27267 UR - http://dx.doi.org/10.2196/27267 UR - http://www.ncbi.nlm.nih.gov/pubmed/34633291 ID - info:doi/10.2196/27267 ER - TY - JOUR AU - Shade, Marcia AU - Rector, Kyle AU - Kupzyk, Kevin PY - 2021/9/28 TI - Voice Assistant Reminders and the Latency of Scheduled Medication Use in Older Adults With Pain: Descriptive Feasibility Study JO - JMIR Form Res SP - e26361 VL - 5 IS - 9 KW - adherence KW - pain medications KW - older adults KW - reminders KW - mHealth KW - voice assistants N2 - Background: Pain is difficult to manage in older adults. It has been recommended that pain management in older adults should include both nonpharmacologic and pharmacologic strategies. Unfortunately, nonadherence to pain medication is more prevalent than nonadherence to any other chronic disease treatment. Technology-based reminders have some benefit for medication adherence, but adherence behavior outcomes have mostly been verified by self-reports. Objective: We aimed to describe objective medication adherence and the latency of medication use after a voice assistant reminder prompted participants to take pain medications for chronic pain. Methods: A total of 15 older adults created a voice assistant reminder for taking scheduled pain medications. A subsample of 5 participants were randomly selected to participate in a feasibility study, in which a medication event monitoring system for pain medications was used to validate medication adherence as a health outcome. Data on the subsample?s self-assessed pain intensity, pain interference, concerns and necessity beliefs about pain medications, self-confidence in managing pain, and medication implementation adherence were analyzed. Results: In the 5 participants who used the medication event monitoring system, the overall latency between voice assistant reminder deployment and the medication event (ie, medication bottle cap opening) was 55 minutes. The absolute latency (before or after the reminder) varied among the participants. The shortest average time taken to open the cap after the reminder was 17 minutes, and the longest was 4.5 hours. Of the 168 voice assistant reminders for scheduled pain medications, 25 (14.6%) resulted in the opening of MEMS caps within 5 minutes of the reminder, and 107 (63.7%) resulted in the opening of MEMS caps within 30 minutes of the reminder. Conclusions: Voice assistant reminders may help cue patients to take scheduled medications, but the timing of medication use may vary. The timing of medication use may influence treatment effectiveness. Tracking the absolute latency time of medication use may be a helpful method for assessing medication adherence. Medication event monitoring may provide additional insight into medication implementation adherence during the implementation of mobile health interventions. UR - https://formative.jmir.org/2021/9/e26361 UR - http://dx.doi.org/10.2196/26361 UR - http://www.ncbi.nlm.nih.gov/pubmed/34581677 ID - info:doi/10.2196/26361 ER - TY - JOUR AU - Park, Sulki AU - Kum, Hye-Chung AU - Morrisey, A. Michael AU - Zheng, Qi AU - Lawley, A. Mark PY - 2021/9/6 TI - Adherence to Telemonitoring Therapy for Medicaid Patients With Hypertension: Case Study JO - J Med Internet Res SP - e29018 VL - 23 IS - 9 KW - telemedicine KW - hypertension KW - Medicaid KW - blood pressure KW - pulse KW - telemonitoring KW - mobile phone N2 - Background: Almost 50% of the adults in the United States have hypertension. Although clinical trials indicate that home blood pressure monitoring can be effective in managing hypertension, the reported results might not materialize in practice because of patient adherence problems. Objective: The aims of this study are to characterize the adherence of Medicaid patients with hypertension to daily telemonitoring, identify the impacts of adherence reminder calls, and investigate associations with blood pressure control. Methods: This study targeted Medicaid patients with hypertension from the state of Texas. A total of 180 days of blood pressure and pulse data in 2016-2018 from a telemonitoring company were analyzed for mean transmission rate and mean blood pressure change. The first 30 days of data were excluded because of startup effects. The protocols required the patients to transmit readings by a specified time daily. Patients not transmitting their readings received an adherence reminder call to troubleshoot problems and encourage transmission. The patients were classified into adherent and nonadherent cohorts; adherent patients were those who transmitted data on at least 80% of the days. Results: The mean patient age was 73.2 (SD 11.7) years. Of the 823 patients, 536 (65.1%) were women, and 660 (80.2%) were urban residents. The adherent cohort (475/823, 57.7%) had mean transmission rates of 74.9% before the adherence reminder call and 91.3% after the call, whereas the nonadherent cohort (348/823, 42.3%) had mean transmission rates of 39% and 58% before and after the call, respectively. From month 1 to month 5, the transmission rates dropped by 1.9% and 10.2% for the adherent and nonadherent cohorts, respectively. The systolic and diastolic blood pressure values improved by an average of 2.2 and 0.7 mm Hg (P<.001 and P=.004), respectively, for the adherent cohort during the study period, whereas only the systolic blood pressure value improved by an average of 1.6 mm Hg (P=.02) for the nonadherent cohort. Conclusions: Although we found that patients can achieve high levels of adherence, many experience adherence problems. Although adherence reminder calls help, they may not be sufficient. Telemonitoring lowered blood pressure, as has been observed in clinical trials. Furthermore, blood pressure control was positively associated with adherence. UR - https://www.jmir.org/2021/9/e29018 UR - http://dx.doi.org/10.2196/29018 UR - http://www.ncbi.nlm.nih.gov/pubmed/34486977 ID - info:doi/10.2196/29018 ER - TY - JOUR AU - Colomina, Jordi AU - Drudis, Reis AU - Torra, Montserrat AU - Pallisó, Francesc AU - Massip, Mireia AU - Vargiu, Eloisa AU - Nadal, Nuria AU - Fuentes, Araceli AU - Ortega Bravo, Marta AU - Miralles, Felip AU - Barbé, Ferran AU - Torres, Gerard AU - de Batlle, Jordi AU - PY - 2021/9/2 TI - Implementing mHealth-Enabled Integrated Care for Complex Chronic Patients With Osteoarthritis Undergoing Primary Hip or Knee Arthroplasty: Prospective, Two-Arm, Parallel Trial JO - J Med Internet Res SP - e28320 VL - 23 IS - 9 KW - mHealth KW - osteoarthritis KW - arthroplasty KW - health plan implementation KW - chronic disease KW - mobile phone N2 - Background: Osteoarthritis is a disabling condition that is often associated with other comorbidities. Total hip or knee arthroplasty is an effective surgical treatment for osteoarthritis when indicated, but comorbidities can impair their results by increasing complications and social and economic costs. Integrated care (IC) models supported by eHealth can increase efficiency through defragmentation of care and promote patient-centeredness. Objective: This study aims to assess the effectiveness and cost-effectiveness of implementing a mobile health (mHealth)?enabled IC model for complex chronic patients undergoing primary total hip or knee arthroplasty. Methods: As part of the Horizon 2020 Personalized Connected Care for Complex Chronic Patients (CONNECARE) project, a prospective, pragmatic, two-arm, parallel implementation trial was conducted in the rural region of Lleida, Catalonia, Spain. For 3 months, complex chronic patients undergoing total hip or knee arthroplasty and their caregivers received the combined benefits of the CONNECARE organizational IC model and the eHealth platform supporting it, consisting of a patient self-management app, a set of integrated sensors, and a web-based platform connecting professionals from different settings, or usual care (UC). We assessed changes in health status (12-item short-form survey [SF-12]), unplanned visits and admissions during a 6-month follow-up, and the incremental cost-effectiveness ratio. Results: A total of 29 patients were recruited for the mHealth-enabled IC arm, and 30 patients were recruited for the UC arm. Both groups were statistically comparable for baseline characteristics, such as age; sex; type of arthroplasty; and Charlson index, American Society of Anesthesiologists classification, Barthel index, Hospital Anxiety and Depression scale, Western Ontario and McMaster Universities Osteoarthritis Index, and Pfeiffer mental status questionnaire scores. Patients in both groups had significant increases in the SF-12 physical domain and total SF-12 score, but differences in differences between the groups were not statistically significant. IC patients had 50% fewer unplanned visits (P=.006). Only 1 hospital admission was recorded during the follow-up (UC arm). The IC program generated savings in different cost scenarios, and the incremental cost-effectiveness ratio demonstrated cost-effectiveness. Conclusions: Chronic patients undergoing hip or knee arthroplasty can benefit from the implementation of patient-centered mHealth-enabled IC models aimed at empowering patients and facilitating transitions from specialized hospital care to primary care. Such models can reduce unplanned contacts with the health system and reduce overall health costs, proving to be cost-effective. Overall, our findings support the notion of system-wide cross-organizational care pathways supported by mHealth as a successful way to implement IC for patients undergoing elective surgery. UR - https://www.jmir.org/2021/9/e28320 UR - http://dx.doi.org/10.2196/28320 UR - http://www.ncbi.nlm.nih.gov/pubmed/34473068 ID - info:doi/10.2196/28320 ER - TY - JOUR AU - Lapierre, Nolwenn AU - Um Din, Nathavy AU - Igout, Manuella AU - Chevrier, Joël AU - Belmin, Joël PY - 2021/8/26 TI - Effects of a Rehabilitation Program Using a Patient-Personalized Exergame on Fear of Falling and Risk of Falls in Vulnerable Older Adults: Protocol for a Randomized Controlled Group Study JO - JMIR Res Protoc SP - e24665 VL - 10 IS - 8 KW - older adult KW - fall KW - fear of falling KW - exergame KW - randomized controlled trial KW - psychomotor therapy KW - rehabilitation KW - fear KW - risk KW - elderly KW - protocol KW - therapy N2 - Background: Older adults often experience physical, sensory, and cognitive decline. Therefore, they have a high risk of falls, which leads to severe health and psychological consequences and can induce fear of falling. Rehabilitation programs using exergames to prevent falls are being increasingly studied. Medimoov is a movement-based patient-personalized exergame for rehabilitation in older adults. A preliminary study showed that its use may influence functional ability and motivation. Most existing studies that evaluate the use of exergames do not involve an appropriate control group and do not focus on patient-personalized exergames. Objective: This study aims to evaluate the effects of Medimoov on risk of falls and fear of falling in older adults compared with standard psychomotor rehabilitation. Methods: This is a serial, comparative, randomized controlled group study. Both groups (n=25 in each) will receive psychomotor rehabilitation care. However, the methods of delivery will be different; one group will be exposed to the Medimoov exergame platform, and the other only to traditional means of psychomotor rehabilitation. The selection criteria will be (1) age of 65 years or older, (2) ability to answer a questionnaire, (3) ability to stand in a bipedal position for at least 1 minute, (4) score of 13 or greater on the Short Fall Efficacy Scale, and (5) stable medical condition. An evaluation will be made prior to starting the intervention, after 4 weeks of intervention, and at the end of the intervention (after 8 weeks), and it will focus on (1) risk of falls, (2) fear of falling, and (3) cognitive evaluations. Physical activity outside the session will also be assessed by actimetry. The outcome assessment will be performed according to intention-to-treat analysis. Results: The protocol (2019-11-22) has been approved by the Comité de Protection des Personnes Nord-Ouest I?Université de Rouen (2019-A00395-52), which is part of the French national ethical committee. The study received funding in February 2020. As of October 2020 (submission date), and due to the context of the COVID-19 pandemic, a total of 10 participants out of 50 had been enrolled in the study. The projected date for the end of the data collection is December 2021. Data analyses have not been started yet, and publication of the results is expected for Spring 2022. Conclusions: The effects of psychomotor rehabilitation using the Medimoov exergame platform on the risk and fear of falls will be evaluated. This pilot study will be the basis for larger trials. Trial Registration: ClinicalTrials.gov NCT04134988; https://clinicaltrials.gov/ct2/show/NCT04134988 International Registered Report Identifier (IRRID): DERR1-10.2196/24665 UR - https://www.researchprotocols.org/2021/8/e24665 UR - http://dx.doi.org/10.2196/24665 UR - http://www.ncbi.nlm.nih.gov/pubmed/34435968 ID - info:doi/10.2196/24665 ER - TY - JOUR AU - Araújo, Fátima AU - Nogueira, Nilza Maria AU - Silva, Joana AU - Rego, Sílvia PY - 2021/8/12 TI - A Technological-Based Platform for Risk Assessment, Detection, and Prevention of Falls Among Home-Dwelling Older Adults: Protocol for a Quasi-Experimental Study JO - JMIR Res Protoc SP - e25781 VL - 10 IS - 8 KW - fall prevention KW - technological platform KW - elderly KW - Otago Exercise Program N2 - Background: According to the United Nations, it is estimated that by 2050, the number of people aged 80 years and older will have increased by 3 times. Increased longevity is often accompanied by structural and functional changes that occur throughout an individual?s lifespan. These changes are often aggravated by chronic comorbidities, adopted behaviors or lifestyles, and environmental exposure, among other factors. Some of the related outcomes are loss of muscle strength, decreased balance control, and mobility impairments, which are strongly associated with the occurrence of falls in the elderly. Despite the continued undervaluation of the importance of knowledge on fall prevention among the elderly population by primary care health professionals, several evidence-based (single or multifaceted) fall prevention programs such as the Otago Exercise Program (OEP) have demonstrated a significant reduction in the risk of falls and fall-related injuries in the elderly within community settings. Recent studies have strived to integrate technology into physical exercise programs, which is effective for adherence and overcoming barriers to exercise, as well as improving physical functioning. Objective: This study aims to assess the impact of the OEP on the functionality of home-dwelling elderly using a common technological platform. Particularly, the impact on muscle strength, balance, mobility, risk of falling, the perception of fear of falling, and the perception of the elderly regarding the ease of use of technology are being examined in this study. Methods: A quasi-experimental study (before and after; single group) will be conducted with male and female participants aged 65 years or older living at home in the district of Porto. Participants will be recruited through the network COLABORAR, with a minimum of 30 participants meeting the study inclusion and exclusion criteria. All participants will sign informed consent forms. The data collection instrument consists of sociodemographic and clinical variables (self-reported), functional evaluation variables, and environmental risk variables. The data collection tool integrates primary and secondary outcome variables. The primary outcome is gait (timed-up and go test; normal step). The secondary outcome variables are lower limb strength and muscle resistance (30-second chair stand test), balance (4-stage balance test), frequency of falls, functional capacity (Lawton and Brody - Portuguese version), fear of falling (Falls Efficacy Scale International - Portuguese version), usability of the technology (System Usability Scale - Portuguese version), and environmental risk variables (home fall prevention checklist for older adults). Technological solutions, such as the FallSensing Home application and Kallisto wearable device, will be used, which will allow the detection and prevention of falls. The intervention is characterized by conducting the OEP through a common technological platform 3 times a week for 8 weeks. Throughout these weeks, the participants will be followed up in person or by telephone contact by the rehabilitation nurse. Considering the COVID-19 outbreak, all guidelines from the National Health Service will be followed. The project was funded by InnoStars, in collaboration with the Local EIT Health Regional Innovation Scheme Hub of the University of Porto. Results: This study was approved on October 9, 2020 by the Ethics Committee of Escola Superior de Enfermagem do Porto (ESEP). The recruitment process was meant to start in October, but due to the COVID-19 pandemic, it was suspended. We expect to restart the study by the beginning of the third quarter of 2021. Conclusions: The findings of this study protocol will contribute to the design and development of future robust studies for technological tests in a clinical context. Trial Registration: ISRCTN 15895163; https://www.isrctn.com/ISRCTN15895163 International Registered Report Identifier (IRRID): PRR1-10.2196/25781 UR - https://www.researchprotocols.org/2021/8/e25781 UR - http://dx.doi.org/10.2196/25781 UR - http://www.ncbi.nlm.nih.gov/pubmed/34387557 ID - info:doi/10.2196/25781 ER - TY - JOUR AU - Rouzaud Laborde, Charlotte AU - Cenko, Erta AU - Mardini, T. Mamoun AU - Nerella, Subhash AU - Kheirkhahan, Matin AU - Ranka, Sanjay AU - Fillingim, B. Roger AU - Corbett, B. Duane AU - Weber, Eric AU - Rashidi, Parisa AU - Manini, Todd PY - 2021/7/14 TI - Satisfaction, Usability, and Compliance With the Use of Smartwatches for Ecological Momentary Assessment of Knee Osteoarthritis Symptoms in Older Adults: Usability Study JO - JMIR Aging SP - e24553 VL - 4 IS - 3 KW - ehealth KW - mobile health KW - ecological momentary assessment KW - real-time online assessment and mobility monitor KW - ROAMM KW - older adults KW - compliance KW - personal satisfaction KW - usability KW - smartwatch KW - knee osteoarthritis KW - pain KW - fatigue KW - wearable electronic device KW - mobile application N2 - Background: Smartwatches enable physicians to monitor symptoms in patients with knee osteoarthritis, their behavior, and their environment. Older adults experience fluctuations in their pain and related symptoms (mood, fatigue, and sleep quality) that smartwatches are ideally suited to capture remotely in a convenient manner. Objective: The aim of this study was to evaluate satisfaction, usability, and compliance using the real-time, online assessment and mobility monitoring (ROAMM) mobile app designed for smartwatches for individuals with knee osteoarthritis. Methods: Participants (N=28; mean age 73.2, SD 5.5 years; 70% female) with reported knee osteoarthritis were asked to wear a smartwatch with the ROAMM app installed. They were prompted to report their prior night?s sleep quality in the morning, followed by ecological momentary assessments (EMAs) of their pain, fatigue, mood, and activity in the morning, afternoon, and evening. Satisfaction, comfort, and usability were evaluated using a standardized questionnaire. Compliance with regard to answering EMAs was calculated after excluding time when the watch was not being worn for technical reasons (eg, while charging). Results: A majority of participants reported that the text displayed was large enough to read (22/26, 85%), and all participants found it easy to enter ratings using the smartwatch. Approximately half of the participants found the smartwatch to be comfortable (14/26, 54%) and would consider wearing it as their personal watch (11/24, 46%). Most participants were satisfied with its battery charging system (20/26, 77%). A majority of participants (19/26, 73%) expressed their willingness to use the ROAMM app for a 1-year research study. The overall EMA compliance rate was 83% (2505/3036 responses). The compliance rate was lower among those not regularly wearing a wristwatch (10/26, 88% vs 16/26, 71%) and among those who found the text too small to read (4/26, 86% vs 22/26, 60%). Conclusions: Older adults with knee osteoarthritis positively rated the ROAMM smartwatch app and were generally satisfied with the device. The high compliance rates coupled with the willingness to participate in a long-term study suggest that the ROAMM app is a viable approach to remotely collecting health symptoms and behaviors for both research and clinical endeavors. UR - https://aging.jmir.org/2021/3/e24553 UR - http://dx.doi.org/10.2196/24553 UR - http://www.ncbi.nlm.nih.gov/pubmed/34259638 ID - info:doi/10.2196/24553 ER - TY - JOUR AU - Kouvonen, Anne AU - Kemppainen, Laura AU - Ketonen, Eeva-Leena AU - Kemppainen, Teemu AU - Olakivi, Antero AU - Wrede, Sirpa PY - 2021/6/14 TI - Digital Information Technology Use, Self-Rated Health, and Depression: Population-Based