TY - JOUR AU - Lee, Li-Yun AU - Tung, Heng-Hsin AU - Liao, George AU - Liu, Su-Ju AU - Chen, Zi-Yu AU - Yang, Yea-Ru PY - 2025/5/1 TI - Multihealth Promotion Programs on Physical Health and Quality of Life in Older Adults: Quasi-Experimental Study JO - Interact J Med Res SP - e65213 VL - 14 KW - older adult KW - body composition KW - physical activity KW - health promotion KW - exercise KW - nutrition KW - diet KW - well-being KW - quality-of-life KW - QoL KW - gerontology KW - geriatrics N2 - Background: Physical activity and appropriate nutrition are essential for older adults. Improving physical health and quality of life can lead to healthy aging. Objective: This study aims to investigate the long-term effects of multihealth promotion programs on the physical and mental health of older adults in communities. Methods: A quasi-experimental method was used to recruit 112 older adults voluntarily from a pharmacy in central Taiwan between April 2021 and February 2023. Participants were divided into an experimental group receiving a multihealth promotion program and a control group with no specific intervention. The study measured frailty, nutritional status, well-being, and quality of life using standardized tools such as the Clinical Frailty Scale (CFS), Mini-Nutritional Assessment-Short Form (MNA-SF), Well-being Scale for Elders, and the EQ-5D-3L. Data were analyzed using descriptive statistics, independent t tests, Pearson correlation, and generalized estimating equations. Results: A total of 112 participants were recruited. There were 64 (57.1%) in the experimental group and 48 (42.9%) in the control group. The experimental group exhibited significantly better quality of life (EQ-5D index) at weeks 12 (?=?.59; P=.01) and 24 (?=?.44; P=.04) compared to the control group. The experimental group muscle mass significantly increased at weeks 24 (?=4.29; P<.01) and 36 (?=3.03; P=.01). Upper limb strength improved significantly at weeks 12 (?=3.4; P=.04) and 36 (?=5; P=.01), while core strength showed significant gains at weeks 12 (?=4.43; P=.01) and 36 (?=6.99; P<.01). Lower limb strength increased significantly only at week 12 (?=4.15; P=.01). Overall physical performance improved significantly at weeks 12 (?=5.47; P<.01), 24 (?=5.17; P<.01), and 36 (?=8.79; P<.01). Conclusions: The study?s findings highlight the practical benefits of interventions, including physical and social activities and nutritional support, in enhancing the quality of life and general physical health of older adults. This study?s findings have significant implications for clinical practice. These findings can aid in the establishment of effective interventions for older adults. Trial Registration: ClinicalTrials.gov NCT05412251; https://clinicaltrials.gov/study/NCT05412251 UR - https://www.i-jmr.org/2025/1/e65213 UR - http://dx.doi.org/10.2196/65213 UR - http://www.ncbi.nlm.nih.gov/pubmed/40310677 ID - info:doi/10.2196/65213 ER - TY - JOUR AU - Jeong, Chang-Uk AU - Leiby, S. Jacob AU - Kim, Dokyoon AU - Choe, Kyung Eun PY - 2025/4/11 TI - Artificial Intelligence-Driven Biological Age Prediction Model Using Comprehensive Health Checkup Data: Development and Validation Study JO - JMIR Aging SP - e64473 VL - 8 KW - biological age KW - aging clock KW - mortality KW - artificial intelligence KW - machine learning KW - record KW - history KW - health checkup KW - clinical relevance KW - gerontology KW - geriatric KW - older KW - elderly KW - aging KW - prediction KW - predictive KW - life expectancy KW - AI N2 - Background: The global increase in life expectancy has not shown a similar rise in healthy life expectancy. Accurate assessment of biological aging is crucial for mitigating diseases and socioeconomic burdens associated with aging. Current biological age prediction models are limited by their reliance on conventional statistical methods and constrained clinical information. Objective: This study aimed to develop and validate an aging clock model using artificial intelligence, based on comprehensive health check-up data, to predict biological age and assess its clinical relevance. Methods: We used data from Koreans who underwent health checkups at the Seoul National University Hospital Gangnam Center as well as from the Korean Genome and Epidemiology Study. Our model incorporated 27 clinical factors and employed machine learning algorithms, including linear regression, least absolute shrinkage and selection operator, ridge regression, elastic net, random forest, support vector machine, gradient boosting, and K-nearest neighbors. Model performance was evaluated using adjusted R2 and the mean squared error (MSE) values. Shapley Additive exPlanation (SHAP) analysis was conducted to interpret the model?s predictions. Results: The Gradient Boosting model achieved the best performance with a mean (SE) MSE of 4.219 (0.14) and a mean (SE) R2 of 0.967 (0.001). SHAP analysis identified significant predictors of biological age, including kidney function markers, gender, glycated hemoglobin level, liver function markers, and anthropometric measurements. After adjusting for the chronological age, the predicted biological age showed strong associations with multiple clinical factors, such as metabolic status, body compositions, fatty liver, smoking status, and pulmonary function. Conclusions: Our aging clock model demonstrates a high predictive accuracy and clinical relevance, offering a valuable tool for personalized health monitoring and intervention. The model?s applicability in routine health checkups could enhance health management and promote regular health evaluations. UR - https://aging.jmir.org/2025/1/e64473 UR - http://dx.doi.org/10.2196/64473 ID - info:doi/10.2196/64473 ER - TY - JOUR AU - Wei, Xindi AU - Zhuang, Longfei AU - Li, Yuan AU - Shi, Junyu AU - Yang, Yijie AU - Lai, Hongchang AU - Liu, Beilei PY - 2025/3/21 TI - Edentulousness and the Likelihood of Becoming a Centenarian: Longitudinal Observational Study JO - JMIR Aging SP - e68444 VL - 8 KW - public health KW - edentulous KW - oral-systemic disease KW - epidemiology KW - cohort studies N2 - Background: In recent decades, the global life expectancy has risen notably to approximately 73.5 years worldwide, coinciding with a rapid growth in the older adult population, which presents a significant public health challenge in promoting healthy aging and longevity. Objective: This study aimed to prospectively investigate the link between edentulousness and the likelihood of reaching centenarian status among individuals aged 80 years and older. Methods: Data from the Chinese Longitudinal Healthy Longevity Survey were analyzed. Logistic regression models were used to assess the relationship between edentulousness and the likelihood of becoming a centenarian. Demographic characteristics, lifestyle habits, and disease histories were adjusted as confounding factors. Several sensitivity analyses, including propensity score matching and 2-year lag analyses, were conducted to further assess the association between edentulousness and the likelihood of becoming a centenarian. The correlation between the number of natural teeth as a continuous variable and the likelihood of becoming a centenarian was evaluated as well. Results: The study included 4239 participants aged 80-100 years. After adjusting for all covariates, the likelihood for becoming a centenarian increased in the nonedentulous group compared to the edentulous group (odds ratio [OR] 1.384, 95% CI 1.093?1.751). The relationship persisted after propensity score matching analysis (OR 1.272, 95% CI 1.037?1.561). The association remained statistically significant after excluding participants with a follow-up duration of less than 2 years (OR 1.522, 95% CI 1.083?2.140; P=.02). Furthermore, a significant positive association between the number of natural teeth and the likelihood of becoming a centenarian was found after adjusting for all covariates (OR 1.022, 95% CI 1.002?1.042; P=.03), which aligned with the main results of the study. Conclusions: The findings revealed that the presence of natural teeth was linked to an increased probability of becoming a centenarian, underscoring the importance of maintaining oral health even in advanced age. UR - https://aging.jmir.org/2025/1/e68444 UR - http://dx.doi.org/10.2196/68444 ID - info:doi/10.2196/68444 ER - TY - JOUR AU - Gomes da Rocha, Carla AU - von Gunten, Armin AU - Vandel, Pierre AU - Jopp, S. Daniela AU - Ribeiro, Olga AU - Verloo, Henk PY - 2025/3/5 TI - Building Consensus on the Relevant Criteria to Screen for Depressive Symptoms Among Near-Centenarians and Centenarians: Modified e-Delphi Study JO - JMIR Aging SP - e64352 VL - 8 KW - centenarians KW - near-centenarians KW - depressive symptoms KW - depression diagnosis KW - screening KW - assessment KW - e-Delphi technique KW - web-based survey N2 - Background: The number of centenarians worldwide is expected to increase dramatically, reaching 3.4 million by 2050 and >25 million by 2100. Despite these projections, depression remains a prevalent yet underdiagnosed and undertreated condition among this population that carries significant health risks. Objective: This study aimed to identify and achieve consensus on the most representative signs and symptoms of depression in near-centenarians and centenarians (aged ?95 years) through an e-Delphi study with an international and interdisciplinary panel of experts. Ultimately, the outcomes of this study might help create a screening instrument that is specifically designed for this unique population. Methods: A modified e-Delphi study was carried out to achieve expert consensus on depressive symptoms in near-centenarians and centenarians. A panel of 28 international experts was recruited. Consensus was defined as 70% agreement on the relevance of each item. Data were collected through a web-based questionnaire over 3 rounds. Experts rated 104 items that were divided into 24 dimensions and 80 criteria to identify the most representative signs and symptoms of depression in this age group. Results: The panel consisted of experts from various countries, including physicians with experience in old age psychiatry or geriatrics as well as nurses and psychologists. The response rate remained consistent over the rounds (20/28, 71% to 21/28, 75%). In total, 4 new dimensions and 8 new criteria were proposed by the experts, and consensus was reached on 86% (24/28) of the dimensions and 80% (70/88) of the criteria. The most consensual potentially relevant dimensions were lack of hope (21/21, 100%), loss of interest (27/28, 96%), lack of reactivity to pleasant events (27/28, 96%), depressed mood (26/28, 93%), and previous episodes of depression or diagnosed depression (19/21, 90%). In addition, the most consensual potentially relevant criteria were despondency, gloom, and despair (25/25, 100%); depressed (27/27, 100%); lack of reactivity to pleasant events or circumstances (28/28, 100%); suicidal ideation (28/28, 100%); suicide attempt(s) (28/28, 100%); ruminations (27/28, 96%); recurrent thoughts of death or suicide (27/28, 96%); feelings of worthlessness (25/26, 96%); critical life events (20/21, 95%); anhedonia (20/21, 95%); loss of interest in activities (26/28, 93%); loss of pleasure in activities (26/28, 93%); and sadness (24/26, 92%). Moreover, when assessing depression in very old age, the duration, number, frequency, and severity of signs and symptoms should also be considered, as evidenced by the high expert agreement. Conclusions: The classification of most elements as relevant highlights the importance of a multidimensional approach for optimal depression screening among individuals of very old age. This study offers a first step toward improving depression assessment in near-centenarians and centenarians. The development of a more adapted screening tool could improve early detection and intervention, enhancing the quality of mental health care for this population. UR - https://aging.jmir.org/2025/1/e64352 UR - http://dx.doi.org/10.2196/64352 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053803 ID - info:doi/10.2196/64352 ER - TY - JOUR AU - Abu El Kheir-Mataria, Wafa AU - Mahmoud Abdelraheem, Omnia AU - Chun, Sungsoo PY - 2025/3/5 TI - Genetic, Socioecological, and Health Determinants of Extreme Longevity in Semi-Supercentenarians and Supercentenarians: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e63900 VL - 14 KW - supercentenarians KW - semi-supercentenarians KW - extreme longevity KW - genetic factors KW - socioecological factors KW - health determinants KW - aging research KW - scoping review KW - cognitive performance KW - data collection methods N2 - Background: The study of supercentenarians (individuals aged 110 years or older) offers valuable insights into aging, longevity, and the factors contributing to exceptional lifespans. These individuals often exhibit extraordinary cognitive and physical performance, which can inform strategies to improve the health of the general population. Research on centenarians (individuals aged 100 years or older), semi-supercentenarians (individuals aged 105-109 years), and supercentenarians covers themes like genetic factors, microbiome, inflammation, diet, lifestyle, and psychological aspects. These studies often focus on various aspects of extreme longevity, using varied objectives and methodologies, highlighting the need for a comprehensive synthesis to map the breadth of research and identify gaps in understanding this demographic. Objective: This scoping review aims to map and synthesize existing evidence on the determinants of extreme longevity, focusing on individuals living beyond 105 years. This review seeks to categorize genetic factors associated with semi-supercentenarians and supercentenarians; explore the range of socioecological factors contributing to their longevity; and identify common themes such as health, functional capacity, cognition, mental health, behaviors, social support, quality of life, personality traits, environmental factors, and religiosity. Additionally, it aims to examine and describe the methodologies and assessment tools used in studies on extreme longevity and provide an overview of global demographic trends and patterns among supercentenarians, including geographic distribution, gender prevalence, and socioeconomic characteristics. Methods: This scoping review follows the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) 2015 guidelines and the Population, Exposure, and Outcome framework. It includes observational and interventional, quantitative and qualitative studies on supercentenarians and semi-supercentenarians. Data will be sourced from databases like Scopus, PubMed, ProQuest, PsycINFO, and The Cochrane Library. The selection process involves abstract and full-text screening by two independent reviewers, with data extraction focusing on study characteristics, participant demographics, interventions or exposures, and key findings. A thematic analysis will identify patterns across various themes Results: As of October 2, 2024, five databases were searched, yielding 844 studies. After removing duplicates, 706 studies remained. Following the first and second screening stages, 135 studies were found to be eligible. The study is expected to be completed by the end of February 2025. Conclusions: By synthesizing evidence, this study will understand the global scope of supercentenarians, describe the main themes of research interest, and identify gaps. The findings are expected to contribute