TY - JOUR AU - Bouwman, Tamara AU - van Tilburg, Theo AU - Aartsen, Marja PY - 2019/07/24 TI - Attrition in an Online Loneliness Intervention for Adults Aged 50 Years and Older: Survival Analysis JO - JMIR Aging SP - e13638 VL - 2 IS - 2 KW - online intervention KW - loneliness KW - attrition KW - coping KW - engagement KW - older adults N2 - Background: Online interventions can be as effective as in-person interventions. However, attrition in online intervention is high and potentially biases the results. More importantly, high attrition rates might reduce the effectiveness of online interventions. Therefore, it is important to discover the extent to which factors affect adherence to online interventions. The setting for this study is the online Friendship Enrichment Program, a loneliness intervention for adults aged 50 years and older. Objective: This study examined the contribution of severity of loneliness, coping preference, activating content, and engagement in attrition within an online intervention. Methods: Data were collected from 352 participants in an online loneliness intervention for Dutch people aged 50 years and older. Attrition was defined as not completing all 10 intervention lessons. The number of completed lessons was assessed through the management system of the intervention. We tested 4 hypotheses on attrition by applying survival analysis (Cox regression). Results: Of the 352 participants who subscribed to the intervention, 46 never started the introduction. The remaining 306 participants were divided into 2 categories: 73 participants who did not start the lessons of the intervention and 233 who started the lessons of the intervention. Results of the survival analysis (n=233) showed that active coping preference (hazard ratio [HR]=0.73), activating content (HR=0.71), and 2 indicators of engagement (HR=0.94 and HR=0.79) lowered attrition. Severity of loneliness was not related to attrition. Conclusions: To reduce attrition, developers of online (loneliness) interventions may focus on stimulating active behavior within the intervention. UR - http://aging.jmir.org/2019/2/e13638/ UR - http://dx.doi.org/10.2196/13638 UR - http://www.ncbi.nlm.nih.gov/pubmed/31518268 ID - info:doi/10.2196/13638 ER - TY - JOUR AU - Litchman, L. Michelle AU - Edelman, S. Linda PY - 2019/9/26 TI - Perceptions of the Diabetes Online Community?s Credibility, Social Capital, and Help and Harm: Cross-Sectional Comparison Between Baby Boomers and Younger Adults JO - JMIR Aging SP - e10857 VL - 2 IS - 2 KW - diabetes mellitus KW - online social networking KW - social capital KW - trust KW - social media KW - older adult N2 - Background: The use of online health communities such as the diabetes online community (DOC) is growing. Individuals who engage in the DOC are able to interact with peers who have the same medical condition. It is not known if older adults are perceiving the DOC differently compared with younger adults. Objective: The purpose of this study was to explore and understand how the DOC is perceived in terms of social capital, source credibility, and help and harm. The findings from this study will shed light on how users of different age groups (baby boomers and younger adult counterparts) perceive DOC use. Methods: This study represents a subset of participants from a larger study of DOC users. Baby boomers and younger adults with diabetes were recruited from the DOC to participate in a cross-sectional survey. Demographics, electronic health use (reasons to join the DOC, DOC intensity, DOC engagement, internet social capital, and help or harm from the DOC), source credibility, health-related quality of life, and diabetes self-care data were collected. We examined the differences between baby boomer and younger adult responses. Results: The participants included baby boomers (N=76) and younger adult counterparts (N=102). Participants scored their diabetes health care team (mean 33.5 [SD 8]) significantly higher than the DOC (mean 32 [SD 6.4]) with regard to competence (P<.05) and trustworthiness (diabetes health care team mean 36.3 [SD 7.1]; DOC mean 33.6 [SD 6.2]; P<.001). High bonding and bridging social capital correlated with high DOC intensity (r=.629; P<.001 and r=.676; P<.001, respectively) and high DOC engagement (r=.474; P<.01 and r=.507; P?.01, respectively). The greater majority (69.8%) reported the DOC as being helpful, and 1.8% reported that the DOC had caused minor harm. Baby boomers perceived DOC credibility, social capital, help, and harm similarly to their younger adult counterparts. Conclusions: Baby boomers are using and perceiving the DOC similarly to younger adults. DOC users find the DOC to be credible; however, they scored their health care team higher with regard to competence and trustworthiness. The DOC is beneficial with low risk and may augment current diabetes care. UR - https://aging.jmir.org/2019/2/e10857/ UR - http://dx.doi.org/10.2196/10857 UR - http://www.ncbi.nlm.nih.gov/pubmed/31573907 ID - info:doi/10.2196/10857 ER - TY - JOUR AU - Sapci, Hasan A. AU - Sapci, Aylin H. PY - 2019/11/29 TI - Innovative Assisted Living Tools, Remote Monitoring Technologies, Artificial Intelligence-Driven