TY - JOUR AU - Lippke, Sonia AU - Ratz, Tiara AU - Keller, Maria Franziska AU - Juljugin, Dennis AU - Peters, Manuela AU - Pischke, Claudia AU - Voelcker-Rehage, Claudia PY - 2022/8/9 TI - Mitigating Feelings of Loneliness and Depression by Means of Web-Based or Print-Based Physical Activity Interventions: Pooled Analysis of 2 Community-Based Intervention Trials JO - JMIR Aging SP - e36515 VL - 5 IS - 3 KW - physical activity KW - older adults KW - intervention KW - loneliness KW - depression KW - eHealth KW - mobile health KW - mHealth N2 - Background: Physical activity (PA) is associated with benefits, such as fewer depressive symptoms and loneliness. Web- and print-based PA interventions can help older individuals accordingly. Objective: We aimed to test the following research questions: Do PA interventions delivered in a web- or print-based mode improve self-reported PA stage of change, social-cognitive determinants of PA, loneliness, and symptoms of depression? Is subjective age a mediator and stage of change a moderator of this effect? Methods: Overall, 831 adults aged ?60 years were recruited and either allocated to a print-based or web-based intervention group or assigned to a wait-list control group (WLCG) in 2 community-based PA intervention trials over 10 weeks. Missing value imputation using an expectation-maximization algorithm was applied. Frequency analyses, multivariate analyses of variance, and moderated mediation analyses were conducted. Results: The web-based intervention outperformed (47/59, 80% of initially inactive individuals being adopters, and 396/411, 96.4% of initially active individuals being maintainers of the recommended PA behavior) the print-based intervention (20/25, 80% of adopters, and 63/69, 91% of maintainers) and the WLCG (5/7, 71% of adopters; 141/150, 94% of maintainers). The pattern regarding adopters was statistically significant (web vs print Z=?1.94; P=.02; WLCG vs web Z=3.8367; P=.01). The pattern was replicated with stages (?24=79.1; P<.001; contingency coefficient 0.314; P<.001); in the WLCG, 40.1% (63/157) of the study participants moved to or remained in action stage. This number was higher in the groups receiving web-based (357/470, 76%) or print-based interventions (64/94, 68.1%). A significant difference was observed favoring the 2 intervention groups over and above the WLCG (F19, 701=4.778; P<.001; ?2=0.098) and a significant interaction of time and group (F19, 701=2.778; P<.001; ?2=0.070) for predictors of behavior. The effects of the interventions on subjective age, loneliness, and depression revealed that both between-group effects (F3, 717=8.668; P<.001; ?2=0.018) and the interaction between group and time were significant (F3, 717=6.101; P<.001; ?2=0.025). In a moderated mediation model, both interventions had a significant direct effect on depression in comparison with the WLCG (web-based: c? path ?0.86, 95% CI ?1.58 to ?0.13, SE 0.38; print-based: c? path ?1.96, 95% CI ?2.99 to ?0.92, SE 0.53). Furthermore, subjective age was positively related to depression (b path 0.14, 95% CI 0.05-0.23; SE 0.05). An indirect effect of the intervention on depression via subjective age was only present for participants who were in actor stage and received the web-based intervention (ab path ?0.14, 95% CI ?0.34 to ?0.01; SE 0.09). Conclusions: Web-based interventions appear to be as effective as print-based interventions. Both modes might help older individuals remain or become active and experience fewer depression symptoms, especially if they feel younger. Trial Registration: German Registry of Clinical Trials DRKS00010052 (PROMOTE 1); https://tinyurl.com/nnzarpsu and DRKS00016073 (PROMOTE 2); https://tinyurl.com/4fhcvkwy International Registered Report Identifier (IRRID): RR2-10.2196/15168 UR - https://aging.jmir.org/2022/3/e36515 UR - http://dx.doi.org/10.2196/36515 UR - http://www.ncbi.nlm.nih.gov/pubmed/35943790 ID - info:doi/10.2196/36515 ER - TY - JOUR AU - Choudhury, Renoa AU - Park, Joon-Hyuk AU - Thiamwong, Ladda AU - Xie, Rui AU - Stout, R. Jeffrey PY - 2022/8/22 TI - Objectively Measured Physical Activity Levels and Associated Factors in Older US Women During the COVID-19 Pandemic: Cross-sectional Study JO - JMIR Aging SP - e38172 VL - 5 IS - 3 KW - physical activity KW - older women KW - COVID-19 KW - sedentary behavior KW - wrist-worn accelerometers KW - ActiGraph KW - aging KW - elderly population KW - women's health KW - digital health KW - frail KW - healthy lifestyle N2 - Background: Physical activity (PA) is vital for attenuating the aging-related physiological and functional declines in women aged 60 years or above. However, little is