significantly to the body of knowledge on longevity, informing future research and public health policies. This scoping review aims to enhance the understanding of factors promoting healthy aging and extreme longevity, benefiting broader public health initiatives. Trial Registration: PROSPERO CRD42024512298; https://tinyurl.com/4cmux7h4 UR - https://www.researchprotocols.org/2025/1/e63900 UR - http://dx.doi.org/10.2196/63900 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053776 ID - info:doi/10.2196/63900 ER - TY - JOUR AU - Harvey, Philip AU - Curiel-Cid, Rosie AU - Kallestrup, Peter AU - Mueller, Annalee AU - Rivera-Molina, Andrea AU - Czaja, Sara AU - Crocco, Elizabeth AU - Loewenstein, David PY - 2025/2/19 TI - Digital Migration of the Loewenstein Acevedo Scales for Semantic Interference and Learning (LASSI-L): Development and Validation Study in Older Participants JO - JMIR Ment Health SP - e64716 VL - 12 KW - mild cognitive impairment KW - cognitive challenge tests KW - elder KW - aging KW - amyloid biomarkers KW - cognition KW - cognitive decline KW - deterioration KW - semantic interference KW - Alzheimer disease KW - self-administered KW - voice recognition KW - technology KW - assessment study KW - accuracy KW - artificial intelligence KW - treatment KW - medication KW - mental health KW - biomarkers KW - amnesia KW - neurodegeneration KW - patient health KW - health monitoring KW - digital mental health KW - neuroscience KW - neurotechnology KW - Loewenstein Acevedo Scales for Semantic Interference and Learning KW - LASSI-L KW - digital Loewenstein-Acevedo Scales for Semantic Interference KW - LASSI-D N2 - Background: The early detection of mild cognitive impairment is crucial for providing treatment before further decline. Cognitive challenge tests such as the Loewenstein-Acevedo Scales for Semantic Interference and Learning (LASSI-L) can identify individuals at highest risk for cognitive deterioration. Performance on elements of the LASSI-L, particularly proactive interference, correlate with the presence of critical Alzheimer disease biomarkers. However, in-person paper tests require skilled testers and are not practical in many community settings or for large-scale screening in prevention. Objective: This study reports on the development and initial validation of a self-administered computerized version of the Loewenstein-Acevedo Scales for Semantic Interference (LASSI), the digital LASSI (LASSI-D). A self-administered digital version, with an artificial intelligence?generated avatar assistant, was the migrated assessment. Methods: Cloud-based software was developed, using voice recognition technology, for English and Spanish versions of the LASSI-D. Participants were assessed with either the LASSI-L or LASSI-D first, in a sequential assessment study. Participants with amnestic mild cognitive impairment (aMCI; n=54) or normal cognition (NC; n=58) were also tested with traditional measures such as the Alzheimer Disease Assessment Scale-Cognition. We examined group differences in performance across the legacy and digital versions of the LASSI, as well as correlations between LASSI performance and other measures across the versions. Results: Differences on recall and intrusion variables between aMCI and NC samples on both versions were all statistically significant (all P<.001), with at least medium effect sizes (d>0.68). There were no statistically significant performance differences in these variables between legacy and digital administration in either sample (all P<.13). There were no language differences in any variables (P>.10), and correlations between LASSI variables and other cognitive variables were statistically significant (all P<.01). The most predictive legacy variables, proactive interference and failure to recover from proactive interference, were identical across legacy and migrated versions within groups and were identical to results of previous studies with the legacy LASSI-L. Classification accuracy was 88% for NC and 78% for aMCI participants. Conclusions: The results for the digital migration of the LASSI-D were highly convergent with the legacy LASSI-L. Across all indices of similarity, including sensitivity, criterion validity, classification accuracy, and performance, the versions converged across languages. Future studies will present additional validation data, including correlations with blood-based Alzheimer disease biomarkers and alternative forms. The current data provide convincing evidence of the use of a fully self-administered digitally migrated cognitive challenge test. UR - https://mental.jmir.org/2025/1/e64716 UR - http://dx.doi.org/10.2196/64716 ID - info:doi/10.2196/64716 ER - TY - JOUR AU - Yang, Hongwu AU - Zhu, Chuangying AU - Zhou, Chunyan AU - Huang, Ruibin AU - Huang, Lipeng AU - Chen, Peifen AU - Zhu, Shanshan AU - Wang, Huanpeng AU - Zhu, Chunmin PY - 2025/2/19 TI - Evaluation of Douyin Short Videos on Mammography in China: Quality and Reliability Analysis JO - JMIR Cancer SP - e59483 VL - 11 KW - breast cancer KW - mammography KW - Douyin KW - information quality KW - social media KW - video KW - DISCERN KW - Global Quality Score KW - web-based education KW - cancer screening KW - health information KW - medical content N2 - Background: Breast cancer is the most common malignant tumor and the fifth leading cause of cancer death worldwide, imposing a significant disease burden in China. Mammography is a key method for breast cancer screening, particularly for early diagnosis. Douyin, a popular social media platform, is increasingly used for sharing health information, but the quality and reliability of mammography-related videos remain unexamined. Objective: This study aimed to evaluate the information quality and reliability of mammography videos on Douyin. Methods: In October 2023, a search using the Chinese keywords for ?mammography? and ?mammography screening? was conducted on Douyin. From 200 retrieved videos, 136 mammography-related videos were selected for analysis. Basic video information, content, and sources were extracted. Video content was assessed for comprehensiveness across 7 categories: conception, examination process, applicable objects, precautions, combined examinations, advantages, and report. Completeness was evaluated using a researcher-developed checklist, while reliability and quality were measured using 2 modified DISCERN (mDISCERN) tool and the Global Quality Score (GQS). Correlations between video quality and characteristics were also examined. Results: Among the video sources, 82.4% (112/136) were attributed to health professionals, and 17.6% (24/136) were attributed to nonprofessionals. Among health professionals, only 1 was a radiologist. Overall, 77.2% (105/136) of the videos had useful information about mammography. Among the useful videos, the advantages of mammography were the most frequently covered topic (53/105, 50.5%). Median values for the mDISCERN and GQS evaluations across all videos stood at 2.5 (IQR 1.63?3) and 2 (IQR 1?2), respectively. Within the subgroup assessment, the median mDISCERN score among the useful and professional groups stood at 2 (IQR 2?3) and 3 (IQR 2?3), respectively, surpassing the corresponding score for the unhelpful and nonprofessional groups at 0 (IQR 0?0) and 0 (IQR 0?0.75; P<.001). Likewise, the median GQS among the useful and professional groups was evaluated at 2 (IQR 1.5?2) and 2 (IQR 1?2), respectively, eclipsing that of the unhelpful and nonprofessional groups at 1 (IQR 1?1) and 1 (IQR 1?1.37; P<.001). The GQS was weak and negatively correlated with the number of likes (r=?0.24; P=.004), comments (r=?0.29; P<.001), and saves (r=?0.20; P=.02). The mDISCERN score was weak and negatively correlated with the number of likes (r=?0.26; P=.002), comments (r=?0.36; P<.001), saves (r=?0.22; P=.009), and shares (r=?0.18; P=.03). Conclusions: The overall quality of mammography videos on Douyin is suboptimal, with most content uploaded by clinicians rather than radiologists. Radiologists should be encouraged to create accurate and informative videos to better educate patients. As Douyin grows as a health information platform, stricter publishing standards are needed to enhance the quality of medical content. UR - https://cancer.jmir.org/2025/1/e59483 UR - http://dx.doi.org/10.2196/59483 ID - info:doi/10.2196/59483 ER - TY - JOUR AU - Gu, Chenyu AU - Qian, Liquan AU - Zhuo, Xiaojie PY - 2025/1/28 TI - Mindfulness Intervention for Health Information Avoidance in Older Adults: Mixed Methods Study JO - JMIR Public Health Surveill SP - e69554 VL - 11 KW - health information avoidance KW - cyberchondria KW - self-determination theory KW - mindfulness KW - elderly N2 - Background: The global aging population and rapid development of digital technology have made health management among older adults an urgent public health issue. The complexity of online health information often leads to psychological challenges, such as cyberchondria, exacerbating health information avoidance behaviors. These behaviors hinder effective health management; yet, little research examines their mechanisms or intervention strategies. Objective: This study investigates the mechanisms influencing health information avoidance among older adults, emphasizing the mediating role of cyberchondria. In addition, it evaluates the effectiveness of mindfulness meditation as an intervention strategy to mitigate these behaviors. Methods: A mixed methods approach was used, combining quantitative and qualitative methodologies. Substudy 1 developed a theoretical model based on self-determination theory to explore internal (positive metacognition and health self-efficacy) and external (subjective norms and health information similarity) factors influencing health information avoidance, with cyberchondria as a mediator. A cross-sectional survey (N=236) was conducted to test the proposed model. Substudy 2 involved a 4-week mindfulness meditation intervention (N=94) to assess its impact on reducing health information avoidance behaviors. Results: Study 1 showed that positive metacognition (?=.26, P=.002), health self-efficacy (?=.25, P<.001), and health information similarity (?=.29, P<.001) significantly predicted health information avoidance among older adults. Cyberchondria mediated these effects: positive metacognition (effect=0.106, 95% CI 0.035-0.189), health self-efficacy (effect=0.103, 95% CI 0.043-0.185), and health information similarity (effect=0.120, 95% CI 0.063-0.191). Subjective norms did not significantly predict health information avoidance (?=?.11, P=.13), and cyberchondria did not mediate this relationship (effect=?0.045, 95% CI ?0.102 to 0.016). Study 2 found that after the 4-week mindfulness intervention, the intervention group (group 1: n=46) exhibited significantly higher mindfulness levels than the control group (group 2: n=48; Mgroup1=4.122, Mgroup2=3.606, P<.001) and higher levels compared with preintervention (Mt2=4.122, Mt1=3.502, P<.001, where t1=preintervention and t2=postintervention). However, cyberchondria levels did not change significantly (Mt1=2.848, Mt2=2.685, P=.18). Nevertheless, the results revealed a significant interaction effect between mindfulness and cyberchondria on health information avoidance (effect=?0.357, P=.002, 95% CI ?0.580 to ?0.131), suggesting that mindfulness intervention effectively inhibited the transformation of cyberchondria into health information avoidance behavior. Conclusions: This study reveals the role of cyberchondria in health information avoidance and validates mindfulness meditation as an effective intervention for mitigating such behaviors. Findings offer practical recommendations for improving digital health information delivery and health management strategies for older adults. UR - https://publichealth.jmir.org/2025/1/e69554 UR - http://dx.doi.org/10.2196/69554 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/69554 ER - TY - JOUR AU - Zhang, Jinbao AU - Prunty, E. Jonathan AU - Charles, C. Alison AU - Forder, Julien PY - 2025/1/2 TI - Association Between Digital Front Doors and Social Care Use for Community-Dwelling Adults in England: Cross-Sectional Study JO - J Med Internet Res SP - e53205 VL - 27 KW - social care support KW - long term care KW - access KW - front door KW - easy-read KW - self-assessment KW - system navigation KW - digital system KW - digital technology KW - internet N2 - Background: Requests for public social care support can be made through an online portal. These digital ?front doors? can help people navigate complex social care systems and access services. These systems can be set up in different ways, but there is little evidence about the impact of alternative arrangements. Digital front-door systems should help people better access services, particularly low-intensity services (high-intensity care is likely to require a full in-person assessment). Objective: This study aimed to investigate the association between 2 primary digital front door arrangements, easy-read information, and self-assessment tools provided on official websites, and the type of social care support that is offered: ongoing low-level support (OLLS), short-term care (STC) and long-term care (LTC). Methods: Information on front door arrangements was collected from the official websites of 152 English local authorities in 2021. We conducted a cross-sectional analysis using aggregated service use data from official government returns at the local authority level. The independent variables were derived from the policy information collected, specifically focusing on the availability of online digital easy-read information and self-assessment tools for adults and caregivers through official websites. The dependent variables were the rates of using social care support, including OLLS, STC, and LTC, across different age groups: the adult population (aged 18 and older), younger population (aged between 18 and 64 years), and older population (aged 65 and older). Multivariate regression analysis was used to examine the association between digital front door arrangements and access to social care support, controlling for population size, dependency level, and financial need factors. Results: Less than 20% (27/147) of local authorities provided an integrated digital easy-read format as part of their digital front door system with about 25% (37/147) adopting digital self-assessment within their system. We found that local authorities that offered an integrated digital easy-read information format showed higher rates of using OLLS (? coefficient=0.54; P=.03; but no statistically significant association with LTC and STC). The provision of an online self-assessment system was not associated with service use in the 1-year (2021) cross-sectional estimate, but when 2 years (2020 and 2021) of service-use data were analyzed, a significant positive association was found on OLLS rates (? coefficient=0.41; P=.21). Notably, these findings were consistent across different age groups. Conclusions: These findings are consistent with our hypothesis that digital systems with built-in easy-read and self-assessment may make access to (low-intensity) services easier for people. Adoption of these arrangements could potentially help increase the uptake of support among those who are eligible, with expected benefits for their care-related well-being. Given the limited adoption of the digital front door by local authorities in England, expanding their use could improve care-related outcomes