Analysis of a Survey Study on Older Migrants JO - J Med Internet Res SP - e20988 VL - 23 IS - 6 KW - digital information technology KW - older adults KW - migrants KW - health KW - depression KW - mobile phone N2 - Background: Previous studies have found that in general, poor health is associated with a lower likelihood of internet use in older adults, but it is not well known how different indicators of health are associated with different types of digital information technology (DIT) use. Moreover, little is known about the relationship between health and the types of DIT use in older ethnic minority and migrant populations. Objective: The aim of this study is to examine the associations among depressive symptoms and self-rated health (SRH) with different dimensions of DIT use in older migrants. Methods: We analyzed data from the Care, Health and Ageing of Russian-speaking Minority (CHARM) study, which is based on a nationally representative sample of community-dwelling, Russian-speaking adults aged 50 years or older residing permanently in Finland (men: 616/1082, 56.93%; age: mean 63.2 years, SD 8.4 years; response rate: 1082/3000, 36.07%). Data were collected in 2019 using a postal survey. Health was measured using depressive symptoms (measured using the Center for Epidemiologic Studies Depression Scale) and SRH. Binary logistic regression analyses were used to investigate the associations between the two health indicators and the following six outcomes: daily internet use, smartphone ownership, the use of the internet for messages and calls, social media use, the use of the internet for personal health data, and obtaining health information from the internet. A number of sociodemographic and socioeconomic factors were controlled for in the logistic regression regression analysis. Analyses were performed with weights accounting for the survey design and nonresponse. Results: After adjusting for sociodemographic and socioeconomic factors, depressive symptoms (odds ratio [OR] 2.68, 95% CI 1.37-5.24; P=.004) and poor SRH (OR 7.90, 95% CI 1.88-33.11; P=.005) were associated with a higher likelihood of not using the internet daily. Depressive symptoms (OR 1.88, 95% CI 1.06-3.35; P=.03) and poor SRH (OR 5.05, 95% CI 1.58-16.19; P=.006) also increased the likelihood of smartphone nonuse. Depressive symptoms were additionally associated with a lower likelihood of social media use, and poor SRH was associated with a lower likelihood of using the internet for messaging and calling. Conclusions: Poor SRH and depressive symptoms are associated with a lower likelihood of DIT use in older adults. Longitudinal studies are required to determine the directions of these relationships. UR - https://www.jmir.org/2021/6/e20988 UR - http://dx.doi.org/10.2196/20988 UR - http://www.ncbi.nlm.nih.gov/pubmed/34125069 ID - info:doi/10.2196/20988 ER - TY - JOUR AU - Lee, Seyeon AU - Oh, Hyunyoung AU - Shi, Chung-Kon AU - Doh, Yim Young PY - 2021/5/20 TI - Mobile Game Design Guide to Improve Gaming Experience for the Middle-Aged and Older Adult Population: User-Centered Design Approach JO - JMIR Serious Games SP - e24449 VL - 9 IS - 2 KW - mobile games KW - older adults KW - middle-aged adults KW - design guideline KW - gaming experience N2 - Background: The number of older adult gamers who play mobile games is growing worldwide. Earlier studies have reported that digital games provide cognitive, physical, and socioemotional benefits for older adults. However, current mobile games that understand older adults? gameplay experience and reflect their needs are very scarce. Furthermore, studies that have analyzed older adults? game experience in a holistic manner are rare. Objective: The purpose of this study was to suggest mobile game design guidelines for adults older than 50 years from a holistic gaming experience perspective. Adopting a human-centric approach, this study analyzes middle-aged and older adults? gameplay experience and suggests practical design guides to increase accessibility and satisfaction. Methods: We organized a living laboratory project called the ?Intergenerational Play Workshop.? In this workshop, 40 middle-aged and older adults (mean age 66.75 years, age range 50-85 years) played commercial mobile games of various genres with young adult partners for 1 month (8 sessions). Using a convergent parallel mixed-method design, we conducted a qualitative analysis of dialogue, game diaries, and behavioral observations during the workshop and a quantitative analysis of the satisfaction level of the game elements for the mobile games that they played. Results: This project was active from April 2019 to December 2021, and the data were collected at the workshops from July 1 to August 28, 2019. Based on the identified themes of positive and negative experiences from the qualitative data, we proposed 45 design guides under 3 categories: (1) cognitive and physical elements, (2) psychological and socioemotional elements, and (3) consumption contextual elements. Our empirical research could reaffirm the proposals from previous studies and provide new guidelines for improving the game design. In addition, we demonstrate how existing commercial games can be evaluated quantitatively by using the satisfaction level of each game?s elements and overall satisfaction level. Conclusions: The final guidelines were presented to game designers to easily find related information and enhance the overall understanding of the game experience of middle-aged and older adults. UR - https://games.jmir.org/2021/2/e24449 UR - http://dx.doi.org/10.2196/24449 UR - http://www.ncbi.nlm.nih.gov/pubmed/34014175 ID - info:doi/10.2196/24449 ER - TY - JOUR AU - Compernolle, Sofie AU - Van Dyck, Delfien AU - Cardon, Greet AU - Brondeel, Ruben PY - 2021/5/10 TI - Exploring Breaks in Sedentary Behavior of Older Adults Immediately After Receiving Personalized Haptic Feedback: Intervention Study JO - JMIR Mhealth Uhealth SP - e26387 VL - 9 IS - 5 KW - tactile feedback KW - sitting behavior KW - sedentary behavior KW - older adults KW - mHealth intervention KW - self-monitoring N2 - Background: ?Push? components of mobile health interventions may be promising to create conscious awareness of habitual sedentary behavior; however, the effect of these components on the near-time, proximal outcome, being breaks in sedentary behavior immediately after receiving a push notification, is still unknown, especially in older adults. Objective: The aims of this study are to examine if older adults break their sedentary behavior immediately after receiving personalized haptic feedback on prolonged sedentary behavior and if the percentage of breaks differs depending on the time of the day when the feedback is provided. Methods: A total of 26 Flemish older adults (mean age 64.4 years, SD 3.8) wore a triaxial accelerometer (Activator, PAL Technologies Ltd) for 3 weeks. The accelerometer generated personalized haptic feedback by means of vibrations each time a participant sat for 30 uninterrupted minutes. Accelerometer data on sedentary behavior were used to estimate the proximal outcome, which was sedentary behavior breaks immediately (within 1, 3, and 5 minutes) after receiving personalized haptic feedback. Generalized estimating equations were used to investigate whether or not participants broke up their sedentary behavior immediately after receiving haptic feedback. A time-related variable was added to the model to investigate if the sedentary behavior breaks differed depending on the time of day. Results: A total of 2628 vibrations were provided to the participants during the 3-week intervention period. Of these 2628 vibrations, 379 (14.4%), 570 (21.7%), and 798 (30.4%) resulted in a sedentary behavior break within 1, 3 and 5 minutes, respectively. Although the 1-minute interval did not reveal significant differences in the percentage of breaks depending on the time at which the haptic feedback was provided, the 3- and 5-minute intervals did show significant differences in the percentage of breaks depending on the time at which the haptic feedback was provided. Concretely, the percentage of sedentary behavior breaks was significantly higher if personalized haptic feedback was provided between noon and 3 PM compared to if the feedback was provided between 6 and 9 AM (odds ratio 1.58, 95% CI 1.01-2.47, within 3 minutes; odds ratio 1.78, 95% CI 1.11-2.84, within 5 minutes). Conclusions: The majority of haptic vibrations, especially those in the morning, did not result in a break in the sedentary behavior of older adults. As such, simply bringing habitual sedentary behavior into conscious awareness seems to be insufficient to target sedentary behavior. More research is needed to optimize push components in interventions aimed at the reduction of the sedentary behavior of older adults. Trial Registration: ClinicalTrials.gov NCT04003324; https://clinicaltrials.gov/ct2/show/NCT04003324 UR - https://mhealth.jmir.org/2021/5/e26387 UR - http://dx.doi.org/10.2196/26387 UR - http://www.ncbi.nlm.nih.gov/pubmed/33970109 ID - info:doi/10.2196/26387 ER - TY - JOUR AU - Martinato, Matteo AU - Lorenzoni, Giulia AU - Zanchi, Tommaso AU - Bergamin, Alessia AU - Buratin, Alessia AU - Azzolina, Danila AU - Gregori, Dario PY - 2021/5/5 TI - Usability and Accuracy of a Smartwatch for the Assessment of Physical Activity in the Elderly Population: Observational Study JO - JMIR Mhealth Uhealth SP - e20966 VL - 9 IS - 5 KW - wearable devices KW - elderly KW - physical activity KW - smartwatches N2 - Background: Regular physical activity (PA) contributes to the primary and secondary prevention of several chronic diseases and reduces the risk of premature death. Physical inactivity is a modifiable risk factor for cardiovascular disease and a variety of chronic disorders such as diabetes, obesity, hypertension, bone and joint diseases (eg, osteoporosis and osteoarthritis), depression, and colon and breast cancer. Population aging and the related increase in chronic diseases have a major impact on the health care systems of most Western countries and will produce an even more significant effect in the future. Monitoring PA is a valuable method of determining whether people are performing enough PA so as to prevent chronic diseases or are showing early symptoms of those diseases. Objective: The aim of this study was to estimate the accuracy of wearable devices in quantifying the PA of elderly people in a real-life setting. Methods: Participants aged 70 to 90 years with the ability to walk safely without any walking aid for at least 300 meters, who had no walking disabilities or episodes of falling while walking in the last 12 months, were asked to walk 150 meters at their preferred pace wearing a vívoactive HR device (Garmin Ltd) and actual steps were monitored and tallied by a researcher using a hand-tally counter to assess the performance of the device at a natural speed. A Bland-Altman plot was used to analyze the difference between manually counted steps and wearable device?measured steps. The intraclass correlation coefficient (ICC) was computed (with a 95% confidence interval) between step measurements. The generalized linear mixed-model (GLMM) ICCs were estimated, providing a random effect term (random intercept) for the individual measurements (gold standard and device). Both adjusted and conditional ICCs were computed for the GLMM models considering separately the effect of age, sex, BMI, and obesity. Analyses were performed using R software (R Foundation for Statistical Computing) with the rms package. Results: A total of 23 females and 26 males were enrolled in the study. The median age of the participants was 75 years. The Bland-Altman plot revealed that, excluding one observation, all differences across measurements were in the confidence bounds, demonstrating the substantial agreement between the step count measurements. The results were confirmed by an ICC equal to .98 (.96-.99), demonstrating excellent agreement between the two sets of measurements. Conclusions: The level of accuracy of wearable devices in quantifying the PA of elderly people in a real-life setting that was found in this study supports the idea of considering wrist-wearable nonmedical devices (widely available in nonspecialized stores) as reliable tools. Both health care professionals and informal caregivers could monitor the level of PA of their patients. UR - https://mhealth.jmir.org/2021/5/e20966 UR - http://dx.doi.org/10.2196/20966 UR - http://www.ncbi.nlm.nih.gov/pubmed/33949953 ID - info:doi/10.2196/20966 ER - TY - JOUR AU - LaMonica, M. Haley AU - Roberts, E. Anna AU - Davenport, A. Tracey AU - Hickie, B. Ian PY - 2021/4/21 TI - Evaluation of the Usability and Acceptability of the InnoWell Platform as Rated by Older Adults: Survey Study JO - JMIR Aging SP - e25928 VL - 4 IS - 2 KW - older adults KW - mental health KW - technology KW - community-based participatory research KW - stakeholder participation KW - smartphone KW - mobile phone N2 - Background: As the global population ages, there is increased interest in developing strategies to promote health and well-being in later life, thus enabling continued productivity, social engagement, and independence. As older adults use technologies with greater frequency, proficiency, and confidence, health information technologies (HITs) now hold considerable potential as a means to enable broader access to tools and services for the purposes of screening, treatment, monitoring, and ongoing maintenance of health for this group. The InnoWell Platform is a digital tool co-designed with lived experience to facilitate better outcomes by enabling access to a comprehensive multidimensional assessment, the results of which are provided in real time to enable consumers to make informed decisions about clinical and nonclinical care options independently or in collaboration with a health professional. Objective: This study aims to evaluate the usability and acceptability of a prototype of the InnoWell Platform, co-designed and configured with and for older adults, using self-report surveys. Methods: Participants were adults 50 years and older who were invited to engage with the InnoWell Platform naturalistically (ie, at their own discretion) for a period of 90 days. In addition, they completed short web-based surveys at baseline regarding their background, health, and mental well-being. After 90 days, participants were asked to complete the System Usability Scale to evaluate the usability and acceptability of the prototyped InnoWell Platform, with the aim of informing the iterative redesign and development of this digital tool before implementation within a health service setting. Results: A total of 19 participants consented to participate in the study; however, only the data from the 16 participants (mean age 62.8 years, SD 7.5; range 50-72) who completed at least part of the survey at 90 days were included in the analyses. Participants generally reported low levels of psychological distress and good mental well-being. In relation to the InnoWell Platform, the usability scores were suboptimal. Although the InnoWell Platform was noted to be easy to use, participants had difficulty identifying the relevance of the tool for their personal circumstances. Ease of use, the comprehensive nature of the assessment tools, and the ability to track progress over time were favored features of the InnoWell Platform, whereas the need for greater personalization and improved mobile functionality were cited as areas for improvement. Conclusions: HITs such as the InnoWell Platform have tremendous potential to improve access to cost-effective and low-intensity interventions at scale to improve and maintain mental health and well-being in later life. However, to promote adoption of and continued engagement with such tools, it is essential that these HITs are personalized and relevant for older adult end users, accounting for differences in background, clinical profiles, and levels of need. UR - https://aging.jmir.org/2021/2/e25928 UR - http://dx.doi.org/10.2196/25928 UR - http://www.ncbi.nlm.nih.gov/pubmed/33881410 ID - info:doi/10.2196/25928 ER - TY - JOUR AU - Naqvi, Ali Imama AU - Montiel, Casameni Tahani AU - Bittar, Yazan AU - Hunter, Norma AU - Okpala, Munachi AU - Johnson, Constance AU - Weiner, G. Mark AU - Savitz, Sean AU - Sharrief, Anjail AU - Beauchamp, Sanner Jennifer Elizabeth PY - 2021/3/8 TI - Internet Access and Usage Among Stroke Survivors and Their Informal Caregivers: Cross-sectional Study JO - JMIR Form Res SP - e25123 VL - 5 IS - 3 KW - internet access KW - stroke KW - caregivers KW - surveys KW - questionnaires KW - mobile phone N2 - Background: Web-based interventions have shown promise for chronic disease management but have not been widely applied to populations with stroke. Existing barriers may inhibit the adoption of web-based interventions among stroke survivors and necessitate the involvement of informal caregivers. However, limited information is available on internet accessibility and usability among stroke survivors and their caregivers. Objective: This study aims to investigate internet access and usage in a cohort of stroke survivors and their caregivers. Methods: A cross-sectional survey was conducted with 375 participants (248 stroke survivors and 127 caregivers). Descriptive statistics were generated using cross-tabulation. Comparisons with categorical data were conducted using the chi-square test, whereas the Mann-Whitney U test was used for comparisons involving ordinal variables. Results: Overall, 86.1% (323/375) of the participants reported having internet access. Caregivers were more likely than stroke survivors to access the internet (N=375, ?21=18.5, P<.001) and used text messaging (n=321, ?21=14.7, P<.001). Stroke survivors and caregivers with internet access were younger than stroke survivors and caregivers without internet access. The highest number of participants who reported internet access were non-Hispanic White. Smartphones were the most common devices used to access the internet. Email was the most common type of internet usage reported. Patients who survived for >12 months after a stroke reported higher internet access than those who survived <3 months (P<.001). The number of hours per week spent using the internet was higher for caregivers than for stroke survivors (P<.001). Conclusions: Future feasibility and acceptability studies should consider the role of the informal caregiver, participant age, race and ethnicity, the use of smartphone apps, email and text correspondence, and the amount of time elapsed since the stroke event in the design and implementation of web-based interventions for populations with stroke. UR - https://formative.jmir.org/2021/3/e25123 UR - http://dx.doi.org/10.2196/25123 UR - http://www.ncbi.nlm.nih.gov/pubmed/33683206 ID - info:doi/10.2196/25123 ER - TY - JOUR AU - Portenhauser, A. Alexandra AU - Terhorst, Yannik AU - Schultchen, Dana AU - Sander, B. Lasse AU - Denkinger, D. Michael AU - Stach, Michael AU - Waldherr, Natalie AU - Dallmeier, Dhayana AU - Baumeister, Harald AU - Messner, Eva-Maria PY - 2021/2/19 TI - Mobile Apps for Older Adults: Systematic Search and Evaluation Within Online Stores JO - JMIR Aging SP - e23313 VL - 4 IS - 1 KW - mHealth KW - MARS KW - MARS-G KW - older adults KW - mobile apps KW - apps KW - aging N2 - Background: Through the increasingly aging population, the health care system is confronted with various challenges such as expanding health care costs. To manage these challenges, mobile apps may represent a cost-effective and low-threshold approach to support older adults. Objective: This systematic review aimed to evaluate the quality, characteristics, as well as privacy and security measures of mobile apps for older adults in the European commercial app stores. Methods: In the European Google Play and App Store, a web crawler systematically searched for mobile apps for older adults. The identified mobile apps were evaluated by two independent reviewers using the German version of the Mobile Application Rating Scale. A correlation between the user star rating and overall rating was calculated. An exploratory regression analysis was conducted to determine whether the obligation to pay fees predicted overall quality. Results: In total, 83 of 1217 identified mobile apps were included in the analysis. Generally, the mobile apps for older adults were of moderate quality (mean 3.22 [SD 0.68]). Four mobile apps (5%) were evidence-based; 49% (41/83) had no security measures. The user star rating correlated significantly positively with the overall rating (r=.30, P=.01). Obligation to pay fees could not predict overall quality. Conclusions: There is an extensive quality range within mobile apps for older adults, indicating deficits in terms of information quality, data protection, and security precautions, as well as a lack of evidence-based approaches. Central databases are needed to identify high-quality mobile apps. UR - https://aging.jmir.org/2021/1/e23313 UR - http://dx.doi.org/10.2196/23313 UR - http://www.ncbi.nlm.nih.gov/pubmed/33605884 ID - info:doi/10.2196/23313 ER - TY - JOUR AU - Hoang, Peter AU - Whaley, Colin AU - Thompson, Karen AU - Ho, Venus AU - Rehman, Uzma AU - Boluk, Karla AU - Grindrod, A. Kelly PY - 2021/2/17 TI - Evaluation of an Intergenerational and Technological Intervention for Loneliness: Protocol for a Feasibility Randomized Controlled Trial JO - JMIR Res Protoc SP - e23767 VL - 10 IS - 2 KW - seniors KW - communication technology KW - social isolation KW - computers KW - intergenerational KW - older adults KW - mobile phone N2 - Background: Social integration and mental health are vital aspects of healthy aging. However, close to half of Canadians older than 80 years report feeling socially isolated. Research has shown that social isolation leads to increased mortality and morbidity, and various interventions have been studied to alleviate loneliness among older adults. This proposal presents an evaluation of an intervention that provides one-on-one coaching, is intergenerational, provides both educational and socialization experiences, and increases technology literacy of older adults to overcome loneliness. Objective: This paper describes the protocol of a randomized, mixed-methods study that will take place in Ontario, Canada. The purpose of this study is to evaluate if an intergenerational technology literacy program can reduce social isolation and depression in older adults via quantitative and qualitative outcome measures. Methods: This study is a randomized, mixed-methods, feasibility trial with 2 conditions. Older adults in the intervention condition will receive 1 hour of weekly technological assistance to send an email to a family member, for 8 weeks, with the assistance of a volunteer. Participants in the control condition will not receive any intervention. The primary outcomes are loneliness, measured using the University of California, Los Angeles Loneliness Scale, and depression, measured using the Center for Epidemiologic Studies Depression scale, both of which are measured weekly. Secondary outcomes are quality of life, as assessed using the Older People?s Quality of Life-Brief version, and technological literacy, evaluated using the Computer Proficiency Questionnaire-12, both of which will be administered before and after the intervention. Semistructured interviews will be completed before and after the intervention to assess participants? social connectedness, familiarity with technology, and their experience with the intervention. The study will be completed in a long-term care facility in Southwestern Ontario, Canada. Significance was set at P<.05. Results: This study was funded in April 2019 and ethical approval was obtained in August 2019. Recruitment for the study started in November 2019. The intervention began in February 2020 but was halted due to the COVID-19 pandemic. The trial will be restarted when safe. As of March 2020, 8 participants were recruited. Conclusions: Information and communication technology interventions have shown varying results in reducing loneliness and improving mental health among older adults. Few studies have examined the role of one-on-one coaching for older adults in addition to technology education in such interventions. Data from this study may have the potential to provide evidence for other groups to disseminate similar interventions in their respective communities. International Registered Report Identifier (IRRID): DERR1-10.2196/23767 UR - http://www.researchprotocols.org/2021/2/e23767/ UR - http://dx.doi.org/10.2196/23767 UR - http://www.ncbi.nlm.nih.gov/pubmed/33595443 ID - info:doi/10.2196/23767 ER - TY - JOUR AU - McLean, Bianca AU - Hossain, Nazia AU - Donison, Valentina AU - Gray, Mikaela AU - Durbano, Sara AU - Haase, Kristen AU - Alibhai, Husayn Shabbir Muhammad AU - Puts, Martine PY - 2021/2/9 TI - Providing Medical Information to Older Adults in a Web-Based Environment: Systematic Review JO - JMIR Aging SP - e24092 VL - 4 IS - 1 KW - eHealth KW - systematic review KW - geriatric assessment KW - geriatric oncology N2 - Background: Cancer is a disease that predominantly affects older adults, and several organizations recommend the completion of a geriatric assessment to help with cancer treatment decision-making. Owing to a shortage of geriatric teams and the vast number of older adults diagnosed with cancer each year, a web-based geriatric assessment may improve access to geriatric assessment for older adults. We systematically reviewed the literature to obtain the latest evidence for the design of our web-based geriatric assessment tool Comprehensive Health Assessment for My Plan. Objective: This review aimed to probe the following questions: what is the impact of providing health test results to older adults in a web-based environment without the presence of a health care provider for patient-centered outcomes, including satisfaction, perceived harm, empowerment, quality of life, and health care use (eg, hospitalization, physician visits, emergency room visits, and costs), and what recommendations do older adults and developers have for designing future apps or websites for older adults? Methods: This systematic review was guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) statement. Studies were limited to publications in English that examined a web-based tool that provided test results to older adults (aged ?65 years) without the presence of a health care provider. A health sciences librarian performed the search on November 29, 2019, on the following electronic databases: MEDLINE, Embase, CINAHL, PsycINFO, and the Cochrane Library. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool Version 2018. The findings are summarized narratively and in tabular format. Results: A total of 26,898 titles and abstracts were screened by 2 independent reviewers, of which 94 studies were selected for a full-text review, and 9 studies were included in this review. There were only 2 randomized controlled trials of high quality that explored the effects of receiving health care results on the web via eHealth tools for older adults or provided evidence-based recommendations for designing such tools. Older adults were generally satisfied with receiving screening results via eHealth tools, and several studies suggested that receiving health screening results electronically improved participants? quality of life. However, user interfaces that were not designed with older adults in mind and older adults? lack of confidence in navigating eHealth tools proved challenging to eHealth uptake and use. All 9 studies included in this systematic review made recommendations on how to design eHealth tools that are intuitive and useful for older adults. Conclusions: eHealth tools should incorporate specific elements to ensure usability for older adults. However, more research is required to fully elucidate the impact of receiving screening and results via eHealth tools without the presence of a health care provider for patient-centered outcomes in this target population. UR - https://aging.jmir.org/2021/1/e24092 UR - http://dx.doi.org/10.2196/24092 UR - http://www.ncbi.nlm.nih.gov/pubmed/33560228 ID - info:doi/10.2196/24092 ER - TY - JOUR AU - Oh, Soyeon Sarah AU - Kim, Kyoung-A AU - Kim, Minsu AU - Oh, Jaeuk AU - Chu, Hui Sang AU - Choi, JiYeon PY - 2021/2/3 TI - Measurement of Digital Literacy Among Older Adults: Systematic Review JO - J Med Internet Res SP - e26145 VL - 23 IS - 2 KW - healthy aging KW - eHealth KW - telehealth KW - mobile health KW - digital literacy KW - ehealth literacy KW - aging KW - elderly KW - older adults KW - review KW - literacy N2 - Background: Numerous instruments are designed to measure digital literacy among the general population. However, few studies have assessed the use and appropriateness of these measurements for older populations. Objective: This systematic review aims to identify and critically appraise studies assessing digital literacy among older adults and to evaluate how digital literacy instruments used in existing studies address the elements of age-appropriate digital literacy using the European Commission?s Digital Competence (DigComp) Framework. Methods: Electronic databases were searched for studies using validated instruments to assess digital literacy among older adults. The quality of all included studies was evaluated using the Crowe Critical Appraisal Tool (CCAT). Instruments were assessed according to their ability to incorporate the competence areas of digital literacy as defined by the DigComp Framework: (1) information and data literacy, (2) communication and collaboration, (3) digital content creation, (4) safety, and (5) problem-solving ability, or attitudes toward information and communication technology use. Results: Searches yielded 1561 studies, of which 27 studies (17 cross-sectional, 2 before and after, 2 randomized controlled trials, 1 longitudinal, and 1 mixed methods) were included in the final analysis. Studies were conducted in the United States (18/27), Germany (3/27), China (1/27), Italy (1/27), Sweden (1/27), Canada (1/27), Iran (1/27), and Bangladesh (1/27). Studies mostly defined older adults as aged ?50 years (10/27) or ?60 years (8/27). Overall, the eHealth Literacy Scale (eHEALS) was the most frequently used instrument measuring digital literacy among older adults (16/27, 59%). Scores on the CCAT ranged from 34 (34/40, 85%) to 40 (40/40, 100%). Most instruments measured 1 or 2 of the DigComp Framework?s elements, but the Mobile Device Proficiency Questionnaire (MDPQ) measured all 5 elements, including ?digital content creation? and ?safety.? Conclusions: The current digital literacy assessment instruments targeting older adults have both strengths and weaknesses, relative to their study design, administration method, and ease of use. Certain instrument modalities like the MDPQ are more generalizable and inclusive and thus, favorable for measuring the digital literacy of older adults. More studies focusing on the suitability of such instruments for older populations are warranted, especially for areas like ?digital content creation? and ?safety? that currently lack assessment. Evidence-based discussions regarding the implications of digitalization for the treatment of older adults and how health care professionals may benefit from this phenomenon are encouraged. UR - https://www.jmir.org/2021/2/e26145 UR - http://dx.doi.org/10.2196/26145 UR - http://www.ncbi.nlm.nih.gov/pubmed/33533727 ID - info:doi/10.2196/26145 ER - TY - JOUR AU - Theis, Sabine AU - Schäfer, Katharina AU - Schäfer, Dajana AU - Jochems, Nicole AU - Nitsch, Verena AU - Mertens, Alexander PY - 2021/2/1 TI - The Relationship Between Individual Coping and the Need to Have and Seek Health Information Among Older Adults: Exploratory Mixed Methods Study JO - JMIR Hum Factors SP - e15858 VL - 8 IS - 1 KW - health KW - information science KW - systems analysis KW - eHealth KW - engineering KW - gerontology KW - information technology KW - mobile phone N2 - Background: The need to have and seek information shapes the context of computing systems. When it comes to health, individual coping influences human behavior. Therefore, the relationship between individual coping and the need to have and seek health information plays a crucial role in the development of digital health systems. Objective: This study aims to examine the relationship between individual coping and the need to have and seek health information among older adults. Methods: Questionnaires and semistructured interviews investigated the health information need (HIN) and health information?seeking behavior (HISB) in relation to the individual coping strategies of 26 older Germans. Results: The mean age of the interviewed group was 71 years (SD 7). Quantitatively, a trend was found for a negative correlation between the avoidance-oriented coping and HIN (rs=?0.37895; bias-corrected and accelerated bootstrap 95% BCa CI ?0.730 to 0.092; P=.05). The qualitative results supported this finding. For some participants, information and exchange was part of dealing with their health situation, whereas others wanted to learn as little as possible to avoid a decline in their health status. The older adults acquired, collected, and exchanged paper-based health data to augment clinical information sources and support information exchange with professionals. Conclusions: Individual coping strategies are relevant for the design of digital health systems. They can support older adults in coping with their health situation, although it remains unclear how systems must be designed for people with an avoidance coping strategy to achieve the same acceptance. UR - https://humanfactors.jmir.org/2021/1/e15858 UR - http://dx.doi.org/10.2196/15858 UR - http://www.ncbi.nlm.nih.gov/pubmed/33522973 ID - info:doi/10.2196/15858 ER - TY - JOUR AU - Cyr, Andrée-Ann AU - Romero, Kristoffer AU - Galin-Corini, Laura PY - 2021/2/1 TI - Web-Based Cognitive Testing of Older Adults in Person Versus at Home: Within-Subjects Comparison Study JO - JMIR Aging SP - e23384 VL - 4 IS - 1 KW - web-based testing KW - aging KW - cognition KW - neuropsychology KW - mobile phone N2 - Background: Web-based research allows cognitive psychologists to collect high-quality data from a diverse pool of participants with fewer resources. However, web-based testing presents unique challenges for researchers and clinicians working with aging populations. Older adults may be less familiar with computer usage than their younger peers, leading to differences in performance when completing web-based tasks in their home versus in the laboratory under the supervision of an experimenter. Objective: This study aimed to use a within-subjects design to compare the performance of healthy older adults on computerized cognitive tasks completed at home and in the laboratory. Familiarity and attitudes surrounding computer use were also examined. Methods: In total, 32 community-dwelling healthy adults aged above 65 years completed computerized versions of the word-color Stroop task, paired associates learning, and verbal and matrix reasoning in 2 testing environments: at home (unsupervised) and in the laboratory (supervised). The paper-and-pencil neuropsychological versions of these tasks were also administered, along with questionnaires examining computer attitudes and familiarity. The order of testing environments was counterbalanced across participants. Results: Analyses of variance conducted on scores from the computerized cognitive tasks revealed no significant effect of the testing environment and no correlation with computer familiarity or attitudes. These null effects were confirmed with follow-up Bayesian analyses. Moreover, performance on the computerized tasks correlated positively with performance on their paper-and-pencil equivalents. Conclusions: Our findings show comparable performance on computerized cognitive tasks in at-home and laboratory testing environments. These findings have implications for researchers and clinicians wishing to harness web-based testing to collect meaningful data from older adult populations. UR - http://aging.jmir.org/2021/1/e23384/ UR - http://dx.doi.org/10.2196/23384 UR - http://www.ncbi.nlm.nih.gov/pubmed/33522972 ID - info:doi/10.2196/23384 ER - TY - JOUR AU - Sturge, Jodi AU - Meijering, Louise AU - Jones, Allyson C. AU - Garvelink, Mirjam AU - Caron, Danielle AU - Nordin, Susanna AU - Elf, Marie AU - Légaré, France PY - 2021/1/21 TI - Technology to Improve Autonomy and Inform Housing Decisions for Older Adults With Memory Problems Who Live at Home in Canada, Sweden, and the Netherlands: Protocol for a Multipronged Mixed Methods Study JO - JMIR Res Protoc SP - e19244 VL - 10 IS - 1 KW - aging in place KW - co-design KW - cross-country comparison KW - electronic decision support intervention KW - housing decisions KW - memory problems KW - mixed methods KW - mobility patterns KW - shared decision making KW - technology N2 - Background: Understanding the mobility patterns and experiences of older adults with memory problems living at home has the potential to improve autonomy and inform shared decision making (SDM) about their housing options. Objective: We aim to (1) assess the mobility patterns and experiences of older adults with memory problems, (2) co-design an electronic decision support intervention (e-DSI) that integrates users? mobility patterns and experiences, (3) explore their intention to use an e-DSI to support autonomy at home, and (4) inform future SDM processes about housing options. Methods: Informed by the Good Reporting of A Mixed Methods Study (GRAMMS) reporting guidelines, we will conduct a 3-year, multipronged mixed methods study in Canada, Sweden, and the Netherlands. For Phase 1, we will recruit a convenience sample of 20 older adults living at home with memory problems from clinical and community settings in each country, for a total of 60 participants. We will ask participants to record their mobility patterns outside their home for 14 days using a GPS tracker and a travel diary; in addition, we will conduct a walking interview and a final debrief interview after 14 days. For Phase 2, referring to results from the first phase, we will conduct one user-centered co-design process per country with older adults with memory issues, caregivers, health care professionals, and information technology representatives informed by the Double Diamond method. We will ask participants how personalized information about mobility patterns and experiences could be added to an existing e-DSI and how this information could inform SDM about housing options. For Phase 3, using online web-based surveys, we will invite 210 older adults with memory problems and/or their caregivers, split equally across the three countries, to use the e-DSI and provide feedback on its strengths and limitations. Finally, in Phase 4, we will triangulate and compare data from all phases and countries to inform a stakeholder meeting where an action plan will be developed. Results: The study opened for recruitment in the Netherlands in November 2018 and in Canada and Sweden in December 2019. Data collection will be completed by April 2021. Conclusions: This project will explore how e-DSIs can integrate the mobility patterns and mobility experiences of older adults with memory problems in three countries, improve older adults? autonomy, and, ultimately, inform SDM about housing options. Trial Registration: ClinicalTrials.gov NCT04267484; https://clinicaltrials.gov/ct2/show/NCT04267484 International Registered Report Identifier (IRRID): DERR1-10.2196/19244 UR - http://www.researchprotocols.org/2021/1/e19244/ UR - http://dx.doi.org/10.2196/19244 UR - http://www.ncbi.nlm.nih.gov/pubmed/33475512 ID - info:doi/10.2196/19244 ER - TY - JOUR AU - Silva, G. Anabela AU - Caravau, Hilma AU - Martins, Ana AU - Almeida, Pisco Ana Margarida AU - Silva, Telmo AU - Ribeiro, Óscar AU - Santinha, Gonçalo AU - Rocha, P. Nelson PY - 2021/1/13 TI - Procedures of User-Centered Usability Assessment for Digital Solutions: Scoping Review of Reviews Reporting on Digital Solutions Relevant for Older Adults JO - JMIR Hum Factors SP - e22774 VL - 8 IS - 1 KW - mobile phone KW - user-centered design KW - aged KW - review KW - telemedicine N2 - Background: The assessment of usability is a complex process that involves several steps and procedures. It is important to standardize the evaluation and reporting of usability procedures across studies to guide researchers, facilitate comparisons across studies, and promote high-quality usability studies. The first step to standardizing is to have an overview of how usability study procedures are reported across the literature. Objective: This scoping review of reviews aims to synthesize the procedures reported for the different steps of the process of conducting a user-centered usability assessment of digital solutions relevant for older adults and to identify potential gaps in the present reporting of procedures. The secondary aim is to identify any principles or frameworks guiding this assessment in view of a standardized approach. Methods: This is a scoping review of reviews. A 5-stage scoping review methodology was used to identify and describe relevant literature published between 2009 and 2020 as follows: identify the research question, identify relevant studies, select studies for review, chart data from selected literature, and summarize and report results. The research was conducted on 5 electronic databases: PubMed, ACM Digital Library, IEEE, Scopus, and Web of Science. Reviews that met the inclusion criteria (reporting on user-centered usability evaluation procedures for any digital solution that could be relevant for older adults and were published in English) were identified, and data were extracted for further analysis regarding study evaluators, study participants, methods and techniques, tasks, and test environment. Results: A total of 3958 articles were identified. After a detailed screening, 20 reviews matched the eligibility criteria. The characteristics of the study evaluators and participants and task procedures were only briefly and differently reported. The methods and techniques used for the assessment of usability are the topics that were most commonly and comprehensively reported in the reviews, whereas the test environment was seldom