Solutions, and Robotic Systems for Aging Societies: Systematic Review JO - JMIR Aging SP - e15429 VL - 2 IS - 2 KW - innovative assisted living tools for aging society KW - artificially intelligent home monitoring KW - older adults KW - robotic technologies KW - smart home N2 - Background: The increase in life expectancy and recent advancements in technology and medical science have changed the way we deliver health services to the aging societies. Evidence suggests that home telemonitoring can significantly decrease the number of readmissions, and continuous monitoring of older adults? daily activities and health-related issues might prevent medical emergencies. Objective: The primary objective of this review was to identify advances in assistive technology devices for seniors and aging-in-place technology and to determine the level of evidence for research on remote patient monitoring, smart homes, telecare, and artificially intelligent monitoring systems. Methods: A literature review was conducted using Cumulative Index to Nursing and Allied Health Literature Plus, MEDLINE, EMBASE, Institute of Electrical and Electronics Engineers Xplore, ProQuest Central, Scopus, and Science Direct. Publications related to older people?s care, independent living, and novel assistive technologies were included in the study. Results: A total of 91 publications met the inclusion criteria. In total, four themes emerged from the data: technology acceptance and readiness, novel patient monitoring and smart home technologies, intelligent algorithm and software engineering, and robotics technologies. The results revealed that most studies had poor reference standards without an explicit critical appraisal. Conclusions: The use of ubiquitous in-home monitoring and smart technologies for aged people?s care will increase their independence and the health care services available to them as well as improve frail elderly people?s health care outcomes. This review identified four different themes that require different conceptual approaches to solution development. Although the engineering teams were focused on prototype and algorithm development, the medical science teams were concentrated on outcome research. We also identified the need to develop custom technology solutions for different aging societies. The convergence of medicine and informatics could lead to the development of new interdisciplinary research models and new assistive products for the care of older adults. UR - http://aging.jmir.org/2019/2/e15429/ UR - http://dx.doi.org/10.2196/15429 UR - http://www.ncbi.nlm.nih.gov/pubmed/31782740 ID - info:doi/10.2196/15429 ER - TY - JOUR AU - Martin-Hammond, Aqueasha AU - Vemireddy, Sravani AU - Rao, Kartik PY - 2019/12/11 TI - Exploring Older Adults? Beliefs About the Use of Intelligent Assistants for Consumer Health Information Management: A Participatory Design Study JO - JMIR Aging SP - e15381 VL - 2 IS - 2 KW - intelligent assistants KW - artificial intelligence KW - chatbots KW - conversational agents KW - digital health KW - elderly KW - aging in place KW - participatory design KW - co-design KW - health information seeking N2 - Background: Intelligent assistants (IAs), also known as intelligent agents, use artificial intelligence to help users achieve a goal or complete a task. IAs represent a potential solution for providing older adults with individualized assistance at home, for example, to reduce social isolation, serve as memory aids, or help with disease management. However, to design IAs for health that are beneficial and accepted by older adults, it is important to understand their beliefs about IAs, how they would like to interact with IAs for consumer health, and how they desire to integrate IAs into their homes. Objective: We explore older adults? mental models and beliefs about IAs, the tasks they want IAs to support, and how they would like to interact with IAs for consumer health. For the purpose of this study, we focus on IAs in the context of consumer health information management and search. Methods: We present findings from an exploratory, qualitative study that investigated older adults? perspectives of IAs that aid with consumer health information search and management tasks. Eighteen older adults participated in a multiphase, participatory design workshop in which we engaged them in discussion, brainstorming, and design activities that helped us identify their current challenges managing and finding health information at home. We also explored their beliefs and ideas for an IA to assist them with consumer health tasks. We used participatory design activities to identify areas in which they felt IAs might be useful, but also to uncover the reasoning behind the ideas they presented. Discussions were audio-recorded and later transcribed. We compiled design artifacts collected during the study to supplement researcher transcripts and notes. Thematic analysis was used to analyze data. Results: We found that participants saw IAs as potentially useful for providing recommendations, facilitating collaboration between themselves and other caregivers, and for alerts of serious illness. However, they also desired familiar and natural