and save social care costs. UR - https://www.jmir.org/2025/1/e53205 UR - http://dx.doi.org/10.2196/53205 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53205 ER - TY - JOUR AU - van Dam, Lotte AU - Christensen, Højlund Sine AU - Tetens, Inge AU - Riley III, William AU - Timmer, Mariëlle AU - Suciu Jr, George AU - Marin, Iuliana AU - De Groot, Lisette AU - Grootswagers, Pol PY - 2024/12/19 TI - Developing a Digital Tool to Calculate Protein Quality in Plant-Based Meals of Older Adults: User Engagement Design Approach With End Users JO - J Particip Med SP - e48323 VL - 16 KW - digital tool KW - protein quality KW - user engagement design approach KW - plant-based diets KW - healthy ageing KW - mobile phone N2 - Background: The global shift toward plant-based diets has been increasing, with more people making the transition for various reasons. In vulnerable subgroups such as older adults, the transition to plant-based diets deserves attention due to the potentially detrimental consequences of lower protein quantity and quality. Objective: We aimed to develop a digital tool that ensures adequate protein quality in plant-based meals for older adults experiencing low protein intake through an interdisciplinary collaboration and user engagement with potential end users. Methods: Three focus group interviews of Dutch and Danish dietitians and older adults as potential end users were conducted to identify their needs, preferences, and deal-breakers. Focus group interviews were based on a user-task-environment analysis, the Walt Disney method, the brainwriting method, and a cognitive walkthrough. The interview transcripts were analyzed with a thematic analysis. The front end and backend development of a potential tool took place in parallel and was well-synced to the focus group interviews. Results: Both dietitians and older adults from Dutch and Danish sites expressed high interest in a tool that provides feedback and background information on protein quality, sustainability, and nutrients or micronutrients. The user-task-environment analysis delivered input among others that dietitians and older adults are good potential users, the tool should be functional as an app as well as a website and the tool should provide preprogrammed meals or recipes. The Walt Disney method delivered usable and realistic solutions to the 4 challenges presented. Thirty-two percent of the solutions on all themes presented with the brainwriting method appeared to be highly feasible and relevant, having the potential to be implemented in a tool. The cognitive walkthrough identified certain screens as unclear, necessitating revisions for improved understandability, for example, the need for explanation in selecting food item filters is shown in screenshot 2, with an overall usability score of 59%. Conclusions: Our user engagement design approach resulted in a prototype that ensured end users? wishes and needs, with a finetuned output tested in focus groups. We conclude that our user engagement design approach was a suitable and meaningful stepwise approach to ensure the relevance of the tool and identify potential barriers. The focus group results indicate that dietitians have a clear understanding and need for a tool to aid in meal planning for enhanced protein quality, highlighting its absence in their current resources despite increasing demands arising from the protein transition. Conversely, for older adults, the introduction of a digital tool appears less appropriate; instead, there is a necessity for foundational education on protein quality before such a tool can be effectively used. Future studies are needed to further implement the prototype into practice. UR - https://jopm.jmir.org/2024/1/e48323 UR - http://dx.doi.org/10.2196/48323 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/48323 ER - TY - JOUR AU - Maxwell, A. Cathy AU - Grubbs, Brandon AU - Dietrich, S. Mary AU - Boon, T. Jeffrey AU - Dunavan, John AU - Knickerbocker, J. Kelly AU - Patel, R. Maulik PY - 2024/12/13 TI - Mitochondrial Fitness Science Communication for Aging Adults: Prospective Formative Pilot Study JO - JMIR Form Res SP - e64437 VL - 8 KW - older adults KW - physical activity KW - exercise KW - science communication KW - gerontology KW - usability KW - behavior change KW - mitochondria KW - fitness KW - health intervention KW - digital health KW - evaluation KW - feasibility study KW - community dwelling N2 - Background: A key driver that leads to age-associated decline and chronic disease is mitochondrial dysfunction. Our previous work revealed strong community interest in the concept of mitochondrial fitness, which led to the development of a video-based science communication intervention to prompt behavior change in adults aged 50 years and older. Objective: This study aimed to conduct formative and summative evaluations of MitoFit, an instructional, biologically based communication intervention aimed at improving physical activity in older adults aged 50 years and older. Methods: In the phase-1 formative evaluation, community-dwelling older adults (N=101) rated the acceptability, appropriateness, and helpfulness of our MitoFit video series, titled ?How to Slow Down Aging Through Mitochondrial Fitness.? In the phase-2 summative evaluation, a subgroup of phase-1 participants (n=19) participated in a 1-month MitoFit intervention prototype to evaluate the intervention and data collection feasibility. Results: In phase 1, participants (mean age 67.8, SD 8.9 y; 75/100, 75% female) rated the MitoFit videos as acceptable (?4 out of 5 on a Likert-scale survey; from 97/101, 96% to 100/101, 99%), appropriate (101/101, 100%), and helpful (from 95/101, 94% to 100/101, 99%) to support adaptation and continued work on our novel approach. Previous knowledge of mitochondria ranged from 52% (50/97; What are mitochondria?) to 80% (78/97; What are the primary functions of mitochondria?). In phase 2, participants (mean age 71.4, SD 7.9 y; 13/19, 72% female) scored better than the national average (50) on the Patient-Reported Outcomes Measurement Information System-19 for physical function (57), social activities (55.5), depression (41), fatigue (48.6), and sleep disturbance (49.6) but worse for anxiety (55.3) and pain interference (52.4). Additionally, 95% (18/19) of participants demonstrated MitoFit competencies within 2 attempts (obtaining pulse: 19/19, 100%; calculating maximum and zone 2 heart rate: 18/19, 95%; and demonstration of exercises: 19/19, 100%). At 1 month after instruction, 68% (13/19) had completed a self-initiated daily walking/exercise plan and submitted a daily activity log. A walking pulse was documented by 85% (11/13) of participants. The time needed to walk 1 mile ranged from 17.4 to 27.1 minutes. The number of miles walked in 1 month was documented by 62% (8/13) of participants and ranged from 10 miles to 31 miles. The number of days of strength training ranged from 2 to 31 days/month. Intervention feasibility scores ranged from 89% (17/19; seems easy to follow) to 95% (18/19; seems implementable, possible, and doable). Overall, 79% (15/19) stated an intention to continue the MitoFit intervention. Furthermore, 4 weeks after delivery of the prototype intervention, the percentage of participants doing aerobic activity for regular moderate activity increased from 35% (6/17) to 59% (10/17; P=.03). Conclusions: MitoFit was enthusiastically embraced and is a cost-effective, scalable, and potentially efficacious intervention to advance with community-dwelling older adults. UR - https://formative.jmir.org/2024/1/e64437 UR - http://dx.doi.org/10.2196/64437 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64437 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 - Galinkala, Prathyusha AU - Atkinson, Elise AU - Campos-Castillo, Celeste PY - 2024/11/27 TI - Age Variation Among US Adults? Social Media Experiences and Beliefs About Who Is Responsible for Reducing Health-Related Falsehoods: Secondary Analysis of a National Survey JO - JMIR Aging SP - e56761 VL - 7 KW - social media KW - health misinformation KW - gray digital divide KW - United States KW - older adults KW - aging KW - health information KW - false information KW - falsehoods N2 - Background: We live in a digital age where social media has become an essential part of people?s lives. It is also one of the leading platforms responsible for spreading health-related falsehoods. This study explores who adults of different age groups perceive as responsible for reducing health-related falsehoods on social media. Objective: Despite growing concern over older adults? exposure to false health information on social media, little research examines their beliefs on how to address the problem. This study examines how the age of US adults is associated with their reported experiences with health-related falsehoods on social media and their beliefs about who should be tasked with reducing such falsehoods. Methods: This study is a secondary analysis of data from the 2022 Health Information National Trends Survey, a nationally representative survey of US adults (18 years and older). Multivariable logistic regressions estimated how a respondent?s age was associated with their self-reported social media use, their difficulty to detect health-related falsehoods on social media, their discussion of health information found on social media with medical providers, and their beliefs regarding who should be responsible for reducing health-related falsehoods on social media. Regression estimates were adjusted for respondents? sociodemographic and health characteristics. Results: Daily social media use decreased with respondents? age. Respondents aged 50?64 years (b=0.515, P=.01) and 65?74 years (b=0.697, P=.002) were more likely than respondents aged 18?34 years to report they strongly agree that it is difficult for them to detect health-related falsehoods on social media. Compared to younger adults, older adults (65?74 years: b=0.818, P=.002; 75 years and older: b=1.058, P<.001) were more likely to believe medical providers should be responsible for reducing online falsehoods. Conclusions: In addition to ongoing efforts by social media platforms to detect and remove falsehoods, the findings suggest medical providers should be tasked with discrediting health-related falsehoods on social media for older adults. However, time during the clinical visit is limited. Future research is needed to discover new approaches and tools tailored to older adults to assist with filtering and discrediting health-related falsehoods on social media. UR - https://aging.jmir.org/2024/1/e56761 UR - http://dx.doi.org/10.2196/56761 ID - info:doi/10.2196/56761 ER - TY - JOUR AU - Longcoy, Huang Li-Ting AU - Li, Chien-Ching AU - Tai, Chun-Yi AU - Doorenbos, Ardith PY - 2024/11/26 TI - Applying the Multiphase Optimization Strategy for the Development of a Culturally Tailored Resilience-Building Intervention to Facilitate Advance Care Planning Discussions for Chinese Americans: Protocol for a Survey and Qualitative Study JO - JMIR Res Protoc SP - e59343 VL - 13 KW - resilience KW - Chinese Americans KW - multiphase optimization strategy KW - protocol KW - advance care planning KW - feasibility studies N2 - Background: Newly arrived Chinese Americans face difficulties engaging in advance care planning (ACP) discussions with their family caregivers. Avoiding such discussions and failing to complete advance directives can delay palliative and hospice care. Yet, timely palliative care is essential to maintaining the quality of life at the end of life. Currently, there is a lack of interventions to help Chinese Americans diagnosed with cancer or heart disease overcome the barriers to engaging in ACP discussions via effective use of resilience. Objective: This study aims to develop a culturally tailored, resilience-building intervention for Chinese Americans with cancer or heart disease. Methods: The development of this intervention will be guided by the 3-phase multiphase optimization strategy. In the first phase of preparation, we will examine the prespecified components of the intervention through pilot studies to understand the necessity of each component. First, a qualitative study will be conducted to understand the experiences of 10 religious or spiritual leaders who have provided pastoral or spiritual care to Chinese Americans in Chicago, United States. The interview findings will be categorized as facilitators and barriers and integrated into the development of the intervention?s resilience-building guide. Second, a cross-sectional study will be conducted to assess the readiness of Chinese Americans to engage in ACP discussions with their family using surveys. Third, think-aloud interviews will be conducted to understand the experiences of 18 pairs of Chinese Americans and their family caregivers regarding the prototype of the culturally tailored, resilience-building intervention. Finally, we will examine the feasibility and acceptability of the intervention prototype along with issues related to the study?s implementation process. Results: Recruitment for the qualitative study began in November 2023. As of October 2024, a total of 7 participants have been recruited, enabling a preliminary qualitative analysis to evaluate the analytical framework developed from the literature. Recruitment for the cross-sectional study began in April 2024, and as of October 2024, a total of 63 Chinese Americans have participated. The potential participant recruitment lists for the think-aloud interviews have been received, enabling recruitment to begin after the preliminary qualitative analysis is completed. Conclusions: The proposed culturally tailored, resilience-building intervention is an innovative way to facilitate ACP discussions among Chinese Americans, particularly those diagnosed with serious chronic diseases. The findings from all 3 study methods will inform the development of the proposed intervention and identify effective recruitment strategies for this underserved and hard-to-reach population to be used in future research. International Registered Report Identifier (IRRID): DERR1-10.2196/59343 UR - https://www.researchprotocols.org/2024/1/e59343 UR - http://dx.doi.org/10.2196/59343 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59343 ER - TY - JOUR AU - Korthauer, E. Laura AU - Rosen, K. Rochelle AU - Tremont, Geoffrey AU - Davis, D. Jennifer PY - 2024/10/16 TI - Intervention Development for Tailored Education for Aging and Cognitive Health (TEACH) for Dementia Prevention in Midlife Adults: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e60395 VL - 13 KW - health behavior change KW - dementia prevention KW - Alzheimer disease KW - multidomain health intervention KW - intervention development KW - dementia N2 - Background: A total of 12 modifiable risk factors account for 40% of dementia cases globally, yet population adherence to health behaviors associated with these factors is low. Midlife is a critical window for dementia prevention, as brain pathology often begins to accumulate years or decades before the onset of symptoms. Although multidomain behavioral interventions have been efficacious in reducing the risk of cognitive decline, adherence is low. Intrapersonal factors, such as health beliefs, are known mediators of the relationship between knowledge and health behavior. Objective: In keeping with stage I of the National Institutes of Health (NIH) Stage Model for Behavioral Intervention Development, this study will