and poorly characterized. Conclusions: A lack of a detailed description of several steps of the process of assessing usability and no evidence on good practices of performing it suggests that there is a need for a consensus framework on the assessment of user-centered usability evaluation. Such a consensus would inform researchers and allow standardization of procedures, which are likely to result in improved study quality and reporting, increased sensitivity of the usability assessment, and improved comparability across studies and digital solutions. Our findings also highlight the need to investigate whether different ways of assessing usability are more sensitive than others. These findings need to be considered in light of review limitations. UR - http://humanfactors.jmir.org/2021/1/e22774/ UR - http://dx.doi.org/10.2196/22774 UR - http://www.ncbi.nlm.nih.gov/pubmed/33439128 ID - info:doi/10.2196/22774 ER - TY - JOUR AU - Kim, Sunyoung PY - 2021/1/13 TI - Exploring How Older Adults Use a Smart Speaker?Based Voice Assistant in Their First Interactions: Qualitative Study JO - JMIR Mhealth Uhealth SP - e20427 VL - 9 IS - 1 KW - older adults KW - voice assistant KW - smart speaker KW - technology acceptance KW - quality of life N2 - Background: Smart speaker?based voice assistants promise support for the aging population, with the advantages of hands-free and eyes-free interaction modalities to handle requests. However, little is known about how older adults perceive the benefits of this type of device. Objective: This study investigates how older adults experience and respond to a voice assistant when they first interact with it. Because first impressions act as strong predictors of the overall attitude and acceptability of new technologies, it is important to understand the user experiences of first exposure. Methods: We conducted semistructured interviews with 18 people 74 years and older who had never used a smart speaker before, investigating the patterns of use, usability issues, and perspectives that older adults have when using a voice assistant for the first time. Results: The overall first response to a voice assistant was positive, thanks to the simplicity of a speech-based interaction. In particular, a positive and polite response to complete the interaction with a voice assistant was prevalent, such as expressing gratitude or giving feedback about the quality of answers. Two predominant topics of commands made in the first interaction include asking health care?related questions and streaming music. However, most of the follow-up reactions were unfavorable because of the difficulty in constructing a structured sentence for a command; misperceptions about how a voice assistant operates; and concerns about privacy, security, and financial burdens. Overall, a speech-based interaction was perceived to be beneficial owing to its efficiency and convenience, but no other benefits were perceived. Conclusions: On the basis of the findings, we discuss design implications that can positively influence older adults' first experiences with a voice assistant, including helping better understand how a voice assistant works, incorporating mistakes and common interaction patterns into its design, and providing features tailored to the needs of older adults. UR - http://mhealth.jmir.org/2021/1/e20427/ UR - http://dx.doi.org/10.2196/20427 UR - http://www.ncbi.nlm.nih.gov/pubmed/33439130 ID - info:doi/10.2196/20427 ER - TY - JOUR AU - Hawley-Hague, Helen AU - Tacconi, Carlo AU - Mellone, Sabato AU - Martinez, Ellen AU - Chiari, Lorenzo AU - Helbostad, Jorunn AU - Todd, Chris PY - 2021/1/12 TI - One-to-One and Group-Based Teleconferencing for Falls Rehabilitation: Usability, Acceptability, and Feasibility Study JO - JMIR Rehabil Assist Technol SP - e19690 VL - 8 IS - 1 KW - aged KW - postural balance KW - telerehabilitation KW - patient compliance KW - accidental falls KW - mobile phone N2 - Background: Falls have implications for the health of older adults. Strength and balance interventions significantly reduce the risk of falls; however, patients seldom perform the dose of exercise that is required based on evidence. Health professionals play an important role in supporting older adults as they perform and progress in their exercises. Teleconferencing could enable health professionals to support patients more frequently, which is important in exercise behavior. Objective: This study aims to examine the overall concept and acceptability of teleconferencing for the delivery of falls rehabilitation with health care professionals and older adults and to examine the usability, acceptability, and feasibility of teleconferencing delivery with health care professionals and patients. Methods: There were 2 stages to the research: patient and public involvement workshops and usability and feasibility testing. A total of 2 workshops were conducted, one with 5 health care professionals and the other with 8 older adults from a community strength and balance exercise group. For usability and feasibility testing, we tested teleconferencing both one-to-one and in small groups on a smartphone with one falls service and their patients for 3 weeks. Semistructured interviews and focus groups were used to explore acceptability, usability, and feasibility. Focus groups were conducted with the service that used teleconferencing with patients and 2 other services that received only a demonstration of how teleconferencing works. Qualitative data were analyzed using the framework approach. Results: In the workshops, the health care professionals thought that teleconferencing provided an opportunity to save travel time. Older adults thought that it could enable increased support. Safety is of key importance, and delivery needs to be carefully considered. Both older adults and health care professionals felt that it was important that technology did not eliminate face-to-face contact. There were concerns from older adults about the intrusiveness of technology. For the usability and feasibility testing, 7 patients and 3 health care professionals participated, with interviews conducted with 6 patients and a focus group with the health care team. Two additional teams (8 health professionals) took part in a demonstration and focus group. Barriers and facilitators were identified, with 5 barriers around reliability due to poor connectivity, cost of connectivity, safety concerns linked to positioning of equipment and connectivity, intrusiveness of technology, and resistance to group teleconferencing. Two facilitators focused on the positive benefits of increased support and monitoring and positive solutions for future improvements. Conclusions: Teleconferencing as a way of delivering fall prevention interventions can be acceptable to older adults, patients, and health care professionals if it works effectively. Connectivity, where there is no Wi-Fi provision, is one of the largest issues. Therefore, local infrastructure needs to be improved. A larger usability study is required to establish whether better equipment for delivery improves usability. UR - http://rehab.jmir.org/2021/1/e19690/ UR - http://dx.doi.org/10.2196/19690 UR - http://www.ncbi.nlm.nih.gov/pubmed/33433398 ID - info:doi/10.2196/19690 ER - TY - JOUR AU - Mascret, Nicolas AU - Delbes, Lisa AU - Voron, Amélie AU - Temprado, Jean-Jacques AU - Montagne, Gilles PY - 2020/12/14 TI - Acceptance of a Virtual Reality Headset Designed for Fall Prevention in Older Adults: Questionnaire Study JO - J Med Internet Res SP - e20691 VL - 22 IS - 12 KW - technology acceptance model KW - acceptability KW - acceptance KW - virtual reality KW - elderly KW - fall KW - eHealth KW - self-efficacy KW - achievement goals N2 - Background: Falls are a common phenomenon among people aged 65 and older and affect older adults? health, quality of life, and autonomy. Technology-based intervention programs are designed to prevent the occurrence of falls and their effectiveness often surpasses that of more conventional programs. However, to be effective, these programs must first be accepted by seniors. Objective: Based on the technology acceptance model, this study aimed to examine the acceptance among older adults before a first use of a virtual reality headset (VRH) used in an intervention program designed to prevent falls. Methods: A sample of 271 French older adults (mean age 73.69 years, SD 6.37 years) voluntarily and anonymously filled out a questionnaire containing the focal constructs (perceived usefulness, perceived enjoyment, perceived ease of use, intention to use, fall-related self-efficacy, and self-avoidance goals) adapted to the VRH, which was designed to prevent falls. Results: The results of the structural equation modeling analysis showed that intention to use the VRH was positively predicted by perceived usefulness, perceived enjoyment, and perceived ease of use. Perceived usefulness of the VRH was also negatively predicted by fall-related self-efficacy (ie, the perceived level of confidence of an individual when performing daily activities without falling) and positively predicted by self-avoidance goals (ie, participating in a physical activity to avoid physical regression). Conclusions: A better understanding of the initial acceptance among older adults of this VRH is the first step to involving older adults in intervention programs designed to prevent falls using this kind of device. UR - http://www.jmir.org/2020/12/e20691/ UR - http://dx.doi.org/10.2196/20691 UR - http://www.ncbi.nlm.nih.gov/pubmed/33315019 ID - info:doi/10.2196/20691 ER - TY - JOUR AU - Rai, Kaur Harleen AU - Schneider, Justine AU - Orrell, Martin PY - 2020/11/16 TI - An Individual Cognitive Stimulation Therapy App for People With Dementia: Development and Usability Study of Thinkability JO - JMIR Aging SP - e17105 VL - 3 IS - 2 KW - dementia KW - cognitive stimulation therapy KW - eHealth KW - development N2 - Background: There is a lack of technological resources for the mental stimulation and communication of people with dementia, which can be helpful in improving cognition and quality of life. Paper-based individual cognitive stimulation therapy (iCST) for people with dementia has the potential to be adapted to a touchscreen format. This can improve accessibility and provide mental stimulation using interactive features. There is a need for a rigorous and systematic approach toward development, leading to improved suitability and implementation of the intervention, so that more people can benefit from its use. Objective: This study aims to develop and investigate the usability of Thinkability, an iCST app that can be used by people with dementia and carers on touchscreen tablets. Methods: The Medical Research Council framework for evaluating complex interventions and the Centre for eHealth Research roadmap served as frameworks for the stages of intervention and technology development. The development of the iCST app itself adopted an agile approach with elements from action research. Hence, it was developed in 3 successive sprints and was evaluated by relevant stakeholders at each sprint. Sprint 1 included 2 patient and public involvement (PPI) consultation meetings, sprint 2 included 1 PPI consultation meeting, and 4 focus groups and 10 individual interviews were organized in sprint 3. A feasibility trial is currently underway. Results: The findings from each sprint were used to inform the development. Sprint 1 helped to identify the relevant evidence base and explored the attitudes of people with dementia and carers toward a potential iCST app. In sprint 2, an initial prototype was evaluated in a small PPI consultation meeting. In sprint 3, feedback was gathered through a qualitative study on the quality and perceived effectiveness of the iCST app. It was well received by people with dementia and carers. A need for more updated and personalized content was highlighted. Conclusions: This study proves that an agile approach toward technology development involving all relevant stakeholders is effective in creating suitable technology. Adding to our previous knowledge of noncomputerized cognitive stimulation therapy, the release of the iCST app will make this psychosocial intervention accessible to more users worldwide. UR - http://aging.jmir.org/2020/2/e17105/ UR - http://dx.doi.org/10.2196/17105 UR - http://www.ncbi.nlm.nih.gov/pubmed/33196451 ID - info:doi/10.2196/17105 ER - TY - JOUR AU - Choi, K. Yong AU - Thompson, J. Hilaire AU - Demiris, George PY - 2020/11/10 TI - Use of an Internet-of-Things Smart Home System for Healthy Aging in Older Adults in Residential Settings: Pilot Feasibility Study JO - JMIR Aging SP - e21964 VL - 3 IS - 2 KW - Internet of Things KW - smart home KW - independent living KW - aging KW - healthy aging N2 - Background: The Internet-of-Things (IoT) technologies can create smart residences that integrate technology within the home to enhance residents? safety as well as monitor their health and wellness. However, there has been little research on real-world testing of IoT smart home devices with older adults, and the feasibility and acceptance of such tools have not been systematically examined. Objective: This study aims to conduct a pilot study to investigate the feasibility of using IoT smart home devices in the actual residences of older adults to facilitate healthy aging. Methods: We conducted a 2-month feasibility study on community-dwelling older adults. Participants chose among different IoT devices to be installed and deployed within their homes. The IoT devices tested varied depending on the participant?s preference: a door and window sensor, a multipurpose sensor (motion, temperature, luminosity, and humidity), a voice-operated smart speaker, and an internet protocol (IP) video camera. Results: We recruited a total of 37 older adults for this study, with 35 (95%) successfully completing all procedures in the 2-month study. The average age of the sample was 78 (SD 9) years and primarily comprised women (29/37, 78%), those who were educated (31/37, 86%; bachelor?s degree or higher), and those affected by chronic conditions (33/37, 89%). The most widely chosen devices among the participants were multipurpose sensors and smart speakers. An IP camera was a significantly unpopular choice among participants in both phases. The participant feedback suggests that perceived privacy concerns, perceived usefulness, and curiosity to technology were strong factors when considering which device to have installed in their home. Conclusions: Overall, our deployment results revealed that the use of IoT smart home devices is feasible in actual residences of older adults. These findings may inform the follow-up assessment of IoT technologies and their impact on health-related outcomes and advance our understanding of the role of IoT home-based monitoring technologies to promote successful aging-in-place for older adults. Future trials should consider older adults? preferences for the different types of smart home devices to be installed in real-world residential settings. UR - http://aging.jmir.org/2020/2/e21964/ UR - http://dx.doi.org/10.2196/21964 UR - http://www.ncbi.nlm.nih.gov/pubmed/33170128 ID - info:doi/10.2196/21964 ER - TY - JOUR AU - Compernolle, Sofie AU - Cardon, Greet AU - van der Ploeg, P. Hidde AU - Van Nassau, Femke AU - De Bourdeaudhuij, Ilse AU - Jelsma, J. Judith AU - Brondeel, Ruben AU - Van Dyck, Delfien PY - 2020/10/29 TI - Engagement, Acceptability, Usability, and Preliminary Efficacy of a Self-Monitoring Mobile Health Intervention to Reduce Sedentary Behavior in Belgian Older Adults: Mixed Methods Study JO - JMIR Mhealth Uhealth SP - e18653 VL - 8 IS - 10 KW - mHealth KW - older adults KW - self-monitoring KW - perceptions KW - engagement KW - acceptability KW - mixed methods N2 - Background: Although healthy aging can be stimulated by the reduction of sedentary behavior, few interventions are available for older adults. Previous studies suggest that self-monitoring might be a promising behavior change technique to reduce older adults? sedentary behavior. However, little is known about older adults? experiences with a self-monitoring?based intervention aimed at the reduction of sedentary behavior. Objective: The aim of this study is to evaluate engagement, acceptability, usability, and preliminary efficacy of a self-monitoring?based mHealth intervention developed to reduce older adults? sedentary behavior. Methods: A mixed methods study was performed among 28 community-dwelling older adults living in Flanders, Belgium. The 3-week intervention consisted of general sedentary behavior information as well as visual and tactile feedback on participants? sedentary behavior. Semistructured interviews were conducted to explore engagement with, and acceptability and usability of, the intervention. Sitting time was measured using the thigh-worn activPAL (PAL Technologies) accelerometer before and after the intervention. System usage data of the app were recorded. Quantitative data were analyzed using descriptive statistics and paired-samples t tests; qualitative data were thematically analyzed and presented using pen profiles. Results: Participants mainly reported positive feelings regarding the intervention, referring to it as motivating, surprising, and interesting. They commonly reported that the intervention changed their thinking (ie, they became more aware of their sedentary behavior) but not their actual behavior. There were mixed opinions on the kind of feedback (ie, tactile vs visual) that they preferred. The intervention was considered easy to use, and the design was described as clear. Some problems were noticed regarding attaching and wearing the self-monitoring device. System usage data showed that the median frequency of consulting the app widely differed among participants, ranging from 0 to 20 times a day. No significant reductions were found in objectively measured sitting time. Conclusions: Although the intervention was well perceived by the majority of older adults, no reductions in sitting time were found. Possible explanations for the lack of reductions might be the short intervention duration or the fact that only bringing the habitual sedentary behavior into conscious awareness might not be sufficient to achieve behavior change. Trial Registration: ClinicalTrials.gov NCT04003324; https://tinyurl.com/y2p4g8hx UR - http://mhealth.jmir.org/2020/10/e18653/ UR - http://dx.doi.org/10.2196/18653 UR - http://www.ncbi.nlm.nih.gov/pubmed/33118951 ID - info:doi/10.2196/18653 ER - TY - JOUR AU - Bartels, Laureen Sara AU - van Knippenberg, M. Rosalia J. AU - Malinowsky, Camilla AU - Verhey, J. Frans R. AU - de Vugt, E. Marjolein PY - 2020/10/16 TI - Smartphone-Based Experience Sampling in People With Mild Cognitive Impairment: Feasibility and Usability Study JO - JMIR Aging SP - e19852 VL - 3 IS - 2 KW - experience sampling method KW - mild cognitive impairment KW - cognition KW - feasibility KW - smartphones N2 - Background: Daily functioning of people with cognitive disorders such as mild cognitive impairment (MCI) is usually depicted by retrospective questionnaires, which can be memory-biased and neglect fluctuations over time or contexts. Objective: This study examines the feasibility and usability of applying the experience sampling method (ESM) in people with MCI to provide a detailed and dynamic picture of behavioral, emotional, and cognitive patterns in everyday life. Methods: For 6 consecutive days, 21 people with MCI used an ESM app on their smartphones. At 8 semi-random timepoints per day, participants filled in momentary questionnaires on mood, activities, social context, and subjective cognitive complaints. Feasibility was determined through self-reports and observable human-technology interactions. Usability was demonstrated on an individual and group level. Results: Of the 21 participants, 3 dropped out due to forgetting to carry their smartphones or forgetting the study instructions. In the remaining 18 individuals, the compliance rate was high, at 78.7%. Participants reported that momentary questions reflected their daily experiences well. Of the 18 participants, 13 (72%) experienced the increase in awareness of their own memory functions as pleasant or neutral. Conclusions: Support was found for the general feasibility of smartphone-based experience sampling in people with MCI. However, many older adults with MCI are currently not in possession of smartphones, and study adherence seems challenging for a minority of individuals. Momentary data can increase the insights into daily patterns and may guide the person-tailored development of self-management strategies in clinical settings. UR - http://aging.jmir.org/2020/2/e19852/ UR - http://dx.doi.org/10.2196/19852 UR - http://www.ncbi.nlm.nih.gov/pubmed/33064084 ID - info:doi/10.2196/19852 ER - TY - JOUR AU - Padala, P. Kalpana AU - Wilson, B. Kerrie AU - Gauss, Heath C. AU - Stovall, D. Jessica AU - Padala, R. Prasad PY - 2020/9/30 TI - VA Video Connect for Clinical Care in Older Adults in a Rural State During the COVID-19 Pandemic: Cross-Sectional Study JO - J Med Internet Res SP - e21561 VL - 22 IS - 9 KW - VA Video Connect KW - older adults KW - rural KW - COVID-19 KW - veterans KW - telehealth KW - elderly KW - disparity KW - veteran affairs KW - capabillity KW - cross-sectional N2 - Background: The COVID-19 pandemic has accelerated the need for telehealth at home. Although the Department of Veterans Affairs is a leading provider of telehealth, disparities may exist in reaching older veterans living in rural areas. VA Video Connect (VVC) is a video conferencing app that enables veterans to connect with their health care provider via a secure and private session. Objective: The aim of this study was to examine the capability and willingness of older veterans to participate in a VVC visit during the COVID-19 pandemic. Methods: A cross-sectional study was conducted on older veterans (N=118) at the Central Arkansas Veterans Healthcare System. Participants were interviewed over the phone and responses to the following items were recorded: availability of internet, email, and an electronic device with a camera; veterans? willingness to complete an appointment via a VVC visit; and availability of assistance from a caregiver for those who were unable to participate in a VVC visit alone. Results: Participants? mean age was 72.6 (SD 8.3) years, 92% (n=108) were male, 69% (n=81) were Caucasian, 30% (n=35) were African Americans, and 36% (n=42) lived in a rural location. The majority reported having access to the internet (n=93, 77%) and email service (n=83, 70%), but only 56% (n=67) had a camera-equipped device. Overall, 53% (n=63) were willing and capable of participating in a VVC visit. The availability of internet access was significantly lower in rural compared to nonrural participants (P=.045) and in those with or less than a high school education compared to those who pursued higher education (P=.02). Willingness to participate in the VVC visit was significantly lower in rural compared to nonrural participants (P=.03). Of the participants who reported they were able and willing to partake in a VVC visit (n=54), 65% (n=35) opted for VVC and 35% (n=19) preferred a phone visit. In total, 77% (n=27) of the scheduled VVC visits were successful. Conclusions: Despite advances in technology, and willingness on the part of health care systems, there are some lingering issues with capability and willingness to participate in video telehealth visits, particularly among older adults residing in rural areas. UR - http://www.jmir.org/2020/9/e21561/ UR - http://dx.doi.org/10.2196/21561 UR - http://www.ncbi.nlm.nih.gov/pubmed/32936773 ID - info:doi/10.2196/21561 ER - TY - JOUR AU - Wang, Hailiang AU - Zhao, Yang AU - Yu, Lisha AU - Liu, Jiaxing AU - Zwetsloot, Maria Inez AU - Cabrera, Javier AU - Tsui, Kwok-Leung PY - 2020/9/30 TI - A Personalized Health Monitoring System for Community-Dwelling Elderly People in Hong Kong: Design, Implementation, and Evaluation Study JO - J Med Internet Res SP - e19223 VL - 22 IS - 9 KW - telehealth monitoring KW - personalized health KW - technology acceptance KW - digital biomarkers KW - digital phenotyping KW - wearables KW - falls detection KW - fitness tracker KW - sensors KW - elderly population N2 - Background: Telehealth is an effective means to assist existing health care systems, particularly for the current aging society. However, most extant telehealth systems employ individual data sources by offline data processing, which may not recognize health deterioration in a timely way. Objective: Our study objective was two-fold: to design and implement an integrated, personalized telehealth system on a community-based level; and to evaluate the system from the perspective of user acceptance. Methods: The system was designed to capture and record older adults? health-related information (eg, daily activities, continuous vital signs, and gait behaviors) through multiple measuring tools. State-of-the-art data mining techniques can be integrated to detect statistically significant changes in daily records, based on which a decision support system could emit warnings to older adults, their family members, and their caregivers for appropriate interventions to prevent further health deterioration. A total of 45 older adults recruited from 3 elderly care centers in Hong Kong were instructed to use the system for 3 months. Exploratory data analysis was conducted to summarize the collected datasets. For system evaluation, we used a customized acceptance questionnaire to examine users? attitudes, self-efficacy, perceived usefulness, perceived ease of use, and behavioral intention on the system. Results: A total of 179 follow-up sessions were conducted in the 3 elderly care centers. The results of exploratory data analysis showed some significant differences in the participants? daily records and vital signs (eg, steps, body temperature, and systolic blood pressure) among the 3 centers. The participants perceived that using the system is a good idea (ie, attitude: mean 5.67, SD 1.06), comfortable (ie, self-efficacy: mean 4.92, SD 1.11), useful to improve their health (ie, perceived usefulness: mean 4.99, SD 0.91), and easy to use (ie, perceived ease of use: mean 4.99, SD 1.00). In general, the participants showed a positive intention to use the first version of our personalized telehealth system in their future health management (ie, behavioral intention: mean 4.45, SD 1.78). Conclusions: The proposed health monitoring system provides an example design for monitoring older adults? health status based on multiple data sources, which can help develop reliable and accurate predictive analytics. The results can serve as a guideline for researchers and stakeholders (eg, policymakers, elderly care centers, and health care providers) who provide care for older adults through such a telehealth system. UR - http://www.jmir.org/2020/9/e19223/ UR - http://dx.doi.org/10.2196/19223 UR - http://www.ncbi.nlm.nih.gov/pubmed/32996887 ID - info:doi/10.2196/19223 ER - TY - JOUR AU - Etingen, Bella AU - Amante, J. Daniel AU - Martinez, N. Rachael AU - Smith, M. Bridget AU - Shimada, L. Stephanie AU - Richardson, Lorilei AU - Patterson, Angela AU - Houston, K. Thomas AU - Frisbee, L. Kathleen AU - Hogan, P. Timothy PY - 2020/9/30 TI - Supporting the Implementation of Connected Care Technologies in the Veterans Health Administration: Cross-Sectional Survey Findings from the Veterans Engagement with Technology Collaborative (VET-C) Cohort JO - J Participat Med SP - e21214 VL - 12 IS - 3 KW - eHealth KW - mobile health KW - patient engagement KW - telehealth KW - veterans N2 - Background: Widespread adoption, use, and integration of patient-facing technologies into the workflow of health care systems has been slow, thus limiting the realization of their potential. A growing body of work has focused on how best to promote adoption and use of these technologies and measure their impacts on processes of care and outcomes. This body of work currently suffers from limitations (eg, cross-sectional analyses, limited patient-generated data linked with clinical records) and would benefit from institutional infrastructure to enhance available data and integrate the voice of the patient into implementation and evaluation efforts. Objective: The Veterans Health Administration (VHA) has launched an initiative called the Veterans Engagement with Technology Collaborative cohort to directly address these challenges. This paper reports the process by which the cohort was developed and describes the baseline data being collected from cohort members. The overarching goal of the Veterans Engagement with Technology Collaborative cohort is to directly engage veterans in the evaluation of new VHA patient-facing technologies and in so doing, to create new infrastructure to support related quality improvement and evaluation activities. Methods: Inclusion criteria for veterans to be eligible for membership in the cohort included being an active user of VHA health care services, having a mobile phone, and being an established user of existing VHA patient-facing technologies as represented by use of the secure messaging feature of VHA?s patient portal. Between 2017 and 2018, we recruited veterans who met these criteria and administered a survey to them over the telephone. Results: The majority of participants (N=2727) were male (2268/2727, 83.2%), White (2226/2727, 81.6%), living in their own apartment or house (2519/2696, 93.4%), and had completed some college (1176/2701, 43.5%) or an advanced degree (1178/2701, 43.6%). Cohort members were 59.9 years old, on average. The majority self-reported their health status as being good (1055/2725, 38.7%) or very good (524/2725, 19.2%). Most cohort members owned a personal computer (2609/2725, 95.7%), tablet computer (1616/2716, 59.5%), and/or smartphone (2438/2722, 89.6%). Conclusions: The Veterans Engagement with Technology Collaborative cohort is an example of a VHA learning health care system initiative designed to support the data-driven implementation of patient-facing technologies into practice and measurement of their impacts. With this initiative, VHA is building capacity for future, rapid, rigorous evaluation and quality improvement efforts to enhance understanding of the adoption, use, and impact of patient-facing technologies. UR - http://jopm.jmir.org/2020/3/e21214/ UR - http://dx.doi.org/10.2196/21214 UR - http://www.ncbi.nlm.nih.gov/pubmed/33044944 ID - info:doi/10.2196/21214 ER - TY - JOUR AU - Hawley-Hague, Helen AU - Tacconi, Carlo AU - Mellone, Sabato AU - Martinez, Ellen AU - Ford, Claire AU - Chiari, Lorenzo AU - Helbostad, Jorunn AU - Todd, Chris PY - 2020/9/28 TI - Smartphone Apps to Support Falls Rehabilitation Exercise: App Development and Usability and Acceptability Study JO - JMIR Mhealth Uhealth SP - e15460 VL - 8 IS - 9 KW - aged KW - postural balance KW - telerehabilitation KW - patient compliance KW - accidental falls N2 - Background: Falls have implications for older adults? health and well-being. Strength and balance interventions significantly reduce the risk of falls. However, patients do not always perform the unsupervised home exercise needed for fall reduction. Objective: This study aims to develop motivational smartphone apps co-designed with health professionals and older adults to support patients to perform exercise proven to aid fall reduction and to explore the apps? usability and acceptability with both health professionals and patients. Methods: There were 3 phases of app development that included analysis, design, and implementation. For analysis, we examined the literature to establish key app components and had a consultation with 12 older adults attending a strength and balance class, exercise instructors, and 3 fall services. For design, we created prototype apps and conducted 2 patient and public involvement workshops, one with 5 health professionals and the second with 8 older adults from an exercise group. The apps were revised based on the feedback. For implementation, we tested them with one fall service and their patients for 3 weeks. Participatory evaluation was used through testing, semistructured interviews, and focus groups to explore acceptability and usability. Focus groups were conducted with the service that tested the apps and two other services. Qualitative data were analyzed using the framework approach. Results: On the basis of findings from the literature and consultations in the analysis phase, we selected Behavior Change Techniques, such as goal setting, action planning, and feedback on behavior, to be key parts of the app. We developed goals using familiar icons for patients to select and add while self-reporting exercise and decided to develop 2 apps, one for patients (My Activity Programme) and one for health professionals (Motivate Me). This enabled health professionals to guide patients through the goal-setting process, making it more accessible to nontechnology users. Storyboards were created during the design phase, leading to prototypes of ?Motivate Me? and ?My Activity Programme.? Key changes from the workshops included being able to add more details about the patients? exercise program and a wider selection of goals within ?Motivate Me.? The overall app design was acceptable to health professionals and older adults. In total, 7 patients and 3 health professionals participated in testing in the implementation phase, with interviews conducted with 6 patients and focus groups, with 3 teams (11 health professionals). Barriers, facilitators, and further functionality were identified for both apps, with 2 cross-cutting themes around phone usability and confidence. Conclusions: The motivational apps were found to be acceptable for older adults taking part in the design stage and patients and health professionals testing the apps in a clinical setting. User-led design is important to ensure that the apps are usable and acceptable. UR - http://mhealth.jmir.org/2020/9/e15460/ UR - http://dx.doi.org/10.2196/15460 UR - http://www.ncbi.nlm.nih.gov/pubmed/32985992 ID - info:doi/10.2196/15460 ER - TY - JOUR AU - Robinson, A. Stephanie AU - Wan, S. Emily AU - Shimada, L. Stephanie AU - Richardson, R. Caroline AU - Moy, L. Marilyn PY - 2020/9/9 TI - Age and Attitudes Towards an Internet-Mediated, Pedometer-Based Physical Activity Intervention for Chronic Obstructive Pulmonary Disease: Secondary Analysis JO - JMIR Aging SP - e19527 VL - 3 IS - 2 KW - aging KW - COPD KW - chronic conditions KW - physical activity KW - eHealth N2 - Background: Chronic obstructive pulmonary disease (COPD) is prevalent among older adults. Promoting physical activity and increasing exercise capacity are recommended for all individuals with COPD. Pulmonary rehabilitation is the standard of care to improve exercise capacity, although there are barriers that hinder accessibility. Technology has the potential to overcome some of these barriers, but it is unclear how aging adults with a chronic disease like COPD perceive technology-based platforms to support their disease self-management. Objective: Guided by the unified theory of acceptance and use of technology, the current retrospective secondary analysis explores if age moderates multiple factors that influence an individual with COPD?s openness toward an internet-mediated, pedometer-based physical activity intervention. Methods: As part of an efficacy study, participants with COPD (N=59) were randomly assigned to use an internet-mediated, pedometer-based physical activity intervention for 12 weeks. At completion, they were asked about their experience with the intervention using a survey, including their performance expectancy and effort expectancy, facilitating conditions (ie, internet use frequency and ability), and use of the intervention technology. Logistic regression and general linear modeling examined the associations between age and these factors. Results: Participants ranged in age from 49 to 89 years (mean 68.66, SD 8.93). Disease severity was measured by forced expiratory volume in the first second percent predicted (mean 60.01, SD 20.86). Nearly all participants (54/59) believed the intervention was useful. Regarding effort expectancy, increasing age was associated with reporting that it was easy to find the time to engage in the intervention. Regarding facilitating conditions, approximately half of the participants believed the automated step count goals were too high (23/59) and many did not feel comfortable reaching their goals (22/59). The probability of these perceptions increased with age, even after accounting for disease severity. Age was not associated with other facilitating conditions or use of the technology. Conclusions: Age does not influence performance expectancy or use of technology with an internet-mediated, pedometer-based physical activity intervention. Age is associated with certain expectations of effort and facilitating conditions. Consideration of age of the user is needed when personalizing step count goals and time needed to log in to the website. Trial Registration: ClinicalTrials.gov NCT01772082; https://clinicaltrials.gov/ct2/show/NCT01772082 UR - http://aging.jmir.org/2020/2/e19527/ UR - http://dx.doi.org/10.2196/19527 UR - http://www.ncbi.nlm.nih.gov/pubmed/32902390 ID - info:doi/10.2196/19527 ER - TY - JOUR AU - ter Stal, Silke AU - Broekhuis, Marijke AU - van Velsen, Lex AU - Hermens, Hermie AU - Tabak, Monique PY - 2020/9/4 TI - Embodied Conversational Agent Appearance for Health Assessment of Older Adults: Explorative Study JO - JMIR Hum Factors SP - e19987 VL - 7 IS - 3 KW - embodied conversational agent KW - appearance design KW - health status assessment KW - older adults KW - eHealth N2 - Background: Embodied conversational agents (ECAs) have great potential for health apps but are rarely investigated as part of such apps. To promote the uptake of health apps, we need to understand how the design of ECAs can influence the preferences, motivation, and behavior of users. Objective: This is one of the first studies that investigates how the appearance of an ECA implemented within a health app affects users? likeliness of following agent advice, their perception of agent characteristics, and their feeling of rapport. In addition, we assessed usability and intention to use. Methods: The ECA was implemented within a frailty assessment app in which three health questionnaires were translated into agent dialogues. In a within-subject experiment, questionnaire dialogues were randomly offered by a young female agent or an older male agent. Participants were asked to think aloud during interaction. Afterward, they rated the likeliness of following the agent?s advice, agent characteristics, rapport, usability, and intention to use and participated in a semistructured interview. Results: A total of 20 older adults (72.2 [SD 3.5] years) participated. The older male agent was perceived as more authoritative than the young female agent (P=.03), but no other differences were found. The app scored high on usability (median 6.1) and intention to use (median 6.0). Participants indicated they did not see an added value of the agent to the health app. Conclusions: Agent age and gender little influence users? impressions after short interaction but remain important at first glance to lower the threshold to interact with the agent. Thus, it is important to take the design of ECAs into account when implementing them into health apps. UR - https://humanfactors.jmir.org/2020/3/e19987 UR - http://dx.doi.org/10.2196/19987 UR - http://www.ncbi.nlm.nih.gov/pubmed/32886068 ID - info:doi/10.2196/19987 ER - TY - JOUR AU - Lai, Rhoda AU - Tensil, Maria AU - Kurz, Alexander AU - Lautenschlager, T. Nicola AU - Diehl-Schmid, Janine PY - 2020/7/31 TI - Perceived Need and Acceptability of an App to Support Activities of Daily Living in People With Cognitive Impairment and Their Carers: Pilot Survey Study JO - JMIR Mhealth Uhealth SP - e16928 VL - 8 IS - 7 KW - Aged KW - dementia KW - memory disorders KW - carers KW - mobile apps N2 - Background: Modern technologies, including smartphone apps, have the potential to assist people with cognitive impairment with activities of daily living, allowing them to maintain their independence and reduce carer burden. However, such tools have seen a slow rate of uptake in this population, and data on the acceptability of assistive technologies in this population are limited. Objective: This pilot study included older adults with cognitive impairment and their carers, and explored the perceived needs for and acceptability of an app that was designed to be a simple assistive tool for activities of daily living. In particular, this study aimed to assess the acceptability of common app functions such as communication, reminder, navigation, and emergency tools in this population, and to compare patients? and carers? responses to them. Methods: A total of 24 German participants with mild cognitive impairment or dementia and their family carers separately completed two short questionnaires. The first questionnaire asked the participants with cognitive impairment and their carers to self-rate the patients? cognitive impairment levels and affinity to technology. Following a demonstration of the app, participants rated the usability and acceptability of the app and its functions in a second questionnaire. Results: Participants rated themselves as much less cognitively impaired than their carers did (P=.01), and insight into the level of support they received was low. The majority of the participants (19/24, 79%) and their carers (20/24, 83%) had low affinity to technology, and even after the demonstration, 63% (15/24) of the participants had low interest in using the app. A breakdown of acceptability responses by app function revealed that participants were more amenable to the reminder function, the emergency feature, and a wearable form of the app. Features that centered around carers monitoring participants? movements were reported to be less acceptable to participants. Conclusions: This study highlights the importance of focusing on acceptability and the consumer?s perceptions in the development of assistive technology for older adults with cognitive impairment. Participants showed an aversion to functions they perceived as eroding their independence, while functions that more