interactions with IAs (eg, using voice) that could, if need be, provide fluid and unconstrained interactions, reason about their symptoms, and provide information or advice. Other participants discussed the need for flexible IAs that could be used by those with low technical resources or skills. Conclusions: From our findings, we present a discussion of three key components of participants? mental models, including the people, behaviors, and interactions they described that were important for IAs for consumer health information management and seeking. We then discuss the role of access, transparency, caregivers, and autonomy in design for addressing participants? concerns about privacy and trust as well as its role in assisting others that may interact with an IA on the older adults? behalf. International Registered Report Identifier (IRRID): RR2-10.1145/3240925.3240972 UR - http://aging.jmir.org/2019/2/e15381/ UR - http://dx.doi.org/10.2196/15381 UR - http://www.ncbi.nlm.nih.gov/pubmed/31825322 ID - info:doi/10.2196/15381 ER - TY - JOUR AU - Turk, Amadea AU - Fairclough, Emma AU - Grason Smith, Gillian AU - Lond, Benjamin AU - Nanton, Veronica AU - Dale, Jeremy PY - 2019/8/20 TI - Exploring the Perceived Usefulness and Ease of Use of a Personalized Web-Based Resource (Care Companion) to Support Informal Caring: Qualitative Descriptive Study JO - JMIR Aging SP - e13875 VL - 2 IS - 2 KW - caregivers KW - information technology KW - internet N2 - Background: Informal carers play an increasingly vital role in supporting the older population and the sustainability of health care systems. Care Companion is a theory-based and coproduced Web-based intervention to help support informal carers? resilience. It aims to provide personalized access to information and resources that are responsive to individuals? caring needs and responsibilities and thereby reduce the burdens associated with caregiving roles. Following the development of a prototype, it was necessary to undertake user acceptability testing to assess its suitability for wider implementation. Objective: This study aimed to undertake user acceptance testing to investigate the perceived usefulness and ease of use of Care Companion. The key objectives were to (1) explore how potential and actual users perceived its usefulness, (2) explore the barriers and facilitators to its uptake and use and (3) gather suggestions to inform plans for an area-wide implementation. Methods: We conducted user acceptance testing underpinned by principles of rapid appraisal using a qualitative descriptive approach. Focus groups, observations, and semistructured interviews were used in two phases of data collection. Participants were adult carers who were recruited through local support groups. Within the first phase, think-aloud interviews and observations were undertaken while the carers familiarized themselves with and navigated through the platform. In the second phase, focus group discussions were undertaken. Interested participants were then invited to trial Care Companion for up to 4 weeks and were followed up through semistructured telephone interviews exploring their experiences of using the platform. Thematic analysis was applied to the data, and a coding framework was developed iteratively with each phase of the study, informing subsequent phases of data collection and analysis. Results: Overall, Care Companion was perceived to be a useful tool to support caregiving activities. The key themes were related to its appearance and ease of use, the profile setup and log-in process, concerns related to the safety and confidentiality of personal information, potential barriers to use and uptake and suggestions for overcoming them, and suggestions for improving Care Companion. More specifically, these related to the need for personalized resources aimed specifically at the carers (instead of care recipients), the benefits of incorporating a Web-based journal, the importance of providing transparency about security and data usage, minimizing barriers to initial registration, offering demonstrations to support uptake by people with low technological literacy, and the need to develop a culturally sensitive approach. Conclusions: The findings identified ways of improving the ease of use and usefulness of Care Companion and demonstrated the importance of undertaking detailed user acceptance testing when developing an intervention for a diverse population, such as informal carers of older people. These findings have informed the further refinement of Care Companion and the strategy for its full implementation. UR - https://aging.jmir.org/2019/2/e13875 UR - http://dx.doi.org/10.2196/13875 UR - http://www.ncbi.nlm.nih.gov/pubmed/31518272 ID - info:doi/10.2196/13875 ER - TY - JOUR AU - Giroux, Dominique AU - Tremblay, Mélanie AU - Latulippe, Karine AU - Provencher, Véronique AU - Poulin, Valérie AU - Giguere, Anik AU - Dubé, Véronique AU - Sévigny, Andrée AU - Guay, Manon AU - Ethier, Sophie AU - Carignan, Maude PY - 2019/08/22 TI - Promoting Identification and Use of Aid Resources by Caregivers of Seniors: Co-Design of an Electronic Health Tool JO - JMIR Aging SP - e12314 VL - 2 IS - 2 KW - caregivers KW - aged KW - help-seeking behavior KW - community-based participatory research KW - eHealth KW - telemedicine N2 - Background: The importance of supporting caregivers is recognized in home care for older persons, and facilitating their help-seeking process is a way to meet that need. The use of electronic health (eHealth) is a potentially promising solution to facilitate caregivers? help-seeking process. Objective: The aim of this research was to develop, in partnership with community organizations, health and social service professionals and caregivers, an eHealth tool promoting the earlier identification of needs of older persons and an optimal use of available resources. Methods: To design the tool, 8 co-design sessions (CoDs) were conducted and 3 advisory committees were created (in 11 regions) in Quebec between May 2017 and May 2018. A variety of methods were used, including the sorting method, the use of personas, eHealth tool analysis, brainstorming, sketching, prototyping, and pretesting. Results: A total of 74 co-designers (women n=64 and men n=10) were recruited to participate in the CoDs or the advisory committees. This number allowed for the identification of needs to which the tool must respond and for the identification of its requirements (functionalities and content), as well as for the development of the information architecture. Throughout the study, adjustments were made to the planning of CoD, notably because certain steps required more sessions than expected. Among others, this was true for the identification of functionalities. Conclusions: This study led to the development of an eHealth tool for caregivers of functionally dependent older persons to help them identify their needs and the resources available to meet them. International Registered Report Identifier (IRRID): RR2-10.2196/11634 UR - https://aging.jmir.org/2019/2/e12314/ UR - http://dx.doi.org/10.2196/12314 UR - http://www.ncbi.nlm.nih.gov/pubmed/31518284 ID - info:doi/10.2196/12314 ER - TY - JOUR AU - López Seguí, Francesc AU - de San Pedro, Marc AU - Aumatell Verges, Eva AU - Simó Algado, Salvador AU - Garcia Cuyàs, Francesc PY - 2019/08/09 TI - An Intergenerational Information and Communications Technology Learning Project to Improve Digital Skills: User Satisfaction Evaluation JO - JMIR Aging SP - e13939 VL - 2 IS - 2 KW - active aging KW - digital inclusion KW - ICT program KW - intergenerational relationships KW - civic participation KW - community service N2 - Background: ?Digital Partners? is an intergenerational information and communications technology learning project carried out in the municipalities of Vic and Centelles (Catalonia) from April to May 2018. Within the framework of the introduction of community service as a subject in secondary education, the Centre for Health and Social Studies (University of Vic) created a training space with 38 intergenerational partners (aged 14-15 years and >65 years), with the aim of improving the senior users? digital skills in terms of use of smartphones and tablets, thus helping reduce the digital divide in the territory. Objective: The aim of this paper is to evaluate the satisfaction of both junior and senior participants toward the intervention and to explore its main drivers. Methods: Participants who volunteered to participate in the study were interviewed. Quantitative and qualitative data gathered in paper-based ad hoc surveys were used to assess participants? satisfaction. Results: The experience shows a broad satisfaction of both junior and senior users. The project?s strengths include the format of working in couples; randomly pairing individuals by operating system; the ability to practice with the device itself; individuals? free choice to decide what they wish to learn, develop, or practice; and the availability of voluntary practice material that facilitates communication and learning. With regard to aspects that could be improved, there is a need to review the timetabling flexibility of meetings to avoid hurrying the elderly and to extend the project?s duration, if necessary. Conclusions: This activity can serve to create mutual learning through the use of mobile devices and generate security and motivation on the part of the seniors, thus reducing the digital divide and improving social inclusion. UR - http://aging.jmir.org/2019/2/e13939/ UR - http://dx.doi.org/10.2196/13939 UR - http://www.ncbi.nlm.nih.gov/pubmed/31518276 ID - info:doi/10.2196/13939 ER - TY - JOUR AU - Odlum, Michelle AU - Yoon, Sunmoo PY - 2019/09/11 TI - Understanding Comorbidities and Their Contribution to Predictors of Medical Resource Utilization for an Age- and Sex-Matched Patient Population Living With HIV: Cross-Sectional Study JO - JMIR Aging SP - e13865 VL - 2 IS - 2 KW - HIV KW - sex differences KW - Charlson scores KW - comorbidity KW - electronic health records KW - health resource N2 - Background: More than 60% of people aging with HIV are observed to have multiple comorbidities, which are attributed to a variety of factors (eg, biological and environmental), with sex differences observed. However, understanding these differences and their contribution to medical resource utilization remains challenging as