use mixed methods to (1) develop an enhanced health education intervention, including an explanatory method for communicating information about dementia risk and personal health beliefs, and (2) conduct a pilot randomized controlled trial (n=20 per intervention arm) over 8 weeks to assess the feasibility of delivering the enhanced intervention versus basic health education alone. Methods: Phase 1 will involve focus groups and individual qualitative interviews. Focus groups will be analyzed using (1) a descriptive framework matrix analysis and (2) interpretive data review by the research team. Individual qualitative interviews will be coded using applied thematic analysis using a phenomenographic approach. Phase 2 will involve a pilot randomized controlled trial. Proximal outcomes (measured at baseline, 4 weeks, and 8 weeks) include the perceived threat of Alzheimer disease, dementia awareness, and self-efficacy. Results: This project was funded in August 2022. Data collection began in 2023 and is projected to be completed in 2025. Conclusions: Study findings will reveal the feasibility of delivering an 8-week multidomain health education intervention for primary prevention of dementia in midlife and will provide preliminary evidence of mechanisms of change. Trial Registration: ClinicalTrials.gov NCT05599425; https://clinicaltrials.gov/study/NCT05599425 International Registered Report Identifier (IRRID): DERR1-10.2196/60395 UR - https://www.researchprotocols.org/2024/1/e60395 UR - http://dx.doi.org/10.2196/60395 UR - http://www.ncbi.nlm.nih.gov/pubmed/39412840 ID - info:doi/10.2196/60395 ER - TY - JOUR AU - Tajika, Atsuko AU - Nakagomi, Atsushi AU - Miyaguni, Yasuhiro AU - Koga, Chie AU - Kondo, Katsunori AU - Ojima, Toshiyuki PY - 2024/9/20 TI - Internet Use and Higher-Level Functional Capacity Decline Suppression in Japanese Older Adults With Low Education: JAGES 2016-2019 Longitudinal Study JO - JMIR Aging SP - e53384 VL - 7 KW - functional capacity KW - instrumental activities of daily living KW - older adults? cognitive engagement KW - older adults? social role KW - internet impact on seniors KW - educational attainment KW - low education KW - independent living KW - older adults KW - health disparities N2 - Background: Higher-level functional capacity (HLFC) is crucial for the independent living of older adults. While internet use positively impacts the health of older adults, its effect on HLFC and how this effect varies with educational attainment remains uncertain. Objective: This longitudinal study aimed to investigate whether internet use could mitigate the risk of HLFC decline and if this benefit extends to older adults with lower levels of education. Methods: The data were sourced from the Japan Gerontological Evaluation Study (JAGES), encompassing 8050 community-dwelling adults aged 65 years and older from 2016 to 2019. The study focused on those who remained self-sufficient from 2016 to 2019, identifying participants with independent HLFC in 2016. The Tokyo Metropolitan Institute of Gerontology Index of Competence defined HLFC operationally, consisting of 3 subscales, namely instrumental activities of daily living, intellectual activity, and social role. The primary variable was the frequency of internet use in 2016; participants who reported using the internet were classified as internet users, while those who answered ?No? were identified as nonusers. The study compared the effects of internet use on HLFC decline across educational levels of ?9 years, 10-12 years, and ?13 years using Poisson regression analysis adjusted for robust SE to calculate the risk ratio (RR) and 95% CI for HLFC decline in 2019. Results: After adjusting for demographic and health condition risk factors, internet use was significantly linked to a decreased risk of HLFC decline in older adults over 3 years, including those with lower educational levels. Internet users with ?9 years of educational attainment experienced a suppressed decline in the total score (RR 0.57, 95% CI 0.43-0.76; P<.001); instrumental activities of daily living (RR 0.58, 95% CI 0.38-0.91; P=.02), intellectual activity (RR 0.60, 95% CI 0.41-0.89; P=.01), and social role (RR 0.74, 95% CI 0.56-0.97; P=.03) compared with nonusers. Participants with 10-12 years of education showed suppression rates of 0.78 (95% CI 0.63-0.98; P=.03), 0.59 (95% CI 0.39-0.90; P=.01), 0.91 (95% CI 0.63-1.31; P=.61), and 0.82 (95% CI 0.68-1.00; P=.05), respectively, and those with ?13 years displayed suppression rates of 0.65 (95% CI 0.51-0.85; P=.001), 0.55 (95% CI 0.36-0.83; P=.01), 0.64 (95% CI 0.37-1.10; P=.11), and 0.83 (95% CI 0.64-1.08; P=.17), respectively. Conclusions: These findings indicate that internet use supports the maintenance of HLFC independence in older adults with higher education and those with lower educational levels. Encouraging internet use among older adults with lower levels of education through future policies could help narrow functional health disparities associated with educational attainment. UR - https://aging.jmir.org/2024/1/e53384 UR - http://dx.doi.org/10.2196/53384 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53384 ER - TY - JOUR AU - Myers, Rae Jennifer AU - Bryk, N. Kelsey AU - Madero, N. Erica AU - McFarlane, Jacob AU - Campitelli, Anthony AU - Gills, Joshua AU - Jones, Megan AU - Paulson, Sally AU - Gray, Michelle AU - Glenn, M. Jordan PY - 2024/7/22 TI - Initial Perspectives From Rural-Residing Adults on a Digital Cognitive Health Coaching Intervention: Exploratory Qualitative Analysis JO - JMIR Form Res SP - e51400 VL - 8 KW - Alzheimer disease KW - cognition KW - intervention KW - rural issues KW - digital health KW - geriatric KW - geriatrics KW - elder KW - elderly KW - diabetes KW - diabetes mellitus KW - dementia KW - digital cognitive health coaching KW - rural KW - countryside KW - qualitative study KW - thematic analysis KW - mHealth KW - telehealth KW - health informatics KW - mental health KW - behavioral change KW - healthy lifestyle KW - coach support KW - self-awareness KW - prevention N2 - Background: A growing body of research has examined lifestyle-based interventions for dementia prevention. Specifically, health coaching interventions have been linked to decreased risk of Alzheimer disease (AD) comorbidities, such as diabetes. Despite the association, there is a lack of research examining the efficacy and perception of digital health coaching on reducing AD risk. Understanding the perceived benefits of participating in a digital health coach program is critical to ensure long-term use, including participant adherence and engagement. Objective: The purpose of this study is to examine the initial attitudes toward a digital health coaching intervention aimed at preventing cognitive decline among at-risk, rural participants. Methods: This exploratory qualitative study is part of the ongoing Digital Cognitive Multidomain Alzheimer Risk Velocity Study (DC-MARVel; ClinicalTrials.gov NCT04559789), a 2-year randomized control trial examining the effects of a digital health coaching intervention on dementia risk, cognitive decline, and general health outcomes. Participants were recruited from the northwest region of Arkansas via word of mouth, email, local radio, and social media. At the time of the analysis, 103 participants randomly assigned to the health coaching group completed an average of 4 coaching sessions over a 4-month period. The intervention included asynchronous messages 1-2 times per week from their health coach that contained health education articles based on the participant?s goals (eg, increase physical activity), unlimited access to their coach for questions and recommendations, and monthly meetings with their coach via videoconference or phone to discuss their goals. Participants were asked 2 open-ended questions, ?What were your top 1 or 2 takeaways from your recent Health Coaching session?? and ?Is there anything you would change about our Health Coaching sessions?? A thematic analysis was conducted using feedback responses from 80 participants (mean age, SD 7.6 years). Results: The following four themes emerged from participants? feedback: (1) healthy lifestyle and behavioral changes, (2) a sense of self-awareness through introspection, (3) value in coach support, and (4) a desire for a change in program format (eg, frequency). In total, 93% (n=74) of participants expressed that the intervention needed no changes. Conclusions: Initial participation in the digital cognitive health coaching intervention was well received, as evidenced by participants reporting value in goal setting and strategies for healthy lifestyle and behavioral changes as well as self-reflection on their personal lifestyle choices. Feedback about their assigned coach also offers insight into the importance of the coach-participant relationship and may serve as a significant factor in overall participant success. Given the exploratory nature of this study, more robust research is needed to elicit more information from participants about their experiences to fully understand the acceptability of the digital health coaching intervention. Trial Registration: ClinicalTrials.gov NCT04559789; https://clinicaltrials.gov/show/NCT04559789 International Registered Report Identifier (IRRID): RR2-10.2196/31841 UR - https://formative.jmir.org/2024/1/e51400 UR - http://dx.doi.org/10.2196/51400 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51400 ER - TY - JOUR AU - Teano, L. Anthony AU - Scott, Ashley AU - Gipson, Cassandra AU - Albert, Marilyn AU - Pettigrew, Corinne PY - 2024/7/9 TI - Social Media Programs for Outreach and Recruitment Supporting Aging and Alzheimer Disease and Related Dementias Research: Longitudinal Descriptive Study JO - JMIR Aging SP - e51520 VL - 7 KW - education KW - social media KW - outreach KW - recruitment KW - Alzheimer?s disease KW - Alzheimer disease N2 - Background: Social media may be a useful method for research centers to deliver health messages, increase their visibility in the local community, and recruit study participants. Sharing examples of social media?based community outreach and educational programs, and evaluating their outcomes in this setting, is important for understanding whether these efforts have a measurable impact. Objective: The aim of this study is to describe one center?s social media activities for community education on topics related to aging, memory loss, and Alzheimer disease and related dementias, and provide metrics related to recruitment into clinical research studies. Methods: Several social media platforms were used, including Facebook, X (formerly Twitter), and YouTube. Objective assessments quantified monthly, based on each platform?s native dashboard, included the number of followers, number of posts, post reach and engagement, post impressions, and video views. The number of participants volunteering for research during this period was additionally tracked using a secure database. Educational material posted to social media most frequently included content developed by center staff, content from partner organizations, and news articles or resources featuring center researchers. Multiple educational programs were developed, including social media series, web-based talks, Twitter chats, and webinars. In more recent years, Facebook content was occasionally boosted to increase visibility in the local geographical region. Results: Up to 4 years of page metrics demonstrated continuing growth in reaching social media audiences, as indicated by increases over time in the numbers of likes or followers on Facebook and X/Twitter and views of YouTube videos (growth trajectories). While Facebook reach and X/Twitter impression rates were reasonable, Facebook engagement rates were more modest. Months that included boosted Facebook posts resulted in a greater change in page followers and page likes, and higher reach and engagement rates (all P?.002). Recruitment of participants into center-affiliated research studies increased during this time frame, particularly in response to boosted Facebook posts. Conclusions: These data demonstrate that social media activities can provide meaningful community educational opportunities focused on Alzheimer disease and related dementias and have a measurable impact on the recruitment of participants into research studies. Additionally, this study highlights the importance of tracking outreach program outcomes for evaluating return on investment. UR - https://aging.jmir.org/2024/1/e51520 UR - http://dx.doi.org/10.2196/51520 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51520 ER - TY - JOUR AU - Sakal, Collin AU - Li, Tingyou AU - Li, Juan AU - Li, Xinyue PY - 2024/3/22 TI - Identifying Predictive Risk Factors for Future Cognitive Impairment Among Chinese Older Adults: Longitudinal Prediction Study JO - JMIR Aging SP - e53240 VL - 7 KW - cognitive impairment KW - China KW - prediction KW - predictions KW - predict KW - predictor KW - predictors KW - risk KW - risks KW - population KW - demographic KW - demographics 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 - MCI KW - cognitive KW - cognition KW - machine learning KW - variable KW - variables KW - model KW - models KW - mild cognitive impairment N2 - Background: The societal burden of cognitive impairment in China has prompted researchers to develop clinical prediction models aimed at making risk assessments that enable preventative interventions. However, it is unclear what types of risk factors best predict future cognitive impairment, if known risk factors make equally accurate predictions across different socioeconomic groups, and if existing prediction models are equally accurate across different subpopulations. Objective: This paper aimed to identify which domain of health information best predicts future cognitive impairment among Chinese older adults and to examine if discrepancies exist in predictive ability across different population subsets. Methods: Using data from the Chinese Longitudinal Healthy Longevity Survey, we quantified the ability of demographics, instrumental activities of daily living, activities of daily living, cognitive tests, social factors and hobbies, psychological factors, diet, exercise and sleep, chronic diseases, and 3 recently published logistic regression?based prediction models to predict 3-year risk of cognitive impairment in the general Chinese population and among male, female, rural-dwelling, urban-dwelling, educated, and not formally educated older adults. Predictive ability was quantified using the area under the receiver operating characteristic curve (AUC) and sensitivity-specificity curves through 20 repeats of 10-fold cross-validation. Results: A total of 4047 participants were included in the study, of which 337 (8.3%) developed cognitive impairment 3 years after baseline data collection. The risk factor groups with the best predictive ability in the general population were demographics (AUC 0.78, 95% CI 0.77-0.78), cognitive tests (AUC 0.72, 95% CI 0.72-0.73), and instrumental activities of daily living (AUC 0.71, 95% CI 0.70-0.71). Demographics, cognitive tests, instrumental activities of daily living, and all 3 recreated prediction models had significantly higher AUCs when making predictions among female older adults compared to male older adults and among older adults with no formal education compared to those with some education. Conclusions: This study suggests that demographics, cognitive tests, and instrumental