closely aligned with independence and autonomy were perceived as more acceptable. UR - http://mhealth.jmir.org/2020/7/e16928/ UR - http://dx.doi.org/10.2196/16928 UR - http://www.ncbi.nlm.nih.gov/pubmed/32735223 ID - info:doi/10.2196/16928 ER - TY - JOUR AU - Kim, HyangHee AU - Lee, Sang-Ho AU - Cho, Nam-Bin AU - You, Heecheon AU - Choi, Teukgyu AU - Kim, Jinwon PY - 2020/7/27 TI - User-Dependent Usability and Feasibility of a Swallowing Training mHealth App for Older Adults: Mixed Methods Pilot Study JO - JMIR Mhealth Uhealth SP - e19585 VL - 8 IS - 7 KW - older adults KW - dysphagia KW - swallowing KW - mHealth KW - thematic analysis KW - usability KW - apps KW - education KW - experience KW - sociodemographic N2 - Background: Swallowing difficulties (ie, dysphagia) are common among older adults, with a 13% to 54% prevalence. Adequate interventions to improve the swallowing function of older adults would reduce morbidity and enhance health-related quality of life outcomes. Mobile health (mHealth) apps may help alleviate dysphagia symptoms by providing programs that maximize the intensity and frequency of training without requiring high costs or regular clinic visits. Objective: The aim of this pilot study was to assess the usability of swallowing training apps by quantitatively and qualitatively evaluating older adults? self-reported data, taking into consideration their educational levels and exposure to mobile technology. We conducted surveys and brief interviews while the participants used a swallowing intervention app we developed. We subsequently identified and resolved individual-specific usability issues to improve future implementation of the app protocol for older persons with swallowing difficulties. Methods: A total of 11 participants (10 women, 91%; mean age 75.7 years, SD 3.93) from two district-run senior welfare centers took part in this study. The participants were divided into a high-potential group and a low-potential group based on their total number of years of education and smart device usage. To investigate the usability of the app twice (ie, in the second week of the intervention and the postintervention stage), we used mixed methods consisting of both quantitative approaches, namely the System Usability Scale (SUS) and modified Computer Self-Efficacy Scale (mCSES) surveys, and qualitative approaches (ie, interviews). Results: The quantitative results of the SUS and mCSES surveys revealed that the high-potential group was more inclined to adopt and learn new technology than the low-potential group. Specifically, within the high-potential group, a Wilcoxon signed-rank test indicated that the postintervention mCSES scores (median 65.50) were significantly higher than those in the second week of intervention (median 54.00; z=?2.023, P=.04). Additionally, the usability scores in the low-potential group were within the ?marginal acceptability? range even after completion of an 8-week intervention program. Qualitative analyses via semi-structured interviews yielded promising outcomes regarding app acceptability, training program utilization, emotional responses, and learning experience. Conclusions: To the best of the authors? knowledge, this usability and feasibility study is the first report of a swallowing training app designed to improve the swallowing function of older adults. Future research should consider several issues, such as user characteristics, pretraining education, and the intensity and innate characteristics of the intervention program. UR - http://mhealth.jmir.org/2020/7/e19585/ UR - http://dx.doi.org/10.2196/19585 UR - http://www.ncbi.nlm.nih.gov/pubmed/32663161 ID - info:doi/10.2196/19585 ER - TY - JOUR AU - Mehra, Sumit AU - van den Helder, Jantine AU - Visser, Bart AU - Engelbert, H. Raoul H. AU - Weijs, M. Peter J. AU - Kröse, A. Ben J. PY - 2020/7/23 TI - Evaluation of a Blended Physical Activity Intervention for Older Adults: Mixed Methods Study JO - J Med Internet Res SP - e16380 VL - 22 IS - 7 KW - frail elderly KW - aged KW - activities of daily living KW - exercise KW - health behavior KW - telemedicine KW - mobile devices KW - tablet computers KW - usability testing KW - evaluation N2 - Background: Physical activity can prolong the ability of older adults to live independently. Home-based exercises can help achieve the recommended physical activity levels. A blended intervention was developed to support older adults in performing home-based exercises. A tablet and a personal coach were provided to facilitate the self-regulation of exercise behavior. Objective: In line with the Medical Research Council framework, this study aimed to carry out process evaluation of a blended intervention. The objectives were (1) to assess the long-term usability of the tablet adopted in the blended intervention and (2) to explore how the tablet, in conjunction with a personal coach, supported older adults in performing home-based exercises. Methods: The process evaluation was conducted with a mixed-methods approach. At baseline, older adults participating in the blended intervention were asked to fill out a questionnaire about their general experience with information and communication technology (ICT) devices and rate their own skill level. After 6 months, participants filled out the Usefulness, Satisfaction, and Ease of use (USE) questionnaire to assess the usefulness, satisfaction, and ease of use of the tablet. With a random selection of participants, in-depth interviews were held to explore how the tablet and coach supported the self-regulation. The interviews were double coded and analyzed with the directed content analysis method. Results: At baseline, 29% (65/224) of participants who started the intervention (mean age 72 years) filled out the ICT survey and 36% (37/103) of participants who used the tablet for 6 months (mean age 71 years) filled out the USE questionnaire. Furthermore, with 17% (18/103) of participants (mean age 73 years), follow-up interviews were held. The results of the baseline questionnaire showed that the large majority of participants already had experience with a tablet, used it regularly, and reported being skillful in operating ICT devices. After 6 months of use, the participants rated the usefulness, satisfaction, and ease of use of the tablet on average as 3.8, 4.2, and 4.1, respectively, on a 5-point scale. The analysis of the interviews showed that the participants felt that the tablet supported action planning, behavior execution, and self-monitoring. On the other hand, especially during the first few months, the personal coach added value during the goal setting, behavior execution, and evaluation phases of self-regulation. Conclusions: The results of the process evaluation showed that older adults who participated in the study were positive about the blended intervention that was designed to support them in performing home-based exercises. Participants reported that the tablet helped them to perform the exercises better, more frequently, and safely. It supported them in various phases of self-regulation. The availability of a personal coach was nevertheless crucial. To support physical activity in older adults, a blended approach is promising. UR - http://www.jmir.org/2020/7/e16380/ UR - http://dx.doi.org/10.2196/16380 UR - http://www.ncbi.nlm.nih.gov/pubmed/32459652 ID - info:doi/10.2196/16380 ER - TY - JOUR AU - Peterson, M. Colleen AU - Mikal, P. Jude AU - McCarron, R. Hayley AU - Finlay, M. Jessica AU - Mitchell, L. Lauren AU - Gaugler, E. Joseph PY - 2020/6/26 TI - The Feasibility and Utility of a Personal Health Record for Persons With Dementia and Their Family Caregivers for Web-Based Care Coordination: Mixed Methods Study JO - JMIR Aging SP - e17769 VL - 3 IS - 1 KW - Alzheimer disease KW - technology KW - disease management KW - personal health record KW - family caregiving KW - informal caregiving KW - caregiver burnout KW - web-based intervention KW - assistive technology N2 - Background: Managing the complex and long-term care needs of persons living with Alzheimer disease and related dementias (ADRD) can adversely impact the health of informal caregivers and their care recipients. Web-based personal health records (PHRs) are one way to potentially alleviate a caregiver?s burden by simplifying ADRD health care management Objective: This study aimed to evaluate Personal Health Record for Persons with Dementia and Their Family Caregivers (PHR-ADRD), a free web-based information exchange tool, using a multiphase mixed methods approach. Methods: Dementia caregivers (N=34) were surveyed for their well-being and perceptions of PHR-ADRD feasibility and utility at 6 and 12 months using close- and open-ended questions as well as a semistructured interview (n=8). Exploratory analyses compared participants? characteristics as well as PHR-ADRD use and experiences based on overall favorability status. Results: Feasibility and utility scores decreased over time, but a subset of participants indicated that the system was helpful. Quantitative comparisons could not explain why some participants indicated favorable, neutral, or unfavorable views of the system overall or had not engaged with PHR-ADRD. Qualitative findings suggested that technology literacy and primary care provider buy-in were barriers. Both qualitative and qualitative findings indicated that time constraints to learn and use the system affected most participants. Conclusions: Development and dissemination of PHRs for family caregivers of persons with ADRD should aim to make systems user-friendly for persons with limited time and technological literacy. Establishing health care provider buy-in may be essential to the future success of any PHR system. UR - http://aging.jmir.org/2020/1/e17769/ UR - http://dx.doi.org/10.2196/17769 UR - http://www.ncbi.nlm.nih.gov/pubmed/32589158 ID - info:doi/10.2196/17769 ER - TY - JOUR AU - Bennion, Russell Matthew AU - Hardy, E. Gillian AU - Moore, K. Roger AU - Kellett, Stephen AU - Millings, Abigail PY - 2020/5/27 TI - Usability, Acceptability, and Effectiveness of Web-Based Conversational Agents to Facilitate Problem Solving in Older Adults: Controlled Study JO - J Med Internet Res SP - e16794 VL - 22 IS - 5 KW - transdiagnostic KW - method of levels KW - system usability KW - acceptability KW - effectiveness KW - mental health KW - conversational agents KW - older adults KW - chatbots KW - web-based KW - N2 - Background: The usability and effectiveness of conversational agents (chatbots) that deliver psychological therapies is under-researched. Objective: This study aimed to compare the system usability, acceptability, and effectiveness in older adults of 2 Web-based conversational agents that differ in theoretical orientation and approach. Methods: In a randomized study, 112 older adults were allocated to 1 of the following 2 fully automated interventions: Manage Your Life Online (MYLO; ie, a chatbot that mimics a therapist using a method of levels approach) and ELIZA (a chatbot that mimics a therapist using a humanistic counseling approach). The primary outcome was problem distress and resolution, with secondary outcome measures of system usability and clinical outcome. Results: MYLO participants spent significantly longer interacting with the conversational agent. Posthoc tests indicated that MYLO participants had significantly lower problem distress at follow-up. There were no differences between MYLO and ELIZA in terms of problem resolution. MYLO was rated as significantly more helpful and likely to be used again. System usability of both the conversational agents was associated with helpfulness of the agents and the willingness of the participants to reuse. Adherence was high. A total of 12% (7/59) of the MYLO group did not carry out their conversation with the chatbot. Conclusions: Controlled studies of chatbots need to be conducted in clinical populations across different age groups. The potential integration of chatbots into psychological care in routine services is discussed. UR - http://www.jmir.org/2020/5/e16794/ UR - http://dx.doi.org/10.2196/16794 UR - http://www.ncbi.nlm.nih.gov/pubmed/32384055 ID - info:doi/10.2196/16794 ER - TY - JOUR AU - Zhong, Runting AU - Rau, Patrick Pei-Luen PY - 2020/5/26 TI - A Mobile Phone?Based Gait Assessment App for the Elderly: Development and Evaluation JO - JMIR Mhealth Uhealth SP - e14453 VL - 8 IS - 5 KW - aged KW - gait KW - mHealth KW - telemedicine KW - falls prevention N2 - Background: Gait disorders are common among older adults. With an increase in the use of technology among older adults, a mobile phone app provides a solution for older adults to self-monitor their gait quality in daily life. Objective: This study aimed to develop a gait-monitoring mobile phone app (Pocket Gait) and evaluate its acceptability and usability among potential older users. Methods: The app was developed to allow older adults to track their gait quality, including step frequency, acceleration root mean square (RMS), step regularity, step symmetry, and step variability. We recruited a total of 148 community-dwelling older adults aged 60 years and older from two cities in China: Beijing and Chongqing. They walked in three ways (single task, dual task, and fast walking) using a smartphone with the gait-monitoring app installed and completed an acceptability and usability survey after the walk test. User acceptability was measured by a questionnaire including four quantitative measures: perceived ease of use, perceived usefulness, ease of learning, and intention to use. Usability was measured using the System Usability Scale (SUS). Interviews were conducted with participants to collect open-ended feedback questions. Results: Task type had a significant effect on all gait parameters, namely, step frequency, RMS, step variability, step regularity, and step symmetry (all P values <.001). Age had a significant effect on step frequency (P=.01), and region had a significant effect on step regularity (P=.04). The acceptability of the gait-monitoring app was positive among older adults. Participants identified the usability of the system with an overall score of 59.7 (SD 10.7) out of 100. Older adults from Beijing scored significantly higher SUS compared with older adults from Chongqing (P<.001). The age of older adults was significantly associated with their SUS score (P=.048). Older adults identified improvements such as a larger font size, inclusion of reference values for gait parameters, and inclusion of heart rate and blood pressure monitoring. Conclusions: This mobile phone app is a health management tool for older adults to self-manage their gait quality and prevent adverse outcomes. In the future, it will be important to take factors such as age and region into consideration while designing a mobile phone?based gait assessment app. The feedback of the participants would help to design more elderly-friendly products. UR - https://mhealth.jmir.org/2020/5/e14453 UR - http://dx.doi.org/10.2196/14453 UR - http://www.ncbi.nlm.nih.gov/pubmed/32473005 ID - info:doi/10.2196/14453 ER - TY - JOUR AU - Bergquist, Ronny AU - Vereijken, Beatrix AU - Mellone, Sabato AU - Corzani, Mattia AU - Helbostad, L. Jorunn AU - Taraldsen, Kristin PY - 2020/4/27 TI - App-based Self-administrable Clinical Tests of Physical Function: Development and Usability Study JO - JMIR Mhealth Uhealth SP - e16507 VL - 8 IS - 4 KW - physical function KW - mHealth app KW - usability KW - older people KW - seniors N2 - Background: Objective measures of physical function in older adults are widely used to predict health outcomes such as disability, institutionalization, and mortality. App-based clinical tests allow users to assess their own physical function and have objective tracking of changes over time by use of their smartphones. Such tests can potentially guide interventions remotely and provide more detailed prognostic information about the participant?s physical performance for the users, therapists, and other health care personnel. We developed 3 smartphone apps with instrumented versions of the Timed Up and Go (Self-TUG), tandem stance (Self-Tandem), and Five Times Sit-to-Stand (Self-STS) tests. Objective: This study aimed to test the usability of 3 smartphone app?based self-tests of physical function using an iterative design. Methods: The apps were tested in 3 iterations: the first (n=189) and second (n=134) in a lab setting and the third (n=20) in a separate home-based study. Participants were healthy adults between 60 and 80 years of age. Assessors observed while participants self-administered the tests without any guidance. Errors were recorded, and usability problems were defined. Problems were addressed in each subsequent iteration. Perceived usability in the home-based setting was assessed by use of the System Usability Scale, the User Experience Questionnaire, and semi-structured interviews. Results: In the first iteration, 7 usability problems were identified; 42 (42/189, 22.0%) and 127 (127/189, 67.2%) participants were able to correctly perform the Self-TUG and Self-Tandem, respectively. In the second iteration, errors caused by the problems identified in the first iteration were drastically reduced, and 108 (108/134, 83.1%) and 106 (106/134, 79.1%) of the participants correctly performed the Self-TUG and Self-Tandem, respectively. The first version of the Self-STS was also tested in this iteration, and 40 (40/134, 30.1%) of the participants performed it correctly. For the third usability test, the 7 usability problems initially identified were further improved. Testing the apps in a home setting gave rise to some new usability problems, and for Self-TUG and Self-STS, the rates of correctly performed trials were slightly reduced from the second version, while for Self-Tandem, the rate increased. The mean System Usability Scale score was 77.63 points (SD 16.1 points), and 80-95% of the participants reported the highest or second highest positive rating on all items in the User Experience Questionnaire. Conclusions: The study results suggest that the apps have the potential to be used to self-test physical function in seniors in a nonsupervised home-based setting. The participants reported a high degree of ease of use. Evaluating the usability in a home setting allowed us to identify new usability problems that could affect the validity of the tests. These usability problems are not easily found in the lab setting, indicating that, if possible, app usability should be evaluated in both settings. Before being made available to end users, the apps require further improvements and validation. UR - http://mhealth.jmir.org/2020/4/e16507/ UR - http://dx.doi.org/10.2196/16507 UR - http://www.ncbi.nlm.nih.gov/pubmed/32338616 ID - info:doi/10.2196/16507 ER - TY - JOUR AU - Neil-Sztramko, E. Sarah AU - Coletta, Giulia AU - Dobbins, Maureen AU - Marr, Sharon PY - 2020/4/20 TI - Impact of the AGE-ON Tablet Training Program on Social Isolation, Loneliness, and Attitudes Toward Technology in Older Adults: Single-Group Pre-Post Study JO - JMIR Aging SP - e18398 VL - 3 IS - 1 KW - technology KW - older adults KW - tablet training KW - education N2 - Background: The internet and technology can help older adults connect with family and friends. However, many older adults face obstacles to internet and technology use, such as lack of knowledge or self-efficacy. Objective: The purpose of this study was to explore the impact of the AGE-ON tablet training program on social isolation, loneliness, and quality of life. Methods: Adults aged >60 years took part in a series of 6 weekly workshops covering the basic features of a tablet. Before and after the program, social isolation, loneliness, social support, and quality of life were assessed. In addition, data on current tablet use and attitudes toward technology use were collected. Satisfaction with the program was also assessed at the end of the study using 6 Likert scale questions. Results: The participants (N=32; mean age 76.3, SD 8.6 years) were predominantly female (n=20, 63%) and retired (n=30, 94%). The participants reported that they were highly satisfied with the program. After completing the program, no differences in social isolation, loneliness, social support, or quality of life were found. Frequency of tablet use increased and the attitudes of the participants toward technology improved. Conclusions: The AGE-ON program resulted in increased tablet use frequency and may improve comfort and attitudes toward tablet use among older adults. This program may assist older adults in overcoming obstacles to internet and technology use to better connect with family and friends; however, further work targeting older adults who are socially isolated or at risk of social isolation is needed to more fully understand whether tablet training programs are beneficial in this population. Trial Registration: ClinicalTrials.gov NCT03472729; https://clinicaltrials.gov/ct2/show/NCT03472729 UR - http://aging.jmir.org/2020/1/e18398/ UR - http://dx.doi.org/10.2196/18398 UR - http://www.ncbi.nlm.nih.gov/pubmed/32310146 ID - info:doi/10.2196/18398 ER - TY - JOUR AU - Zheng, Yaguang AU - Weinger, Katie AU - Greenberg, Jordan AU - Burke, E. Lora AU - Sereika, M. Susan AU - Patience, Nicole AU - Gregas, C. Matt AU - Li, Zhuoxin AU - Qi, Chenfang AU - Yamasaki, Joy AU - Munshi, N. Medha PY - 2020/3/23 TI - Actual Use of Multiple Health Monitors Among Older Adults With Diabetes: Pilot Study JO - JMIR Aging SP - e15995 VL - 3 IS - 1 KW - mobile health KW - aged KW - lifestyle KW - self-management KW - diabetes mellitus, type 2 N2 - Background: Previous studies have reported older adults? perceptions of using health monitors; however, no studies have examined the actual use of multiple health monitors for lifestyle changes over time among older adults with type 2 diabetes (T2D). Objective: The primary aim of this study was to examine the actual use of multiple health monitors for lifestyle changes over 3 months among older adults with T2D. The secondary aim was to explore changes in caloric intake and physical activity (PA) over 3 months. Methods: This was a single-group study lasting 3 months. The study sample included participants who were aged ?65 years with a diagnosis of T2D. Participants were recruited through fliers posted at the Joslin Diabetes Center in Boston. Participants attended five 60-min, biweekly group sessions, which focused on self-monitoring, goal setting, self-regulation to achieve healthy eating and PA habits, and the development of problem-solving skills. Participants were provided with the Lose It! app to record daily food intake and devices such as a Fitbit Alta for monitoring PA, a Bluetooth-enabled blood glucose meter, and a Bluetooth-enabled digital scale. Descriptive statistics were used for analysis. Results: Of the enrolled participants (N=9), the sample was white (8/9, 89%) and female (4/9, 44%), with a mean age of 76.4 years (SD 6.0; range 69-89 years), 15.7 years (SD 2.0) of education, 33.3 kg/m2 (SD 3.1) BMI, and 7.4% (SD 0.8) hemoglobin A1c. Over the 84 days of self-monitoring, the mean percentage of days using the Lose It!, Fitbit Alta, blood glucose meter, and scale were 82.7 (SD 17.6), 85.2 (SD 19.7), 65.3 (SD 30.1), and 53.0 (SD 34.5), respectively. From baseline to completion of the study, the mean daily calorie intake was 1459 (SD 661) at week 1, 1245 (SD 554) at week 11, and 1333 (SD 546) at week 12, whereas the mean daily step counts were 5618 (SD 3654) at week 1, 5792 (SD 3814) at week 11, and 4552 (SD 3616) at week 12. The mean percentage of weight loss from baseline was 4.92% (SD 0.25). The dose of oral hypoglycemic agents or insulin was reduced in 55.6% (5/9) of the participants. Conclusions: The results from the pilot study are encouraging and suggest the need for a larger study to confirm the outcomes. In addition, a study design that includes a control group with educational sessions but without the integration of technology would offer additional insight to understand the value of mobile health in behavior changes and the health outcomes observed during this pilot study. UR - http://aging.jmir.org/2020/1/e15995/ UR - http://dx.doi.org/10.2196/15995 UR - http://www.ncbi.nlm.nih.gov/pubmed/32202506 ID - info:doi/10.2196/15995 ER - TY - JOUR AU - López Seguí, Francesc AU - de San Pedro, Marc AU - Aumatell Verges, Eva AU - Simó Algado, Salvador AU - Garcia Cuyŕs, Francesc PY - 2019/08/09 TI - An Intergenerational Information and Communications Technology Learning Project to Improve Digital Skills: User Satisfaction Evaluation JO - JMIR Aging SP - e13939 VL - 2 IS - 2 KW - active aging KW - digital inclusion KW - ICT program KW - intergenerational relationships KW - civic participation KW - community service N2 - Background: ?Digital Partners? is an intergenerational information and communications technology learning project carried out in the municipalities of Vic and Centelles (Catalonia) from April to May 2018. Within the framework of the introduction of community service as a subject in secondary education, the Centre for Health and Social Studies (University of Vic) created a training space with 38 intergenerational partners (aged 14-15 years and >65 years), with the aim of improving the senior users? digital skills in terms of use of smartphones and tablets, thus helping reduce the digital divide in the territory. Objective: The aim of this paper is to evaluate the satisfaction of both junior and senior participants toward the intervention and to explore its main drivers. Methods: Participants who volunteered to participate in the study were interviewed. Quantitative and qualitative data gathered in paper-based ad hoc surveys were used to assess participants? satisfaction. Results: The experience shows a broad satisfaction of both junior and senior users. The project?s strengths include the format of working in couples; randomly pairing individuals by operating system; the ability to practice with the device itself; individuals? free choice to decide what they wish to learn, develop, or practice; and the availability of voluntary practice material that facilitates communication and learning. With regard to aspects that could be improved, there is a need to review the timetabling flexibility of meetings to avoid hurrying the elderly and to extend the project?s duration, if necessary. Conclusions: This activity can serve to create mutual learning through the use of mobile devices and generate security and motivation on the part of the seniors, thus reducing the digital divide and improving social inclusion. UR - http://aging.jmir.org/2019/2/e13939/ UR - http://dx.doi.org/10.2196/13939 UR - http://www.ncbi.nlm.nih.gov/pubmed/31518276 ID - info:doi/10.2196/13939 ER - TY - JOUR AU - Anderberg, Peter AU - Eivazzadeh, Shahryar AU - Berglund, Sanmartin Johan PY - 2019/05/23 TI - A Novel Instrument for Measuring Older People?s Attitudes Toward Technology (TechPH): Development and Validation JO - J Med Internet Res SP - e13951 VL - 21 IS - 5 KW - technophilia KW - aging KW - internet KW - health technology KW - eHealth N2 - Background: The use of health technology by older people is coming increasingly in focus with the demographic changes. Health information technology is generally perceived as an important factor in enabling increased quality of life and reducing the cost of care for this group. Age-appropriate design and facilitation of technology adoption are important to ensure functionality and removal of various barriers to usage. Development of assessment tools and instruments for evaluating older persons? technology adoption and usage as well as measuring the effects of the interventions are of high priority. Both usability and acceptance of a specific technology or service are important factors in evaluating the impact of a health information technology intervention. Psychometric measures are seldom included in evaluations of health technology. However, basic attitudes and sentiments toward technology (eg, technophilia) could be argued to influence both the level of satisfaction with the technology itself as well as the perception of the health intervention outcome. Objective: The purpose of this study is to develop a reduced and refined instrument for measuring older people's attitudes and enthusiasm for technology based on relevant existing instruments for measuring technophilia. A requirement of the new instrument is that it should be short and simple to make it usable for evaluation of health technology for older people. Methods: Initial items for the TechPH questionnaire were drawn from a content analysis of relevant existing technophilia measure instruments. An exploratory factor analysis was conducted in a random selection of persons aged 65 years or older (N=374) on eight initial items. The scale was reduced to six items, and the internal consistency and reliability of the scale were examined. Further validation was made by a confirmatory factor analysis (CFA). Results: The exploratory factor analysis resulted in two factors. These factors were analyzed and labeled techEnthusiasm and techAnxiety. They demonstrated relatively good internal consistency (Cronbach alpha=.72 and .68, respectively). The factors were confirmed in the CFA and showed good model fit (?28=21.2, ?2/df=2.65, comparative fit index=0.97, adjusted goodness-of-fit index=0.95, root mean square error of approximation=0.067, standardized root mean square residual=0.036). Conclusions: The construed TechPH score showed expected relations to external real-world criteria, and the two factors showed interesting internal relations. Different technophilia personality traits distinguish clusters with different behaviors of adaptation as well as usage of new technology. Whether there is an independent association with the TechPH score against outcomes in health technology projects needs to be shown in further studies. The instrument must also be validated in different contexts, such as other countries. UR - http://www.jmir.org/2019/5/e13951/ UR - http://dx.doi.org/10.2196/13951 UR - http://www.ncbi.nlm.nih.gov/pubmed/31124467 ID - info:doi/10.2196/13951 ER - TY - JOUR AU - Quinn, C. Charlene AU - Staub, Sheila AU - Barr, Erik AU - Gruber-Baldini, Ann PY - 2019/05/23 TI - Mobile Support for Older Adults and Their Caregivers: Dyad Usability Study JO - JMIR Aging SP - e12276 VL - 2 IS - 1 KW - older adult KW - caregiver KW - mobile health KW - patient engagement N2 - Background: Evaluation of digital health applications to support older adults? independence and family caregiving is needed. Digital health is increasingly providing opportunities for older adults and their family caregivers to educate, engage, and share health information across digital platforms. Few apps have documented evidence of usability by older adults and their caregivers. Objective: The objective of this study was to determine the usability of a mobile app in a community-based older adult population aged ?65 years. The app was designed to improve engagement of the patient-informal caregiver team. Methods: This observational usability study was conducted in participants? homes and independent living facilities in Baltimore, Maryland. Community-dwelling older adults aged ?65 years and their caregivers enrolled as a dyad (n=24, 12 dyads). The usability evaluation was a mobile and Web-based app that allowed older adult users to record social and health information and share this information with their caregivers. The older adult-caregiver dyad downloaded the app to a smart phone or accessed the Web version, participated in training and onboarding, and used the app for a 1-month period. Participants responded to weekly surveys sent by app push notifications and to the usability and satisfaction surveys at the end of the study. Participant satisfaction and usability were assessed using the Modified Mobile Application Rating Scale (M-MARS) and the System Usability Scale (SUS). Results: The final sample comprised 16 people (8 dyads). Responses to the M-MARS were comparable between older adults and caregiver respondents in terms of engagement and functionality. Caregivers rated aesthetics slightly higher (mean 3.7) than older adult participants did (mean 3.3). Although most responses to the SUS were around the mean (2.3-3.4), older adults and their caregivers differed with regard to integration of app features (mean 3.7 vs 2.8) and the need to learn more before using the app (mean 2.3 vs 3.1). Conclusions: Technology ownership and use among older adults and caregivers was high. Usability and engagement of the mobile app was average. Additional training is recommended for older adults and their caregivers, including that on targeted behaviors for digital health record keeping. UR - http://aging.jmir.org/2019/1/e12276/ UR - http://dx.doi.org/10.2196/12276 UR - http://www.ncbi.nlm.nih.gov/pubmed/31518271 ID - info:doi/10.2196/12276 ER - TY - JOUR AU - Wang, Jing AU - Du, Yan AU - Coleman, Deidra AU - Peck, Michelle AU - Myneni, Sahiti AU - Kang, Hong AU - Gong, Yang PY - 2019/05/15 TI - Mobile and Connected Health Technology Needs for Older Adults Aging in Place: Cross-Sectional Survey Study JO - JMIR Aging SP - e13864 VL - 2 IS - 1 KW - mobile health KW - connected health KW - wearable technology KW - remote monitoring KW - independent living KW - aging in place N2 - Background: An increasing number of mobile and wearable devices are available in the market. However, the extent to which these devices can be used to assist older adults to age in place remains unclear. Objective: This study aimed to assess older adults? perceptions of using mobile and connected health technologies. Methods: Using a cross-sectional design, a total of 51 participants were recruited from a senior community center. Demographics and usage of mobile or wearable devices and online health communities were collected using a survey questionnaire. Descriptive statistics assessed usage of devices and online health communities. The Fisher exact test was used to examine the relationship between technology usage and having access to a smartphone. Results: The sample was primarily comprised non-Hispanic white (35/51, 69%), educated (39/51, 76% any college), and female (36/51, 71%) participants, with an average age of 70 (SD 8) years. All participants were insured and nearly all lived at home (49/51, 94%). A total of 86% (44/51) of the participants had heard of wearable health devices, but only 18 out of 51 (35%) had ever used them. Over 80% (42/51) expressed interest in using such devices and were interested in tracking exercise and physical activity (46/51, 90%), sleep (38/51, 75%), blood pressure (34/51, 67%), diet (31/51, 61%), blood sugar (28/51, 55%), weight (26/51, 51%), and fall risk (23/51, 45%). The greatest concerns about using wearable devices were cost (31/51, 61%), safety (14/51, 28%), and privacy (13/51, 26%); one-fourth (12/51) reported having no concerns. They were mostly interested in sharing data from mobile and connected devices with their health care providers followed by family, online communities, friends, and no one. About 41% (21/51) of the older adults surveyed reported having ever heard of an online health community, and roughly 40% (20/51) of the participants reported being interested in joining such a community. Most participants reported having access to a smartphone (38/51, 74%), and those with such access were significantly more likely to show interest in using a wearable health device (P<.001) and joining an online health community (P=.05). Conclusions: Our findings suggest that, although few older adults are currently using mobile and wearable devices and connected health technologies for managing health, they are open to this idea and are mostly interested in sharing such data with their health care providers. Further studies are warranted to explore strategies to balance the data sharing preference of older adults and how to best integrate mobile and wearable device data with clinical workflow for health care providers to promote healthy aging in place. UR - http://aging.jmir.org/2019/1/e13864/ UR - http://dx.doi.org/10.2196/13864 UR - http://www.ncbi.nlm.nih.gov/pubmed/31518283 ID - info:doi/10.2196/13864 ER - TY - JOUR AU - Ding, Y. Eric AU - Han, Dong AU - Whitcomb, Cody AU - Bashar, Khairul Syed AU - Adaramola, Oluwaseun AU - Soni, Apurv AU - Saczynski, Jane AU - Fitzgibbons, P. Timothy AU - Moonis, Majaz AU - Lubitz, A. Steven AU - Lessard, Darleen AU - Hills, True Mellanie AU - Barton, Bruce AU - Chon, Ki AU - McManus, D. David PY - 2019/05/15 TI - Accuracy and Usability of a Novel Algorithm for Detection of Irregular Pulse Using a Smartwatch Among Older Adults: Observational Study JO - JMIR Cardio SP - e13850 VL - 3 IS - 1 KW - mobile health KW - mHealth KW - atrial fibrillation KW - screening KW - photoplethysmography KW - electrocardiography KW - smartwatch N2 - Background: Atrial fibrillation (AF) is often paroxysmal and minimally symptomatic, hindering its diagnosis. Smartwatches may enhance AF care by facilitating long-term, noninvasive monitoring. Objective: This study aimed to examine the accuracy and usability of arrhythmia discrimination using a smartwatch. Methods: A total of 40 adults presenting to a cardiology clinic wore a smartwatch and Holter monitor and performed scripted movements to simulate activities of daily living (ADLs). Participants? clinical and sociodemographic characteristics were abstracted from medical records. Participants completed a questionnaire assessing different domains of the device?s usability. Pulse recordings were analyzed blindly using a real-time realizable algorithm and compared with gold-standard Holter monitoring. Results: The average age of participants was 71 (SD 8) years; most participants had AF risk factors and 23% (9/39) were in AF. About half of the participants owned smartphones, but none owned smartwatches. Participants wore the smartwatch for 42 (SD 14) min while generating motion noise to simulate ADLs. The algorithm determined 53 of the 314 30-second noise-free pulse segments as consistent with AF. Compared with the gold standard, the algorithm demonstrated excellent sensitivity (98.2%), specificity (98.1%), and accuracy (98.1%) for identifying irregular pulse. Two-thirds of participants considered the smartwatch highly usable. Younger age and prior cardioversion were associated with greater overall comfort and comfort with data privacy with using a smartwatch for rhythm monitoring, respectively. Conclusions: A real-time realizable algorithm analyzing smartwatch pulse recordings demonstrated high accuracy for identifying pulse irregularities among older participants. Despite advanced age, lack of smartwatch familiarity, and high burden of comorbidities, participants found the smartwatch to be highly acceptable. UR - http://cardio.jmir.org/2019/1/e13850/ UR - http://dx.doi.org/10.2196/13850 UR - http://www.ncbi.nlm.nih.gov/pubmed/31758787 ID - info:doi/10.2196/13850 ER - TY - JOUR AU - Portz, Dickman Jennifer AU - Bayliss, A. Elizabeth AU - Bull, Sheana AU - Boxer, S. Rebecca AU - Bekelman, B. David AU - Gleason, Kathy AU - Czaja, Sara PY - 2019/04/08 TI - Using the Technology Acceptance Model to Explore User Experience, Intent to Use, and Use Behavior of a Patient Portal Among Older Adults With Multiple Chronic Conditions: Descriptive Qualitative Study JO - J Med Internet Res SP - e11604 VL - 21 IS - 4 KW - multiple chronic conditions KW - personal health record KW - patient portals KW - aging KW - health information technology N2 - Background: Patient portals offer modern digital tools for older adults with multiple chronic conditions (MCC) to engage in their health management. However, there are barriers to portal adoption among older adults. Understanding portal user interface and user experience (UI and UX) preferences of older adults with MCC may improve the accessibility, acceptability, and adoption of patient portals. Objective: The aim of this study was to use the Technology Acceptance Model (TAM) as a framework for qualitatively describing the UI and UX, intent to use, and use behaviors among older patients with MCC. Methods: We carried out a qualitative descriptive study of Kaiser Permanente Colorado?s established patient portal, My Health Manager. Older patients (N=24; mean 78.41 (SD 5.4) years) with MCC participated in focus groups. Stratified random sampling was used to maximize age and experience with the portal among participants. The semistructured focus groups used a combination of discussion and think-aloud strategies. A total of 2 coders led the theoretically driven analysis based on the TAM to determine themes related to use behavior, portal usefulness and ease of use, and intent to use. Results: Portal users commonly used email, pharmacy, and lab results sections of the portal. Although, generally, the portal was seen to be easy to use, simple, and quick, challenges related to log-ins, UI design (color and font), and specific features were identified. Such challenges inhibited participants? intent to use the portal entirely or specific features. Participants indicated that the portal improved patient-provider communication, saved time and money, and provided relevant health information. Participants intended to use features that were beneficial to their health management and easy to use. Conclusions: Older adults are interested in using patient portals and are already taking advantage of the features available to them. We have the opportunity to better engage older adults in portal use but need to pay close attention to key considerations promoting usefulness and ease of use. UR - https://www.jmir.org/2019/4/e11604/ UR - http://dx.doi.org/10.2196/11604 UR - http://www.ncbi.nlm.nih.gov/pubmed/30958272 ID - info:doi/10.2196/11604 ER - TY - JOUR AU - Kononova, Anastasia AU - Li, Lin AU - Kamp, Kendra AU - Bowen, Marie AU - Rikard, RV AU - Cotten, Shelia AU - Peng, Wei PY - 2019/04/05 TI - The Use of Wearable Activity Trackers Among Older Adults: Focus Group Study of Tracker Perceptions, Motivators, and Barriers in the Maintenance Stage of Behavior Change JO - JMIR Mhealth Uhealth SP - e9832 VL - 7 IS - 4 KW - aging KW - wearable electronic devices KW - biobehavioral sciences KW - transtheoretical model of behavior change KW - exercise KW - physical activity N2 - Background: Wearable activity trackers offer the opportunity to increase physical activity through continuous