studies conducted exclusively and predominantly among males do not translate well to females, resulting in inconsistent findings across study cohorts and limiting our knowledge of sex-specific comorbidities. Objective: The objective of the study was to provide further insight into aging-related comorbidities, their associated sex-based differences, and their contribution to medical resource utilization, through the analysis of HIV patient data matched by sex. Methods: International Classification of Disease 9/10 diagnostic codes that comprise the electronic health records of males (N=229) and females (N=229) were categorized by individual characteristics, chronic and mental health conditions, treatment, high-risk behaviors, and infections and the codes were used as predictors of medical resource utilization represented by Charlson comorbidity scores. Results: Significant contributors to high Charlson scores in males were age (beta=2.37; 95% CI 1.45-3.29), longer hospital stay (beta=.046; 95% CI 0.009-0.083), malnutrition (beta=2.96; 95% CI 1.72-4.20), kidney failure (beta=2.23; 95% CI 0.934-3.52), chemotherapy (beta=3.58; 95% CI 2.16-5.002), history of tobacco use (beta=1.40; 95% CI 0.200-2.61), and hepatitis C (beta=1.49; 95% CI 0.181-2.79). Significant contributors to high Charlson scores in females were age (beta=1.37; 95% CI 0.361-2.38), longer hospital stay (beta=.042; 95% CI 0.005-0.078), heart failure (beta=2.41; 95% CI 0.833-3.98), chemotherapy (beta=3.48; 95% CI 1.626-5.33), and substance abuse beta=1.94; 95% CI 0.180, 3.702). Conclusions: Our findings identified sex-based differences in medical resource utilization. These include kidney failure for men and heart failure for women. Increased prevalence of comorbidities in people living long with HIV has the potential to overburden global health systems. The development of narrower HIV phenotypes and aging-related comorbidity phenotypes with greater clinical validity will support intervention efficacy. UR - http://aging.jmir.org/2019/2/e13865/ UR - http://dx.doi.org/10.2196/13865 UR - http://www.ncbi.nlm.nih.gov/pubmed/31516123 ID - info:doi/10.2196/13865 ER - TY - JOUR AU - Lewis, H. Zakkoyya AU - Swartz, C. Maria AU - Martinez, Eloisa AU - Lyons, J. Elizabeth PY - 2019/08/23 TI - Social Support Patterns of Middle-Aged and Older Adults Within a Physical Activity App: Secondary Mixed Method Analysis JO - JMIR Aging SP - e12496 VL - 2 IS - 2 KW - social support KW - aged KW - middle aged KW - physical activity KW - technology KW - fitness tracker N2 - Background: Physical activity (PA) is critical for maintaining independence and delaying mobility disability in aging adults. However, 27 to 44% of older adults in the United States are meeting the recommended PA level. Activity trackers are proving to be a promising tool to promote PA adherence through activity tracking and enhanced social interaction features. Although social support has been known to be an influential behavior change technique to promote PA, how middle-aged and older adults use the social interaction feature of mobile apps to provide virtual support to promote PA engagement remains mostly underexplored. Objective: This study aimed to describe the social support patterns of middle-aged and older adults using a mobile app as part of a behavioral PA intervention. Methods: Data from 35 participants (mean age 61.66 [SD 6] years) in a 12-week, home-based activity intervention were used for this secondary mixed method analysis. Participants were provided with a Jawbone Up24 activity monitor and an Apple iPad Mini installed with the UP app to facilitate self-monitoring and social interaction. All participants were given an anonymous account and encouraged to interact with other participants using the app. Social support features included comments and likes. Thematic coding was used to identify the type of social support provided within the UP app and characterize the levels of engagement from users. Participants were categorized as superusers or contributors, and passive participants were categorized as lurkers based on the literature. Results: Over the 12-week intervention, participants provided a total of 3153 likes and 1759 comments. Most participants (n=25) were contributors, with 4 categorized as superusers and 6 categorized as lurkers. Comments were coded as emotional support, informational support, instrumental support, self-talk, and other, with emotional support being the most prevalent type. Conclusions: Our cohort of middle-aged and older adults was willing to use the social network feature in an activity app to communicate with anonymous peers. Most of our participants were contributors. In addition, the social support provided through the activity app followed social support constructs. In sum, PA apps are a promising tool for delivering virtual social support to enhance PA engagement and have the potential to make a widespread impact on PA promotion. Trial Registration: ClinicalTrials.gov NCT01869348; https://clinicaltrials.gov/ct2/show/NCT01869348 UR - http://aging.jmir.org/2019/2/e12496/ UR - http://dx.doi.org/10.2196/12496 UR - http://www.ncbi.nlm.nih.gov/pubmed/31518281 ID - info:doi/10.2196/12496 ER -