activities of daily living are the most useful risk factors for predicting future cognitive impairment among Chinese older adults. However, the most predictive risk factors and existing models have lower predictive power among male, urban-dwelling, and educated older adults. More efforts are needed to ensure that equally accurate risk assessments can be conducted across different socioeconomic groups in China. UR - https://aging.jmir.org/2024/1/e53240 UR - http://dx.doi.org/10.2196/53240 ID - info:doi/10.2196/53240 ER - TY - JOUR AU - Chu, Charlene AU - Donato-Woodger, Simon AU - Khan, S. Shehroz AU - Shi, Tianyu AU - Leslie, Kathleen AU - Abbasgholizadeh-Rahimi, Samira AU - Nyrup, Rune AU - Grenier, Amanda PY - 2024/3/22 TI - Strategies to Mitigate Age-Related Bias in Machine Learning: Scoping Review JO - JMIR Aging SP - e53564 VL - 7 KW - age KW - ageing KW - ageism KW - aging KW - algorithm KW - algorithmic bias KW - artificial intelligence KW - bias KW - digital ageism KW - elder KW - elderly KW - geriatric KW - gerontology KW - machine learning KW - older adult KW - older people KW - older person KW - review methodology KW - review methods KW - scoping KW - search KW - searching KW - synthesis N2 - Background: Research suggests that digital ageism, that is, age-related bias, is present in the development and deployment of machine learning (ML) models. Despite the recognition of the importance of this problem, there is a lack of research that specifically examines the strategies used to mitigate age-related bias in ML models and the effectiveness of these strategies. Objective: To address this gap, we conducted a scoping review of mitigation strategies to reduce age-related bias in ML. Methods: We followed a scoping review methodology framework developed by Arksey and O?Malley. The search was developed in conjunction with an information specialist and conducted in 6 electronic databases (IEEE Xplore, Scopus, Web of Science, CINAHL, EMBASE, and the ACM digital library), as well as 2 additional gray literature databases (OpenGrey and Grey Literature Report). Results: We identified 8 publications that attempted to mitigate age-related bias in ML approaches. Age-related bias was introduced primarily due to a lack of representation of older adults in the data. Efforts to mitigate bias were categorized into one of three approaches: (1) creating a more balanced data set, (2) augmenting and supplementing their data, and (3) modifying the algorithm directly to achieve a more balanced result. Conclusions: Identifying and mitigating related biases in ML models is critical to fostering fairness, equity, inclusion, and social benefits. Our analysis underscores the ongoing need for rigorous research and the development of effective mitigation approaches to address digital ageism, ensuring that ML systems are used in a way that upholds the interests of all individuals. Trial Registration: Open Science Framework AMG5P; https://osf.io/amg5p UR - https://aging.jmir.org/2024/1/e53564 UR - http://dx.doi.org/10.2196/53564 UR - http://www.ncbi.nlm.nih.gov/pubmed/38517459 ID - info:doi/10.2196/53564 ER - TY - JOUR AU - Wang, Lu AU - Ye, Chen AU - Zhao, Fanghong AU - Wu, Hongjing AU - Wang, Ruoyu AU - Zhang, Zhaofeng AU - Li, Jie PY - 2023/8/17 TI - Association Between the Dietary Inflammatory Index and the Risk of Fracture in Chinese Adults: Longitudinal Study JO - JMIR Public Health Surveill SP - e43501 VL - 9 KW - dietary inflammatory index KW - fractures KW - diet KW - risk N2 - Background: Chronic inflammation plays a crucial role in tissue injury, osteoporosis, and fracture. The dietary inflammatory index (DII) is a tool for assessing the potential for inflammation in the diet. However, the association between the DII and fractures remains controversial from previous studies. Objective: We aimed to explore the correlation between the DII and fracture risk in Chinese adults. Methods: We included 11,999 adults (5519 men and 6480 women) who were a part of the China Health and Nutrition Survey (1997-2015) prospective cohort. A 3-day, 24-hour meal review method was used to calculate the DII score. The fractures were identified using a questionnaire. Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95% CIs for fractures. Subgroup, sensitivity, and restricted cubic spline analyses were performed. Results: During the 18 years of follow-up (median follow-up 9.0 years), 463 men and 439 women developed fractures. The median DII score was 0.64 (IQR ?1.74 to 1.46) for the total sample, 0.75 (IQR ?1.68 to 1.50) for men, and 0.53 (IQR ?1.79 to 1.42) for women. The DII score had a positive correlation with the risk of fracture among women but not among men. For men, after adjusting for covariates, the HRs for quintiles of DII were 1, 0.96 (95% CI 0.66-1.41), 1.05 (95% CI 0.74-1.49), 0.89 (95% CI 0.62-1.26), and 0.94 (95% CI 0.67-1.34; trend: P=.62). The HRs for women were 1, 1.13 (95% CI 0.72-1.79), 1.24 (95% CI 0.83-1.86), 1.51 (95% CI 1.02-2.22), and 1.62 (95% CI 1.10-2.39; trend: P=.004). The restricted cubic spline analysis showed a significant association between fracture risk and DII score in women (overall association: P=.01); as the DII scores were >0.53, HRs showed a significant upward trend. Women aged <50 years or who are nonsmokers, who are nondrinkers, or with nonabdominal obesity had a positive association between fracture risk and the DII score. In sensitivity analyses, after excluding people with diabetes or hypertension, there was still a positive association between fracture risk and the DII score in women. Among the DII components, the DII scores of protein (trend: P=.03), niacin (trend: P=.002), and iron (trend: P=.02) showed significant associations with the risk of fracture in women. Conclusions: Proinflammatory diet consumption increased the fracture risk in Chinese women aged <50 years. The high consumption of anti-inflammatory foods and low consumption of proinflammatory foods may be an important strategy to prevent fractures in women. UR - https://publichealth.jmir.org/2023/1/e43501 UR - http://dx.doi.org/10.2196/43501 UR - http://www.ncbi.nlm.nih.gov/pubmed/37590048 ID - info:doi/10.2196/43501 ER - TY - JOUR AU - Wang, Jing AU - Kwan, Patrick AU - Zhang, Gong AU - Shen, Mingwang AU - Piccenna, Loretta AU - O?Brien, J. Terence AU - Zhang, Lei PY - 2023/8/10 TI - A Multidimensional Assessment of Activities of Daily Living, Mental Status, Communication, and Social Abilities Among Older Adults in Shenzhen, China: Cross-Sectional Study JO - JMIR Public Health Surveill SP - e43612 VL - 9 KW - older adults KW - ability assessment KW - activities of daily living KW - mental status KW - sensory and communication KW - social participation N2 - Background: China is facing a rapidly expanding aging population. Insights into the health status of older adults are of great significance for health resource allocation and health care provision to this population. Objective: With the goal of providing a comprehensive understanding of the health status of older adults and to inform potential interventions, we investigated the level of disability and identified risk factors associated with disability among the older population (aged ?60 years) living in China. Methods: A total of 8467 older adults living in the Chinese city of Shenzhen were enrolled in this cross-sectional study. We used a multidimensional ability assessment survey, which assessed their activities of daily living (ADL; including eating, bathing, grooming, dressing, defecation control, urination control, using a toilet unaided, transfer, flat-ground walking, stair activity), mental status (including cognitive function, aggressive behavior, depression symptoms), sensory and communication (including consciousness level, vision, hearing, communication), and social participation (including living, working, time/space orientation, distinguish persons, social communication) abilities. The impact of demographic risk factors on ability levels was analyzed using ordinal logistic regression. The correlations between the four dimensions of ability mentioned above were analyzed using Spearman correlation analysis. Results: A total of 7766 participants were effectively assessed. The participants? average age was 70.64 (SD 8.46) years comprising 56.53% females. The overall ability level was classified as mildly, moderately, and severely impaired for 27.57% (n=2141), 2.83% (n=220), and 4.28% (n=332) of the 7766 participants, respectively. With increasing age, the proportion of impaired participants increased from 17.62% (365/2071) in the age group 60-64 years to 91.3% (253/277) in the age group above 90 years (P<.001), corresponding to an approximate 10% rise for every 5-year age increment. The odds of having more severe overall ability impairment in females was 1.15 times that in males (odds ratio [OR] 1.15, 95% CI 1.04-1.28). Participants who were divorced or widowed had a higher risk of more severe overall ability impairment than those currently married (OR 1.98, 95% CI 1.68-2.33). Participants living with nonrelatives had an increased risk of more severe overall ability impairment than those living alone (OR 2.38, 95% CI 1.46-3.91). Higher education level was a protective factor of overall ability impairment (college degree or above: OR 0.32, 95% CI 0.24-0.42). The four dimensions of ability assessed were significantly correlated; a low score for ADL was significantly correlated with poorer mental status, sensory and communication, and social participation (all P<.001). Conclusions: The proportion of disability among Chinese older adults increases with age, being female, having lower education levels, being divorced or widowed, and living with nonrelatives. Impairment in ADL ability is significantly correlated with poor mental status, social participation, and sensory and communication abilities. A holistic approach to improving the health of the older population is recommended in China. UR - https://publichealth.jmir.org/2023/1/e43612 UR - http://dx.doi.org/10.2196/43612 UR - http://www.ncbi.nlm.nih.gov/pubmed/37561566 ID - info:doi/10.2196/43612 ER - TY - JOUR AU - Stawarz, Katarzyna AU - Liang, Ju Ian AU - Alexander, Lyndsay AU - Carlin, Angela AU - Wijekoon, Anjana AU - Western, J. Max PY - 2023/5/24 TI - Exploring the Potential of Technology to Promote Exercise Snacking for Older Adults Who Are Prefrail in the Home Setting: User-Centered Design Study JO - JMIR Aging SP - e41810 VL - 6 KW - physical activity KW - older adults KW - Internet of Things KW - user-centered design KW - qualitative research KW - mobile phone N2 - Background: Older adults are at increased risk of falls, injury, and hospitalization. Maintaining or increasing participation in physical activity during older age can prevent some of the age-related declines in physical functioning that contribute to loss of independence and low reported quality of life. Exercise snacking may overcome some commonly cited barriers to exercise and encourage older adults to engage in muscle strength and balance activity, but the best way to deliver and support this novel format remains unknown. Objective: Our aim was to explore how the novel exercise snacking approach, that is, incorporating short bouts of strength and balance activities into everyday routines, could be supported by technology within a home setting and what types of technologies would be acceptable for older adults who are prefrail. Methods: Following a user-centered design process, 2 design workshops (study 1) were conducted first to understand older adults? (n=11; aged 69-89 years) attitudes toward technology aimed at supporting exercise snacking at home and to inform the design of 2 prototypes. Next, based on the findings of study 1, an exploratory pilot study (study 2) was conducted over 1 day with 2 prototypes (n=5; aged 69-80 years) at the participants? homes. Participants were interviewed over the telephone afterward about their experience. Transcripts were analyzed using framework analysis. Results: The results showed that the participants were positive toward using technology at home to support exercise snacking, but both exercises and technology would need to be simple and match the participants? everyday routines. Workshop discussions (study 1) led to the design of 2 prototypes using a pressure mat to support resistance and balance exercises. The exploratory pilot study (study 2) participants reported the potential in using smart devices to support exercise snacking, but the design of the initial prototypes influenced the participants? attitudes toward them. It also hampered the acceptability of these initial versions and highlighted the challenges in fitting exercise snacking into everyday life. Conclusions: Older adults were positive about using technology in their homes to support strength and balance exercise snacking. However, although promising, the initial prototypes require further refinement and optimization before feasibility, acceptability, and efficacy testing. Technologies to support exercise snacking need to be adaptable and personalized to individuals, to ensure that users are snacking on balance and strengthening exercises that are appropriate for them. UR - https://aging.jmir.org/2023/1/e41810 UR - http://dx.doi.org/10.2196/41810 UR - http://www.ncbi.nlm.nih.gov/pubmed/37223992 ID - info:doi/10.2196/41810 ER - TY - JOUR AU - Scott, F. Andrew AU - Ayers, Stephanie AU - Pluye, Pierre AU - Grad, Roland AU - Sztramko, Richard AU - Marr, Sharon AU - Papaioannou, Alexandra AU - Clark, Sandra AU - Gerantonis, Patricia AU - Levinson, J. Anthony PY - 2022/12/22 TI - Impact and Perceived Value of iGeriCare e-Learning Among Dementia Care Partners and Others: Pilot Evaluation Using the IAM4all Questionnaire JO - JMIR Aging SP - e40357 VL - 5 IS - 4 KW - dementia KW - caregiver KW - web-based education KW - internet KW - consumer health information KW - feedback KW - perception KW - survey KW - questionnaire KW - patient education KW - health education KW - care partner KW - caregiving KW - spousal care KW - informal care KW - Alzheimer KW - cognitive impairment KW - cognitively impaired KW - Lewy body KW - gerontology KW - geriatric N2 - Background: Care partners of people living with dementia may benefit from web-based education. We developed iGeriCare, an award-winning internet-based platform with 12 multimedia e-learning lessons about dementia. Objective: Our objective was to evaluate users? perceptions of impact. Methods: From March 17, 2021 to May 16, 2022, data were collected upon lesson completion. We used the content-validated Information Assessment Method for all (IAM4all) for patients and the public adapted for dementia care partners. The IAM4all questionnaire assesses outcomes of web-based consumer health information. Responses were collected using SurveyMonkey, and data were analyzed using IBM SPSS Statistics (version 28). Results: A total of 409 responses were collected, with 389 (95.1%) survey respondents completing the survey. Of 409 respondents, 179 (43.8%) identified as a family or friend care partner, 84 (20.5%) identified as an individual concerned they may have mild cognitive impairment or dementia, 380 (92.9%) identified the lesson as relevant or very relevant, and 403 (98.5%) understood the lesson well or very well. Over half of respondents felt they were motivated to learn more, they were taught something new, or they felt validated in what they do, while some felt reassured or felt that the lesson refreshed their