monitoring. Viewing tracker use as a beneficial health behavior, we explored the factors that facilitate and hinder long-term activity tracker use, applying the transtheoretical model of behavior change with the focus on the maintenance stage and relapse. Objective: The aim of this study was to investigate older adults? perceptions and uses of activity trackers at different points of use: from nonuse and short-term use to long-term use and abandoned use to determine the factors to maintain tracker use and prevent users from discontinuing tracker usage. Methods: Data for the research come from 10 focus groups. Of them, 4 focus groups included participants who had never used activity trackers (n=17). These focus groups included an activity tracker trial. The other 6 focus groups (without the activity tracker trial) were conducted with short-term (n=9), long-term (n=11), and former tracker users (n=11; 2 focus groups per user type). Results: The results revealed that older adults in different tracker use stages liked and wished for different tracker features, with long-term users (users in the maintenance stage) being the most diverse and sophisticated users of the technology. Long-term users had developed a habit of tracker use whereas other participants made an effort to employ various encouragement strategies to ensure behavior maintenance. Social support through collaboration was the primary motivator for long-term users to maintain activity tracker use. Short-term and former users focused on competition, and nonusers engaged in vicarious tracker use experiences. Former users, or those who relapsed by abandoning their trackers, indicated that activity tracker use was fueled by curiosity in quantifying daily physical activity rather than the desire to increase physical activity. Long-term users saw a greater range of pros in activity tracker use whereas others focused on the cons of this behavior. Conclusions: The results suggest that activity trackers may be an effective technology to encourage physical activity among older adults, especially those who have never tried it. However, initial positive response to tracker use does not guarantee tracker use maintenance. Maintenance depends on recognizing the long-term benefits of tracker use, social support, and internal motivation. Nonadoption and relapse may occur because of technology?s limitations and gaining awareness of one?s physical activity without changing the physical activity level itself. UR - https://mhealth.jmir.org/2019/4/e9832/ UR - http://dx.doi.org/10.2196/mhealth.9832 UR - http://www.ncbi.nlm.nih.gov/pubmed/30950807 ID - info:doi/10.2196/mhealth.9832 ER - TY - JOUR AU - Manini, Matthew Todd AU - Mendoza, Tonatiuh AU - Battula, Manoj AU - Davoudi, Anis AU - Kheirkhahan, Matin AU - Young, Ellen Mary AU - Weber, Eric AU - Fillingim, Benton Roger AU - Rashidi, Parisa PY - 2019/03/26 TI - Perception of Older Adults Toward Smartwatch Technology for Assessing Pain and Related Patient-Reported Outcomes: Pilot Study JO - JMIR Mhealth Uhealth SP - e10044 VL - 7 IS - 3 KW - smartwatch KW - focus group KW - ecological momentary assessment (EMA) KW - patient-reported outcomes (PRO) N2 - Background: Chronic pain, including arthritis, affects about 100 million adults in the United States. Complexity and diversity of the pain experience across time and people and its fluctuations across and within days show the need for valid pain reports that do not rely on patient?s long-term recall capability. Smartwatches can be used as digital ecological momentary assessment (EMA) tools for real-time collection of pain scores. Smartwatches are generally less expensive than smartphones, are highly portable, and have a simpler user interface, providing an excellent medium for continuous data collection and enabling a higher compliance rate. Objective: The aim of this study was to explore the attitudes and perceptions of older adults towards design and technological aspects of a smartwatch framework for measuring patient report outcomes (PRO) as an EMA tool. Methods: A focus group session was conducted to explore the perception of participants towards smartwatch technology and its utility for PRO assessment. Participants included older adults (age 65+), with unilateral or bilateral symptomatic knee osteoarthritis. A preliminary user interface with server communication capability was developed and deployed on 10 Samsung Gear S3 smartwatches and provided to the users during the focus group. Pain was designated as the main PRO, while fatigue, mood, and sleep quality were included as auxiliary PROs. Pre-planned topics included participants? attitude towards the smartwatch technology, usability of the custom-designed app interface, and suitability of the smartwatch technology for PRO assessment. Discussions were transcribed, and content analysis with theme characterization was performed to identify and code the major themes. Results: We recruited 19 participants (age 65+) who consented to take part in the focus group study. The overall attitude of the participants toward the smartwatch technology was positive. They showed interest in the direct phone-call capability, availability of extra apps such as the weather apps and sensors for tracking health and wellness such as accelerometer and heart rate sensor. Nearly three-quarters of participants showed willingness to participate in a one-year study to wear the watch daily. Concerns were raised regarding usability, including accessibility (larger icons), notification customization, and intuitive interface design (unambiguous icons and assessment scales). Participants expressed interest in using smartwatch technology for PRO assessment and the availability of methods for sharing data with health care providers. Conclusions: All participants had overall positive views of the smartwatch technology for measuring PROs to facilitate patient-provider communications and to provide more targeted treatments and interventions in the future. Usability concerns were the major issues that will require special consideration in future smartwatch PRO user interface designs, especially accessibility issues, notification design, and use of intuitive assessment scales. UR - http://mhealth.jmir.org/2019/3/e10044/ UR - http://dx.doi.org/10.2196/10044 UR - http://www.ncbi.nlm.nih.gov/pubmed/30912756 ID - info:doi/10.2196/10044 ER - TY - JOUR AU - Mehra, Sumit AU - Visser, Bart AU - Cila, Nazli AU - van den Helder, Jantine AU - Engelbert, HH Raoul AU - Weijs, JM Peter AU - Kröse, JA Ben PY - 2019/02/01 TI - Supporting Older Adults in Exercising With a Tablet: A Usability Study JO - JMIR Hum Factors SP - e11598 VL - 6 IS - 1 KW - frail elderly KW - aged KW - activities of daily living KW - exercise KW - health behavior KW - telemedicine KW - mobile devices KW - tablet computers KW - usability testing KW - mobile phone N2 - Background: For older adults, physical activity is vital for maintaining their health and ability to live independently. Home-based programs can help them achieve the recommended exercise frequency. An application for a tablet computer was developed to support older adults in following a personal training program. It featured goal setting, tailoring, progress tracking, and remote feedback. Objective: In line with the Medical Research Council Framework, which prescribes thorough testing before evaluating the efficacy with a randomized controlled trial, the aim of this study was to assess the usability of a tablet-based app that was designed to support older adults in doing exercises at home. Methods: A total of 15 older adults, age ranging from 69 to 99 years old, participated in a usability study that utilized a mixed-methods approach. In a laboratory setting, novice users were asked to complete a series of tasks while verbalizing their ongoing thoughts. The tasks ranged from looking up information about exercises and executing them to tailoring a weekly exercise schedule. Performance errors and time-on-task were calculated as proxies of effective and efficient usage. Overall satisfaction was assessed with a posttest interview. All responses were analyzed independently by 2 researchers. Results: The participants spent 13-85 seconds time-on-task. Moreover, 79% (11/14)-100% (14/14) participants completed the basic tasks with either no help or after having received 1 hint. For expert tasks, they needed a few more hints. During the posttest interview, the participants made 3 times more positive remarks about the app than negative remarks. Conclusions: The app that was developed to support older adults in doing exercises at home is usable by the target audience. First-time users were able to perform basic tasks in an effective and efficient manner. In general, they were satisfied with the app. Tasks that were associated with behavior execution and evaluation were performed with ease. Complex tasks such as tailoring a personal training schedule needed more effort. Learning effects, usefulness, and long-term satisfaction will be investigated through longitudinal follow-up studies. UR - http://humanfactors.jmir.org/2019/1/e11598/ UR - http://dx.doi.org/10.2196/11598 UR - http://www.ncbi.nlm.nih.gov/pubmed/30707106 ID - info:doi/10.2196/11598 ER - TY - JOUR AU - Backman, Chantal AU - Harley, Anne AU - Peyton, Liam AU - Kuziemsky, Craig AU - Mercer, Jay AU - Monahan, Anne Mary AU - Schmidt, Sandra AU - Singh, Harvinder AU - Gravelle, Deborah PY - 2018/9/24 TI - Development of a Path to Home Mobile App for the Geriatric Rehabilitation Program at Bruyčre Continuing Care: Protocol for User-Centered Design and Feasibility Testing Studies JO - JMIR Res Protoc SP - e11031 VL - 7 IS - 9 KW - patient discharge KW - care transition KW - user-centered design KW - geriatric rehabilitation KW - mHealth KW - transitional care KW - rehabilitation KW - health services for the aged KW - telemedicine N2 - Background: As the population ages, the need for appropriate geriatric rehabilitation services will also increase. Pressures faced by hospitals to reduce length of stay and reduce costs have driven the need for more complex care being delivered in the home or community setting. As a result, a multifaceted approach that can provide geriatric rehabilitation patients with safe and effective person- and family-centered care during transitions from hospital to home is required. We hypothesize that a technology-supported person- and family-centered care transition could empower geriatric rehabilitation patients, engage them in shared decision making, and ultimately help them to safely manage their personalized needs during care transitions from hospital to home. Objective: The purpose of this study is to design and test the feasibility of a novel Path to Home mobile app to manage the personalized needs of geriatric rehabilitation patients during their transitions from hospital to home. Methods: This study will consist of (1) codesigning a patient- and provider-tailored mobile app, and (2) feasibility pilot testing of the mobile app to manage the needs of geriatric rehabilitation patients when leaving the hospital. In phase 1, we will follow a user-centered design process integrated with a modern agile software development methodology to iteratively codesign the personalized care transition Path to Home mobile app. In phase 2, we will conduct a single-arm feasibility pilot test with geriatric rehabilitation patients using the personalized care transition Path to Home mobile app to manage their needs during the transition from hospital to home. Results: The project was funded in May 2018, and enrollment and data analysis are underway. First results are expected to be submitted for publication in 2019. Conclusions: Our findings will help validate the use of this technology for geriatric rehabilitation patients discharged from the hospital to home. Future research will more rigorously evaluate the health and economic benefits to inform wide-scale adoption of the technology. Registered Report Identifier: RR1-10.2196/11031 UR - http://www.researchprotocols.org/2018/9/e11031/ UR - http://dx.doi.org/10.2196/11031 UR - http://www.ncbi.nlm.nih.gov/pubmed/30249591 ID - info:doi/10.2196/11031 ER - TY - JOUR AU - Theis, Sabine AU - Rasche, Victor Peter Wilhelm AU - Bröhl, Christina AU - Wille, Matthias AU - Mertens, Alexander PY - 2018/07/09 TI - Task-Data Taxonomy for Health Data Visualizations: Web-Based Survey With Experts and Older Adults JO - JMIR Med Inform SP - e39 VL - 6 IS - 3 KW - classification KW - data display KW - computer graphics KW - task performance and analysis KW - medicine KW - telemedicine KW - user/machine systems KW - human factors N2 - Background: Increasingly, eHealth involves health data visualizations to enable users to better understand their health situation. Selecting efficient and ergonomic visualizations requires knowledge about the task that the user wants to carry out and the type of data to be displayed. Taxonomies of abstract tasks and data types bundle this knowledge in a general manner. Task-data taxonomies exist for visualization tasks and data. They also exist for eHealth tasks. However, there is currently no joint task taxonomy available for health data visualizations incorporating the perspective of the prospective users. One of the most prominent prospective user groups of eHealth are older adults, but their perspective is rarely considered when constructing tasks lists. Objective: The aim of this study was to construct a task-data taxonomy for health data visualizations based on the opinion of older adults as prospective users of eHealth systems. eHealth experts served as a control group against the bias of lacking background knowledge. The resulting taxonomy would then be used as an orientation in system requirement analysis and empirical evaluation and to facilitate a common understanding and language in eHealth data visualization. Methods: Answers from 98 participants (51 older adults and 47 eHealth experts) given in an online survey were quantitatively analyzed, compared between groups, and synthesized into a task-data taxonomy for health data visualizations. Results: Consultation, diagnosis, mentoring, and monitoring were confirmed as relevant abstract tasks in eHealth. Experts and older adults disagreed on the importance of mentoring (?24=14.1, P=.002) and monitoring (?24=22.1, P<.001). The answers to the open questions validated the findings from the closed questions and added therapy, communication, cooperation, and quality management to the aforementioned tasks. Here, group differences in normalized code counts were identified for ?monitoring? between the expert group (mean 0.18, SD 0.23) and the group of older adults (mean 0.08, SD 0.15; t96=2431, P=.02). Time-dependent data was most relevant across all eHealth tasks. Finally, visualization tasks and data types were assigned to eHealth tasks by both experimental groups. Conclusions: We empirically developed a task-data taxonomy for health data visualizations with prospective users. This provides a general framework for theoretical concession and for the prioritization of user-centered system design and evaluation. At the same time, the functionality dimension of the taxonomy for telemedicine?chosen as the basis for the construction of present taxonomy?was confirmed. UR - http://medinform.jmir.org/2018/3/e39/ UR - http://dx.doi.org/10.2196/medinform.9394 UR - http://www.ncbi.nlm.nih.gov/pubmed/29986844 ID - info:doi/10.2196/medinform.9394 ER - TY - JOUR AU - Zheng, Hua AU - Rosal, C. Milagros AU - Li, Wenjun AU - Borg, Amy AU - Yang, Wenyun AU - Ayers, C. David AU - Franklin, D. Patricia PY - 2018/04/30 TI - A Web-Based Treatment Decision Support Tool for Patients With Advanced Knee Arthritis: Evaluation of User Interface and Content Design JO - JMIR Hum Factors SP - e17 VL - 5 IS - 2 KW - usability evaluation KW - patient decision support KW - knee osteoarthritis KW - total knee replacement KW - outcome prediction N2 - Background: Data-driven surgical decisions will ensure proper use and timing of surgical care. We developed a Web-based patient-centered treatment decision and assessment tool to guide treatment decisions among patients with advanced knee osteoarthritis who are considering total knee replacement surgery. Objective: The aim of this study was to examine user experience and acceptance of the Web-based treatment decision support tool among older adults. Methods: User-centered formative and summative evaluations were conducted for the tool. A sample of 28 patients who were considering total knee replacement participated in the study. Participants? responses to the user interface design, the clarity of information, as well as usefulness, satisfaction, and acceptance of the tool were collected through qualitative (ie, individual patient interviews) and quantitative (ie, standardized Computer System Usability Questionnaire) methods. Results: Participants were older adults with a mean age of 63 (SD 11) years. Three-quarters of them had no technical questions using the tool. User interface design recommendations included larger fonts, bigger buttons, less colors, simpler navigation without extra ?next page? click, less mouse movement, and clearer illustrations with simple graphs. Color-coded bar charts and outcome-specific graphs with positive action were easiest for them to understand the outcomes data. Questionnaire data revealed high satisfaction with the tool usefulness and interface quality, and also showed ease of use of the tool, regardless of age or educational status. Conclusions: We evaluated the usability of a patient-centered decision support tool designed for advanced knee arthritis patients to facilitate their knee osteoarthritis treatment decision making. The lessons learned can inform other decision support tools to improve interface and content design for older patients? use. UR - http://humanfactors.jmir.org/2018/2/e17/ UR - http://dx.doi.org/10.2196/humanfactors.8568 UR - http://www.ncbi.nlm.nih.gov/pubmed/29712620 ID - info:doi/10.2196/humanfactors.8568 ER - TY - JOUR AU - Harte, Richard AU - Hall, Tony AU - Glynn, Liam AU - Rodríguez-Molinero, Alejandro AU - Scharf, Thomas AU - Quinlan, R. Leo AU - ÓLaighin, Gearóid PY - 2018/04/26 TI - Enhancing Home Health Mobile Phone App Usability Through General Smartphone Training: Usability and Learnability Case Study JO - JMIR Hum Factors SP - e18 VL - 5 IS - 2 KW - smartphone KW - aged KW - elderly KW - wearable electronic devices KW - telemedicine KW - user-computer interface KW - education KW - user centered-design KW - usability KW - connected health KW - human factors KW - falls detection N2 - Background: Each year, millions of older adults fall, with more than 1 out of 4 older people experiencing a fall annually, thereby causing a major social and economic impact. Falling once doubles one?s chances of falling again, making fall prediction an important aspect of preventative strategies. In this study, 22 older adults aged between 65 and 85 years were trained in the use of a smartphone-based fall prediction system. The system is designed to continuously assess fall risk by measuring various gait and balance parameters using a smart insole and smartphone, and is also designed to detect falls. The use case of the fall prediction system in question required the users to interact with the smartphone via an app for device syncing, data uploads, and checking system status. Objective: The objective of this study was to observe the effect that basic smartphone training could have on the user experience of a group that is not technically proficient with smartphones when using a new connected health system. It was expected that even short rudimentary training could have a large effect on user experience and therefore increase the chances of the group accepting the new technology. Methods: All participants received training on how to use the system smartphone app; half of the participants (training group) also received extra training on how to use basic functions of the smartphone, such as making calls and sending text messages, whereas the other half did not receive this extra training (no extra training group). Comparison of training group and no extra training group was carried out using metrics such as satisfaction rating, time taken to complete tasks, cues required to complete tasks, and errors made during tasks. Results: The training group fared better in the first 3 days of using the system. There were significant recorded differences in number of cues required and errors committed between the two groups. By the fourth and fifth day of use, both groups were performing at the same level when using the system. Conclusions: Supplementary basic smartphone training may be critical in trials where a smartphone app?based system for health intervention purposes is being introduced to a population that is not proficient with technology. This training could prevent early technology rejection and increase the engagement of older participants and their overall user experience with the system. UR - http://humanfactors.jmir.org/2018/2/e18/ UR - http://dx.doi.org/10.2196/humanfactors.7718 UR - http://www.ncbi.nlm.nih.gov/pubmed/29699969 ID - info:doi/10.2196/humanfactors.7718 ER -