memory. Of 409 respondents, 401 (98%) said they would use the information, in particular, to better understand something, discuss the information with someone else, do things differently, or do something. Conclusions: Users identified iGeriCare as relevant and beneficial and said that they would use the information. To our knowledge, this is the first time the IAM4all questionnaire has been used to assess patient and caregiver feedback on internet-based dementia education resources. A randomized controlled trial to study feasibility and impact on caregiver knowledge, self-efficacy, and burden is in progress. UR - https://aging.jmir.org/2022/4/e40357 UR - http://dx.doi.org/10.2196/40357 UR - http://www.ncbi.nlm.nih.gov/pubmed/36150051 ID - info:doi/10.2196/40357 ER - TY - JOUR AU - Howes, Jared AU - Denier, Yvonne AU - Gastmans, Chris PY - 2022/11/11 TI - Electronic Tracking Devices for People With Dementia: Content Analysis of Company Websites JO - JMIR Aging SP - e38865 VL - 5 IS - 4 KW - dementia KW - wandering KW - electronic tracking devices KW - bioethics KW - locators KW - monitors KW - surveillance devices KW - management KW - technology KW - care tool KW - caregiver KW - device KW - vulnerable KW - elderly N2 - Background: Electronic tracking devices, also known as locators, monitors, or surveillance devices, are increasingly being used to manage dementia-related wandering and, subsequently, raising various ethical questions. Despite the known importance technology design has on the ethics of technologies, little research has focused on the companies responsible for the design and development of electronic tracking devices. This paper is the first to perform a qualitative analysis of the ethically related content of the websites of companies that design and develop electronic tracking devices. Objective: The aim of this study was to understand how companies that design, develop, and market electronic tracking devices for dementia care frame, through textual marketing content, the vulnerabilities and needs of persons with dementia and caregivers, the way in which electronic tracking devices respond to these vulnerabilities and needs, and the ethical issues and values at stake. Methods: Electronic tracking device company websites were identified via a Google search, 2 device recommendation lists (Alzheimer?s Los Angeles and the Canadian Agency for Drugs and Technologies in Health), and the 2 recent reviews of wander management technology by Neubauer et al and Ray et al. To be included, websites must be official representations of companies (not market or third-party websites) developing and selling electronic tracking devices for use in dementia care. The search was conducted on December 22, 2020, returning 199 websites excluding duplicates. Data synthesis and analysis were conducted on the textual content of the included websites using a modified form of the Qualitative Analysis Guide of Leuven. Results: In total, 29 websites met the inclusion criteria. Most (15/29, 52%) companies were in the United States. The target audience of the websites was largely caregivers. A range of intertwined vulnerabilities facing persons with dementia and their caregivers were identified, and the companies addressed these via care tools that centered on certain values such as providing information while preserving privacy. Life after device implementation was characterized as a world aspired to that sees increased safety for persons with dementia and peace of mind for caregivers. Conclusions: The way electronic tracking device content is currently conveyed excludes persons with dementia as a target audience. In presenting their products as a response to vulnerabilities, particular values are linked to design elements. A limitation of the results is the opaque nature of website content origins. How or when values arise in the process of design, development, and marketing is unknown. Therefore, further research should explore the process companies use to identify vulnerabilities, how values are decided upon and integrated into the design of products, and the perceptions of developers regarding the ethics of electronic tracking devices. UR - https://aging.jmir.org/2022/4/e38865 UR - http://dx.doi.org/10.2196/38865 UR - http://www.ncbi.nlm.nih.gov/pubmed/36367765 ID - info:doi/10.2196/38865 ER - TY - JOUR AU - Brijnath, Bianca AU - Baruah, Upasana AU - Antoniades, Josefine AU - Varghese, Mathew AU - Cooper, Claudia AU - Dow, Briony AU - Kent, Mike AU - Loganathan, Santosh PY - 2022/6/2 TI - Using Digital Media to Improve Dementia Care in India: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e38456 VL - 11 IS - 6 KW - dementia KW - care KW - India KW - digital health KW - film N2 - Background: India is undergoing a demographic transition characterized by population aging and is witnessing a high dementia rate. Although nearly 7 million people live with dementia in India, dementia awareness is poor, and current resources addressing dementia care are basic and often incomplete, duplicated, or conflicting. To address this gap, this study aims to use digital media, which has had a massive technological uptake in India, to improve dementia care in India. Objective: The objective of this paper is to describe an intervention study design that examines the feasibility and acceptability of Moving Pictures India, a digital media resource to improve dementia care in India. Methods: This study employs a mixed methods design and is divided into 4 phases: (1) video interviews with Indian caregivers and health professionals; (2) coproduction of resources; (3) pilot randomized controlled trial (RCT); and (4) dissemination and analytics. The pilot RCT will follow an experimental parallel group design with 2 arms aiming to assess the impact, feasibility, and acceptability of the developed resources. The primary outcome measures for the pilot RCT will be feasibility and acceptability, while the secondary outcome measures will be caregiver burden, mood, and quality of life. Results: This study received funding from the Alzheimer?s Association in the United States in July 2021. In 2023, we will enroll 60 dementia caregivers (40 caregivers in the intervention arm and 20 in the control) for the pilot RCT. The study has been approved by the National Institute of Mental Health and Neuro Sciences Ethics Committee (26th IEC (BEH.SC.DIV.)/2020-21 dated November 11, 2020); the Health Ministry's Screening Committee, India (proposal ID 2020-10137); the Curtin University Human Research Ethics Committee (approval number HRE2020-0735); and the NARI Research Governance Office (site-specific approval dated March 17, 2021). Conclusions: This protocol is designed to deliver unique, coproduced, and evidence-based media resources to support caregivers of persons with dementia in India and other countries aiming to utilize digital media for dementia care. If the intervention is found feasible and acceptable, postpiloting analytics and qualitative feedback will be used to develop an implementation trial to evaluate the effectiveness of the potential low-risk high-benefit intervention in practice. Trial Registration: Clinical Trials Registry-India CTRI/2021/01/030403; http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=50794 International Registered Report Identifier (IRRID): DERR1-10.2196/38456 UR - https://www.researchprotocols.org/2022/6/e38456 UR - http://dx.doi.org/10.2196/38456 UR - http://www.ncbi.nlm.nih.gov/pubmed/35653168 ID - info:doi/10.2196/38456 ER - TY - JOUR AU - Husted, Skov Karina Louise AU - Brink-Kjær, Andreas AU - Fogelstrøm, Mathilde AU - Hulst, Pernille AU - Bleibach, Akita AU - Henneberg, Kaj-Åge AU - Sørensen, Dissing Helge Bjarup AU - Dela, Flemming AU - Jacobsen, Brings Jens Christian AU - Helge, Wulff Jørn PY - 2022/5/10 TI - A Model for Estimating Biological Age From Physiological Biomarkers of Healthy Aging: Cross-sectional Study JO - JMIR Aging SP - e35696 VL - 5 IS - 2 KW - biological age KW - model development KW - principal component analysis KW - healthy aging KW - biomarkers KW - aging N2 - Background: Individual differences in the rate of aging and susceptibility to disease are not accounted for by chronological age alone. These individual differences are better explained by biological age, which may be estimated by biomarker prediction models. In the light of the aging demographics of the global population and the increase in lifestyle-related morbidities, it is interesting to invent a new biological age model to be used for health promotion. Objective: This study aims to develop a model that estimates biological age based on physiological biomarkers of healthy aging. Methods: Carefully selected physiological variables from a healthy study population of 100 women and men were used as biomarkers to establish an estimate of biological age. Principal component analysis was applied to the biomarkers and the first principal component was used to define the algorithm estimating biological age. Results: The first principal component accounted for 31% in women and 25% in men of the total variance in the biological age model combining mean arterial pressure, glycated hemoglobin, waist circumference, forced expiratory volume in 1 second, maximal oxygen consumption, adiponectin, high-density lipoprotein, total cholesterol, and soluble urokinase-type plasminogen activator receptor. The correlation between the corrected biological age and chronological age was r=0.86 (P<.001) and r=0.81 (P<.001) for women and men, respectively, and the agreement was high and unbiased. No difference was found between mean chronological age and mean biological age, and the slope of the regression line was near 1 for both sexes. Conclusions: Estimating biological age from these 9 biomarkers of aging can be used to assess general health compared with the healthy aging trajectory. This may be useful to evaluate health interventions and as an aid to enhance awareness of individual health risks and behavior when deviating from this trajectory. Trial Registration: ClinicalTrials.gov NCT03680768; https://clinicaltrials.gov/ct2/show/NCT03680768 International Registered Report Identifier (IRRID): RR2-10.2196/19209 UR - https://aging.jmir.org/2022/2/e35696 UR - http://dx.doi.org/10.2196/35696 UR - http://www.ncbi.nlm.nih.gov/pubmed/35536617 ID - info:doi/10.2196/35696 ER - TY - JOUR AU - Coley, Nicola AU - Andre, Laurine AU - Hoevenaar-Blom, P. Marieke AU - Ngandu, Tiia AU - Beishuizen, Cathrien AU - Barbera, Mariagnese AU - van Wanrooij, Lennard AU - Kivipelto, Miia AU - Soininen, Hilkka AU - van Gool, Willem AU - Brayne, Carol AU - Moll van Charante, Eric AU - Richard, Edo AU - Andrieu, Sandrine AU - PY - 2022/5/9 TI - Factors Predicting Engagement of Older Adults With a Coach-Supported eHealth Intervention Promoting Lifestyle Change and Associations Between Engagement and Changes in Cardiovascular and Dementia Risk: Secondary Analysis of an 18-Month Multinational Randomized Controlled Trial JO - J Med Internet Res SP - e32006 VL - 24 IS - 5 KW - aging KW - eHealth KW - disparities KW - engagement KW - prevention KW - cardiovascular KW - lifestyle KW - risk factors N2 - Background: Digital health interventions could help to prevent age-related diseases, but little is known about how older adults engage with such interventions, especially in the long term, or whether engagement is associated with changes in clinical, behavioral, or biological outcomes in this population. Disparities in engagement levels with digital health interventions may exist among older people and be associated with health inequalities. Objective: This study aimed to describe older adults? engagement with an eHealth intervention, identify factors associated with engagement, and examine associations between engagement and changes in cardiovascular and dementia risk factors (blood pressure, cholesterol, BMI, physical activity, diet, and cardiovascular and dementia risk scores). Methods: This was a secondary analysis of the 18-month randomized controlled Healthy Ageing Through Internet Counselling in the Elderly trial of a tailored internet-based intervention encouraging behavior changes, with remote support from a lifestyle coach, to reduce cardiovascular and cognitive decline risk in 2724 individuals aged ?65 years, recruited offline in the Netherlands, Finland, and France. Engagement was assessed via log-in frequency, number of lifestyle goals set, measurements entered and messages sent to coaches, and percentage of education materials read. Clinical and biological data were collected during in-person visits at baseline and 18 months. Lifestyle data were self-reported on a web-based platform. Results: Of the 1389 intervention group participants, 1194 (85.96%) sent at least one message. They logged in a median of 29 times, and set a median of 1 goal. Higher engagement was associated with significantly greater improvement in biological and behavioral risk factors, with evidence of a dose-response effect. Compared with the control group, the adjusted mean difference (95% CI) in 18-month change in the primary outcome, a composite z-score comprising blood pressure, BMI, and cholesterol, was ?0.08 (?0.12 to ?0.03), ?0.04 (?0.08 to 0.00), and 0.00 (?0.08 to 0.08) in the high, moderate, and low engagement groups, respectively. Low engagers showed no improvement in any outcome measures compared with the control group. Participants not using a computer regularly before the study engaged much less with the intervention than those using a computer up to 7 (adjusted odds ratio 5.39, 95% CI 2.66-10.95) or ?7 hours per week (adjusted odds ratio 6.58, 95% CI 3.21-13.49). Those already working on or with short-term plans for lifestyle improvement at baseline, and with better cognition, engaged more. Conclusions: Greater engagement with an eHealth lifestyle intervention was associated with greater improvement in risk factors in older adults. However, those with limited computer experience, who tended to have a lower level of education, or who had poorer cognition engaged less. Additional support or forms of intervention delivery for such individuals could help minimize potential health inequalities associated with the use of digital health interventions in older people. UR - https://www.jmir.org/2022/5/e32006 UR - http://dx.doi.org/10.2196/32006 UR - http://www.ncbi.nlm.nih.gov/pubmed/35385395 ID - info:doi/10.2196/32006 ER - TY - JOUR AU - Zhao, Chris Yuxiang AU - Zhao, Mengyuan AU - Song, Shijie PY - 2022/2/16 TI - Online Health Information Seeking Behaviors Among Older Adults: Systematic Scoping Review JO - J Med Internet Res SP - e34790 VL - 24 IS - 2 KW - older adults KW - online health information seeking KW - health information behavior KW - aging technology KW - systematic scoping review N2 - Background: With the world?s population aging, more health-conscious older adults are seeking health information to make better-informed health decisions. The rapid growth of the internet has empowered older adults to access web-based health information sources. However, research explicitly exploring older adults? online health information seeking (OHIS) behavior is still underway. Objective: This systematic scoping review aims to understand older adults? OHIS and answer four research questions: (1) What types of health information do older adults seek and where do they seek health information on the internet? (2) What are the factors that influence older adults? OHIS? (3) What are the barriers to older adults? OHIS? (4) How can we intervene and support older adults? OHIS? Methods: A comprehensive literature search was performed in November 2020, involving the following academic databases: Web of Science; Cochrane Library database; PubMed; MEDLINE; CINAHL Plus; APA PsycINFO; Library and Information Science Source; Library, Information Science and Technology Abstracts; Psychology and Behavioral Sciences Collection; Communication & Mass Media Complete; ABI/INFORM; and ACM Digital Library. The initial search identified 8047 publications through database search strategies. After the removal of duplicates, a data set consisting of 5949 publications was obtained for screening. Among these, 75 articles met the inclusion criteria. Qualitative content analysis was performed to identify themes related to the research questions. Results: The results suggest that older adults seek 10 types of health information from 6 types of internet-based information sources and that 2 main categories of influencing factors, individual-related and source-related, impact older adults? OHIS. Moreover, the results reveal that in their OHIS, older adults confront 3 types of barriers, namely individual, social, and those related to information and communication technologies. Some intervention programs based on educational training workshops have been created to intervene and support older adults? OHIS. Conclusions: Although OHIS has become increasingly common among older adults, the review reveals that older adults? OHIS behavior is not adequately investigated. The findings suggest that more studies are needed to understand older adults? OHIS behaviors and better support their medical and health decisions in OHIS. Based on the results, the review proposes multiple objectives for future studies, including (1) more investigations on the OHIS behavior of older adults above 85 years; (2) conducting more longitudinal, action research, and mixed methods studies; (3) elaboration of the mobile context and cross-platform scenario of older adults? OHIS; (4) facilitating older adults? OHIS by explicating technology affordance; and (5) promoting and measuring the performance of OHIS interventions for older adults. UR - https://www.jmir.org/2022/2/e34790 UR - http://dx.doi.org/10.2196/34790 UR - http://www.ncbi.nlm.nih.gov/pubmed/35171099 ID - info:doi/10.2196/34790 ER - TY - JOUR AU - O'Loughlin, Patricia AU - Pavithra, Pavithra AU - Regan, John AU - Bennett, Marc AU - Knight, Rachel AU - Lenaert, Bert AU - Marquez, Melissa AU - Taddeo, Michelle AU - Griffith, James AU - Shapiro, Rita AU - Farina, Francesca PY - 2021/7/30 TI - A Randomized Controlled Trial Investigating the Feasibility of a Low-Intensity Psychological Intervention for Fear of Memory Loss and Quality of Life in Older Adults: Protocol for the Reducing Fear and Avoidance of Memory Loss (REFRAME) Study JO - JMIR Res Protoc SP - e30514 VL - 10 IS - 7 KW - fear KW - memory loss KW - dementia KW - older adults KW - mindfulness KW - behavioral activation N2 - Background: Dementia is the most feared disease associated with aging. Prolonged fears about memory loss and dementia can have harmful consequences even in the absence of cognitive decline. Fear of dementia is associated with poorer health outcomes and psychological well-being and increased memory failures in older adults. Objective: We will conduct a randomized controlled trial to determine the feasibility of a tailored, web-based mindfulness program to reduce fear of memory loss and increase quality of life in older adults experiencing heightened fear. Methods: Eighty participants will be recruited and divided into 2 groups (40 in each group). One group will receive psychoeducation plus mindfulness training. A second group will receive psychoeducation, mindfulness training, and additional modules targeting maladaptive behavioral avoidance (ie, social and cognitive withdrawal). Results: Our recent etiological model posits that maladaptive behavioral avoidance strategies critically underlie psychosocial dysfunction associated with fear of memory loss. Thus, we predict better outcomes in the second group, including reduced fear of memory loss (primary outcome), Alzheimer disease, anxiety, and subjective memory failures, and increased quality of life (secondary outcomes). Outcome measures will be applied at 5 time points (before, baseline, interim, and after the intervention, and at 3-month follow-up). Data will be analyzed using mixed models and correlations. Conclusions: Results from this study will contribute to the current literature on dementia-related fear and improve our understanding of how to effectively address and reduce these fears. Trial Registration: ClinicalTrials.gov NCT04821960; https://clinicaltrials.gov/ct2/show/NCT04821960. International Registered Report Identifier (IRRID): PRR1-10.2196/30514 UR - https://www.researchprotocols.org/2021/7/e30514 UR - http://dx.doi.org/10.2196/30514 UR - http://www.ncbi.nlm.nih.gov/pubmed/34328428 ID - info:doi/10.2196/30514 ER - TY - JOUR AU - van Allen, Zack AU - Bacon, L. Simon AU - Bernard, Paquito AU - Brown, Heather AU - Desroches, Sophie AU - Kastner, Monika AU - Lavoie, Kim AU - Marques, Marta AU - McCleary, Nicola AU - Straus, Sharon AU - Taljaard, Monica AU - Thavorn, Kednapa AU - Tomasone, R. Jennifer AU - Presseau, Justin PY - 2021/6/11 TI - Clustering of Unhealthy Behaviors: Protocol for a Multiple Behavior Analysis of Data From the Canadian Longitudinal Study on Aging JO - JMIR Res Protoc SP - e24887 VL - 10 IS - 6 KW - health behaviors KW - multiple behaviors KW - cluster analysis KW - network analysis KW - CLSA N2 - Background: Health behaviors such as physical inactivity, unhealthy eating, smoking tobacco, and alcohol use are leading risk factors for noncommunicable chronic diseases and play a central role in limiting health and life satisfaction. To date, however, health behaviors tend to be considered separately from one another, resulting in guidelines and interventions for healthy aging siloed by specific behaviors and often focused only on a given health behavior without considering the co-occurrence of family, social, work, and other behaviors of everyday life. Objective: The aim of this study is to understand how behaviors cluster and how such clusters are associated with physical and mental health, life satisfaction, and health care utilization may provide opportunities to leverage this co-occurrence to develop and evaluate interventions to promote multiple health behavior changes. Methods: Using cross-sectional baseline data from the Canadian Longitudinal Study on Aging, we will perform a predefined set of exploratory and hypothesis-generating analyses to examine the co-occurrence of health and everyday life behaviors. We will use agglomerative hierarchical cluster analysis to cluster individuals based on their behavioral tendencies. Multinomial logistic regression will then be used to model the relationships between clusters and demographic indicators, health care utilization, and general health and life satisfaction, and assess whether sex and age moderate these relationships. In addition, we will conduct network community detection analysis using the clique percolation algorithm to detect overlapping communities of behaviors based on the strength of relationships between variables. Results: Baseline data for the Canadian Longitudinal Study on Aging were collected from 51,338 participants aged between 45 and 85 years. Data were collected between 2010 and 2015. Secondary data analysis for this project was approved by the Ottawa Health Science Network Research Ethics Board (protocol ID #20190506-01H). Conclusions: This study will help to inform the development of interventions tailored to subpopulations of adults (eg, physically inactive smokers) defined by the multiple behaviors that describe their everyday life experiences. International Registered Report Identifier (IRRID): DERR1-10.2196/24887 UR - https://www.researchprotocols.org/2021/6/e24887 UR - http://dx.doi.org/10.2196/24887 UR - http://www.ncbi.nlm.nih.gov/pubmed/34114962 ID - info:doi/10.2196/24887 ER - TY - JOUR AU - Kylén, Maya AU - Schmidt, M. Steven AU - Jonsson, Oskar AU - Slaug, Björn AU - Iwarsson, Susanne PY - 2020/9/21 TI - Awareness of and Attitudes Toward User Involvement in Research on Aging and Health: Protocol for a Quantitative Large-Scale Panel Study JO - JMIR Res Protoc SP - e17759 VL - 9 IS - 9 KW - partnerships KW - public involvement KW - older people KW - UserAge program KW - user participation N2 - Background: User involvement is a requirement of most research funders. There is a growing body of literature exploring the benefits and challenges of user involvement in research, but such studies are scarce in the field of aging and health. Moreover, the majority of such research is qualitative, which limits the generalizability of results. The UserAge panel study will be instrumental in expanding knowledge that will benefit the quality and impact of user involvement in future research. Objective: The aim of this study is to determine the awareness and understanding of and attitudes toward user involvement in research among different categories of knowledge users and researchers over time. Methods: A panel study will be implemented with 3 different categories of knowledge users (people aged 60 years and older, informal carers, and professionals in health care and architecture) and researchers in aging and health. A professional survey company will collect data from all samples in parallel. Potential participants will be asked to complete the survey via telephone or online, or participants can request a paper survey to be sent to them in the post. A draft set of questions on attitudes and behavioral patterns related to research utilization and user involvement in research was compiled based on existing literature and input from the research team. Using a participatory approach, we engaged a user forum, where 8 older people and 3 researchers jointly refined the survey for time/length to complete, terminology, readability, and context. Data collected via the internet or telephone will be automatically processed, and data collected on paper forms will be entered in machine-readable forms. The survey company will store all data and deliver the quality-controlled database to the university for further storage. Analyses of frequencies and measures of central tendency will be used for descriptive purposes. To compare groups, state-of-the art statistical analyses will be used. Results: Data collection for the first study wave started in September 2019 and will be completed in spring 2020. Data will be ready for analysis following cleaning and quality control, which started during summer 2020 and will be completed autumn 2020. We anticipate the data collection for the second study wave to start in September 2021. Conclusions: This is the first quantitative large-scale panel study focusing on trends in attitudes toward, awareness of, and knowledge about user involvement in research on aging and health in Sweden. The results will generate new and important knowledge to advance the understanding of user needs and preferences as well as the relevance of user involvement in research on aging and health. International Registered Report Identifier (IRRID): DERR1-10.2196/17759 UR - http://www.researchprotocols.org/2020/9/e17759/ UR - http://dx.doi.org/10.2196/17759 UR - http://www.ncbi.nlm.nih.gov/pubmed/32955444 ID - info:doi/10.2196/17759 ER - TY - JOUR AU - Bogza, Laura-Mihaela AU - Patry-Lebeau, Cassandra AU - Farmanova, Elina AU - Witteman, O. Holly AU - Elliott, Jacobi AU - Stolee, Paul AU - Hudon, Carol AU - Giguere, C. Anik M. PY - 2020/8/19 TI - User-Centered Design and Evaluation of a Web-Based Decision Aid for Older Adults Living With Mild Cognitive Impairment and Their Health Care Providers: Mixed Methods Study JO - J Med Internet Res SP - e17406 VL - 22 IS - 8 KW - decision aid KW - mild cognitive impairment KW - elderly KW - decision support technique KW - aging N2 - Background: Mild cognitive impairment (MCI) is often considered a transitional state between normal and pathologic (eg, dementia) cognitive aging. Although its prognosis varies largely, the diagnosis carries the risk of causing uncertainty and overtreatment of older adults with MCI who may never progress to dementia. Decision aids help people become better informed and more involved in decision making by providing evidence-based information about options and possible outcomes and by assisting them in clarifying their personal values in relation to the decision to be made. Objective: This study aimed to incorporate features that best support values clarification and adjust the level of detail of a web-based decision aid for individuals with MCI. Methods: We conducted a rapid review to identify options to maintain or improve cognitive functions in individuals with MCI. The evidence was structured into a novel web-based decision aid designed in collaboration with digital specialists and graphic designers. Qualitative and user-centered evaluations were used to draw on users? knowledge, clarify values, and inform potential adoption in routine clinical practice. We invited clinicians, older adults with MCI, and their caregivers to evaluate the decision aid in 6 consecutive rounds, with new participants in each round. Quantitative data were collected using the Values Clarity and Informed subscales of the Decisional Conflict Scale, the System Usability Scale, the Ottawa Acceptability questionnaire, and a 5-point satisfaction rating scale. We verified their comprehension using a teach-back method and recorded usability issues. We recorded the audio and computer screen during the session. An inductive thematic qualitative analysis approach was used to identify and describe the issues that arose. After each round, an expert panel met to prioritize and find solutions to mitigate the issues. An integrated analysis was conducted to confirm our choices. Results: A total of 7 clinicians (social workers, nurses, family physicians, psychologists) and 12 older (?60 years) community-dwelling individuals with MCI, half of them women, with education levels going from none to university diploma, were recruited and completed testing. The thematic analysis revealed 3 major issues. First, the user should be guided through the decision-making process by tailoring the presentation of options to users? priorities using the values clarification exercise. Second, its content should be simple, but not simplistic, notably by using information layering, plain language, and pictograms. Third, the interface should be intuitive and user friendly, utilize pop-up windows and information tips, avoid drop-down menus, and limit the need to scroll down. The quantitative assessments corroborated the qualitative findings. Conclusions: This project resulted in a promising web-based decision aid that can support decision making for MCI intervention, based on the personal values and preferences of the users. Further ongoing research will allow its implementation to be tested in clinical settings. UR - https://www.jmir.org/2020/8/e17406 UR - http://dx.doi.org/10.2196/17406 UR - http://www.ncbi.nlm.nih.gov/pubmed/32442151 ID - info:doi/10.2196/17406 ER - TY - JOUR AU - Appalasamy, Rani Jamuna AU - Joseph, Pauline Joyce AU - Seeta Ramaiah, Siva AU - Md Zain, Zaini Anuar AU - Quek, Fatt Kia AU - Tha, Kyi Kyi PY - 2020/7/10 TI - Video Narratives Intervention Among Stroke Survivors: Feasibility and Acceptability Study of a Randomized Controlled Trial JO - JMIR Aging SP - e17182 VL - 3 IS - 2 KW - feasibility and acceptability KW - medication understanding KW - use self-efficacy KW - stroke KW - video narratives N2 - Background: A large number of stroke survivors worldwide suffer from moderate to severe disability. In Malaysia, long-term uncontrolled stroke risk factors lead to unforeseen rates of recurrent stroke and a growing incidence of stroke occurrence across ages, predominantly among the elderly population. This situation has motivated research efforts focused on tapping into patient education, especially related to patient self-efficacy of understanding and taking medication appropriately. Video narratives integrated with health belief model constructs have demonstrated potential impacts as an aide to patient education efforts. Objective: The aim of this study was to investigate the feasibility and acceptability of study procedures based on a randomized controlled trial protocol of a video narratives intervention among poststroke patients. We also aimed to obtain preliminary findings of video narratives related to medication understanding and use self-efficacy (MUSE) and blood pressure control. Methods: A parallel group randomized controlled trial including a control group (without video viewing) and an intervention group (with video viewing) was conducted by researchers at a neurology outpatient clinic on poststroke patients (N=54). Baseline data included patients? sociodemographic characteristics, medical information, and all outcome measures. Measurements of MUSE and blood pressure following the trial were taken during a 3-month follow-up period. Feasibility of the trial was assessed based on recruitment and study completion rates along with patients? feedback on the burden of the study procedures and outcome measures. Acceptability of the trial was analyzed qualitatively. Statistical analysis was applied to ascertain the preliminary results of video narratives. Results: The recruitment rate was 60 out of 117 patients (51.3%). Nevertheless, the dropout rate of 10% was within the acceptable range. Patients were aged between 21 and 74 years. Nearly 50 of the patients (>85%) had adequate health literacy and exposure to stroke education. Most of the patients (>80%) were diagnosed with ischemic stroke, whereby the majority had primary hypertension. The technicalities of randomization and patient approach were carried out with minimal challenge and adequate patient satisfaction. The video contents received good responses with respect to comprehension and simplicity. Moreover, an in-depth phone interview with 8 patients indicated that the video narratives were considered to be useful and inspiring. These findings paralleled the preliminary findings of significant improvement within groups in MUSE (P=.001) and systolic blood pressure control (P=.04). Conclusions: The queries and feedback from each phase in this study have been acknowledged and will be taken forward in the full trial. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN 12618000174280; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373554 UR - https://aging.jmir.org/2020/2/e17182 UR - http://dx.doi.org/10.2196/17182 UR - http://www.ncbi.nlm.nih.gov/pubmed/32469839 ID - info:doi/10.2196/17182 ER - TY - JOUR AU - Shu, Sara AU - Woo, P. Benjamin K. PY - 2020/4/13 TI - The Roles of YouTube and WhatsApp in Dementia Education for the Older Chinese American Population: Longitudinal Analysis JO - JMIR Aging SP - e18179 VL - 3 IS - 1 KW - dementia KW - mental health KW - social media KW - geriatrics KW - health promotion KW - health education N2 - Background: Dementia remains a stigmatized topic in the Chinese community. Objective: This study aims to analyze and compare the usage of dementia educational YouTube videos and the modalities of video sharing over a 6-year period. Methods: Dementia educational videos were uploaded to YouTube. Data was collected over a 6-year period. Results from the first 3 years were compared to those from the second 3 years using descriptive statistics and chi-square analysis. Results: Over 6 years, the dementia educational videos generated a total watch time of 269,388 minutes, 37,690 views, and an average view duration of 7.1 minutes. Comparing the first and second 3-year periods of video performance data, there was a longer watch time (59,262 vs 210,126 minutes), more total views (9387 vs 28,303 views), and a longer average view duration (6.3 vs 7.4 minutes). Furthermore, WhatsApp has become a leading external traffic source and top sharing service, accounting for 43.5% (929/2137) and 67.0% (677/1011), respectively. Conclusions: Over 6 years, YouTube has become an increasingly popular tool to deliver culturally sensitive dementia education to Chinese Americans. WhatsApp continues to be the preferred method of sharing dementia education and has become a top external traffic source to dementia educational videos. Taken together, these social media platforms are promising means of reducing the disparity in dementia knowledge in linguistically and culturally isolated populations. UR - http://aging.jmir.org/2020/1/e18179/ UR - http://dx.doi.org/10.2196/18179 UR - http://www.ncbi.nlm.nih.gov/pubmed/32281940 ID - info:doi/10.2196/18179 ER - TY - JOUR AU - Athilingam, Ponrathi AU - Jenkins, Bradlee AU - Redding, A. Barbara PY - 2019/04/25 TI - Reading Level and Suitability of Congestive Heart Failure (CHF) Education in a Mobile App (CHF Info App): Descriptive Design Study JO - JMIR Aging SP - e12134 VL - 2 IS - 1 KW - health literacy KW - reading level KW - patient education KW - heart failure KW - mobile app N2 - Background: Education at the time of diagnosis or at discharge after an index illness is a vital component of improving outcomes in congestive heart failure (CHF). About 90 million Americans have limited health literacy and have a readability level at or below a 5th-grade level, which could affect their understanding of education provided at the time of diagnosis or discharge from hospital. Objective: The aim of this paper was to assess the suitability and readability level of a mobile phone app, the CHF Info App. Methods: A descriptive design was used to assess the reading level and suitability of patient educational materials included in the CHF Info App. The suitability assessment of patient educational materials included in the CHF Info App was independently assessed by two of the authors using the 26-item Suitability Assessment of Materials (SAM) tool. The reading grade level for each of the 10 CHF educational modules included in the CHF Info App was assessed using the comprehensive online Text Readability Consensus Calculator based on the seven most-common readability formulas: the Flesch Reading Ease Formula, the Gunning Fog Index, the Flesch-Kincaid Grade Level Formula, the Coleman-Liau Index, the Simplified Measure of Gobbledygook Index, the Automated Readability Index, and the Linsear Write Formula. The reading level included the text-scale score, the ease-of-reading score, and the corresponding grade level. Results: The educational materials included in the CHF Info App ranged from a 5th-grade to an 8th-grade reading level, with a mean of a 6th-grade level, which is recommended by the American Medical Association. The SAM tool result demonstrated adequate-to-superior levels in all four components assessed, including content, appearance, visuals, and layout and design, with a total score of 77%, indicating superior suitability. Conclusions: The authors conclude that the CHF Info App will be suitable and meet the recommended health literacy level for American adult learners. Further testing of the CHF Info App in a longitudinal study is warranted to determine improvement in CHF knowledge. UR - http://aging.jmir.org/2019/1/e12134/ UR - http://dx.doi.org/10.2196/12134 UR - http://www.ncbi.nlm.nih.gov/pubmed/31518265 ID - info:doi/10.2196/12134 ER - TY - JOUR AU - Appalasamy, Rani Jamuna AU - Joseph, Pauline Joyce AU - Seeta Ramaiah, Siva AU - Quek, Fatt Kia AU - Md Zain, Zaini Anuar AU - Tha, Kyi Kyi PY - 2019/03/21 TI - An Intervention to Promote Medication Understanding and Use Self-Efficacy: Design of Video Narratives for Aging Patients at Risk of Recurrent Stroke JO - JMIR Aging SP - e11539 VL - 2 IS - 1 KW - Delphi technique KW - self-efficacy KW - stroke KW - personal narratives KW - video-audio media KW - beliefs N2 - Background: The debilitating effects of recurrent stroke among aging patients have urged researchers to explore medication adherence among these patients. Video narratives built upon Health Belief Model (HBM) constructs have displayed potential impact on medication adherence, adding an advantage to patient education efforts. However, its effect on medication understanding and use self-efficacy have not been tested. Objective: The researchers believed that culturally sensitive video narratives, which catered to a specific niche, would reveal a personalized impact on medication adherence. Therefore, this study aimed to develop and validate video narratives for this purpose. Methods: This study adapted the Delphi method to develop a consensus on the video scripts? contents based on learning outcomes and HBM constructs. The panel of experts comprised 8 members representing professional stroke disease experts and experienced poststroke patients in Malaysia. The Delphi method involved 3 rounds of discussions. Once the consensus among members was achieved, the researchers drafted the initial scripts in English, which were then back translated to the Malay language. A total of 10 bilingual patients, within the study?s inclusion criteria, screened the scripts for comprehension. Subsequently, a neurologist and poststroke patient narrated the scripts in both languages as they were filmed, to add to the realism of the narratives. Then, the video narratives underwent a few cycles of editing after some feedback on video engagement by the bilingual patients. Few statistical analyses were applied to confirm the validity and reliability of the video narratives. Results: Initially, the researchers proposed 8 learning outcomes and 9 questions based on HBM constructs for the video scripts? content. However, following Delphi rounds 1 to 3, a few statements were omitted and rephrased. The Kendall coefficient of concordance, W, was about 0.7 (P<.001) for both learning outcomes and questions which indicated good agreement between members. Each statement?s Cronbach alpha was above .8 with SD values within a range below 1.5 that confirmed satisfactory content and construct validity. Approximately 75% (6/8) of members agreed that all chosen statements were relevant and suitable for video script content development. Similarly, more than 80% (8/10) of patients scored video engagement above average, intraclass correlation coefficient was above 0.7, whereas its Kendall W was about 0.7 with significance (P<.001), which indicated average agreement that the video narratives perceived realism. Conclusions: The Delphi method was proven to be helpful in conducting discussions systematically and providing precise content for the development of video narratives, whereas the Video Engagement Scale was an appropriate measurement of video realism and emotions, which the researchers believed could positively impact medication understanding and use self-efficacy among patients with stroke. A feasibility and acceptability study in an actual stroke care center is needed. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618000174280; https://www.anzctr.org.au /Trial/Registration/TrialReview.aspx?id=373554&isReview=true UR - http://aging.jmir.org/2019/1/e11539/ UR - http://dx.doi.org/10.2196/11539 UR - http://www.ncbi.nlm.nih.gov/pubmed/31518260 ID - info:doi/10.2196/11539 ER - TY - JOUR AU - Dobbins, Maureen AU - Watson, Susannah AU - Read, Kristin AU - Graham, Kelly AU - Yousefi Nooraie, Reza AU - Levinson, J. Anthony PY - 2018/05/07 TI - A Tool That Assesses the Evidence, Transparency, and Usability of Online Health Information: Development and Reliability Assessment JO - JMIR Aging SP - e3 VL - 1 IS - 1 KW - knowledge translation KW - Consumer Health Information KW - consumer health standards KW - internet standards KW - Patient Education as Topic KW - Patient Education as standards KW - critical appraisal KW - online health information KW - reliability analysis N2 - Background: The internet is commonly used by older adults to obtain health information and this trend has markedly increased in the past decade. However, studies illustrate that much of the available online health information is not informed by good quality evidence, developed in a transparent way, or easy to use. Furthermore, studies highlight that the general public lacks the skills necessary to distinguish between online products that are credible and trustworthy and those that are not. A number of tools have been developed to assess the evidence, transparency, and usability of online health information; however, many have not been assessed for reliability or ease of use. Objective: The first objective of this study was to determine if a tool assessing the evidence, transparency, and usability of online health information exists that is easy and quick to use and has good reliability. No such tool was identified, so the second objective was to develop such a tool and assess it for reliability when used to assess online health information on topics of relevant to optimal aging. Methods: An electronic database search was conducted between 2002 and 2012 to identify published papers describing tools that assessed the evidence, transparency, and usability of online health information. Papers were retained if the tool described was assessed for reliability, assessed the quality of evidence used to create online health information, and was quick and easy to use. When no one tool met expectations, a new instrument was developed and tested for reliability. Reliability between two raters was assessed using the intraclass correlation coefficient (ICC) for each item at two time points. SPSS Statistics 22 software was used for statistical analyses and a one-way random effects model was used to report the results. The overall ICC was assessed for the instrument as a whole in July 2015. The threshold for retaining items was ICC>0.60 (ie, ?good? reliability). Results: All tools identified that evaluated online health information were either too complex, took a long time to complete, had poor reliability, or had not undergone reliability assessment. A new instrument was developed and assessed for reliability in April 2014. Three items had an ICC<0.60 (ie, ?good? reliability). One of these items was removed (?minimal scrolling?) and two were retained but reworded for clarity. Four new items were added that assessed the level of research evidence that informed the online health information and the tool was retested in July 2015. The total ICC score showed excellent agreement with both single measures (ICC=0.988; CI 0.982?0.992) and average measures (ICC=0.994; CI 0.991?0.996). Conclusions: The results of this study suggest that this new tool is reliable for assessing the evidence, transparency, and usability of online health information that is relevant to optimal aging. UR - http://aging.jmir.org/2018/1/e3/ UR - http://dx.doi.org/10.2196/aging.9216 UR - http://www.ncbi.nlm.nih.gov/pubmed/31518240 ID - info:doi/10.2196/aging.9216 ER -