known about the objectively assessed PA behavior in older women during the COVID-19 pandemic and its association with sociodemographics, health and physical function, and COVID-19 related factors. Objective: This study aims to examine the objectively measured PA levels and associated factors among older US women who were living under the physical distancing guidelines during the second year of the pandemic. Methods: In this cross-sectional study, we collected free-living PA data from 94 community-dwelling older women aged between 60 and 96 years (mean age 75.1 years, SD 7.3) using wrist-worn ActiGraph GT9X accelerometers between February and August 2021. We examined whether their daily duration spent in sedentary behavior (SB), light-intensity physical activity (LPA), and moderate-to-vigorous-intensity physical activity (MVPA) varied by sociodemographic characteristics, health and physical function, and COVID-19 related factors. Results: On average, participants accumulated 12.4 (SD 1.9) hours/day in SB, 218.6 (SD 64.3) minutes/day in LPA, and 42.4 (SD 31.0) minutes/day in MVPA, exhibiting overall reduced PA levels than previously published pre?COVID-19 norms of older US women. Among participants aged ?80 years, sedentary time was 7.5% (P=.003) higher and the time spent in LPA and MVPA was, respectively, 13.3% (P=.03) and 44.9% (P<.001) lower than those aged 60-79 years. More MVPA participation and a less sedentary lifestyle were observed in those who had a higher self-rated health score (MVPA: P=.001, SB: P=.04) and lower fear of falling (FOF; MVPA: P=.003, SB: P=.04). Poorer performance in the 30-second sit-to-stand (STS) test was independently associated with more SB (P=.01) and less LPA (P=.04) and MVPA (P=.001) time among participants. In addition, sedentary time was 5.0% higher (P=.03) in frail and prefrail participants than their healthy counterparts. Conclusions: During the pandemic, older women spent the majority of their waking time being sedentary, while LPA accounted for a larger portion of their daily PA. Therefore, replacing SB with LPA (rather than MVPA) might provide a more feasible PA target for older women, particularly those aged ?80 years or who have reduced physical function. In addition, targeted interventions might be beneficial in promoting an active lifestyle for those who live alone, are prefrail or frail, and have a high FOF in older age. International Registered Report Identifier (IRRID): RR2-10.2196/27381 UR - https://aging.jmir.org/2022/3/e38172 UR - http://dx.doi.org/10.2196/38172 UR - http://www.ncbi.nlm.nih.gov/pubmed/35994346 ID - info:doi/10.2196/38172 ER - TY - JOUR AU - Bradwell, Hannah AU - Edwards, J. Katie AU - Winnington, Rhona AU - Thill, Serge AU - Allgar, Victoria AU - Jones, B. Ray PY - 2022/8/24 TI - Implementing Affordable Socially Assistive Pet Robots in Care Homes Before and During the COVID-19 Pandemic: Stratified Cluster Randomized Controlled Trial and Mixed Methods Study JO - JMIR Aging SP - e38864 VL - 5 IS - 3 KW - social robots KW - companion robots KW - well-being KW - older adults KW - dementia KW - robot pets KW - COVID-19 N2 - Background: Robot pets may assist in the challenges of supporting an aging population with growing dementia prevalence. Prior work has focused on the impacts of the robot seal Paro on older adult well-being, but recent studies have suggested the good acceptability and implementation feasibility of more affordable devices (Joy for All [JfA] cats and dogs). Objective: We aimed to address the limited effectiveness research on JfA devices. Methods: We conducted an 8-month, stratified, cluster randomized controlled trial in 8 care homes in Cornwall, United Kingdom. Over 4 months, 4 care homes each received 2 JfA devices (1 cat and 1 dog; intervention group), and 4 homes received care as usual (control group). Psychometrics were collected before and after the intervention to compare the change from baseline to follow-up between the groups. In the final 4 months, all 8 care homes received devices, but only qualitative data were collected owing to COVID-19 and reduced capacity. The primary outcome was neuropsychiatric symptoms (Neuropsychiatric Inventory [NPI] Nursing Home version). Care provider burden was a secondary outcome (occupational disruptiveness NPI subscale), alongside the Challenging Behavior scale, the Holden communication scale, the Campaign to End Loneliness questionnaire, and medication use. Qualitative data were collected through care staff observation calendars and end-of-study interviews to understand use, experience, and impact. We also collected demographic data and assessed dementia severity. In total, 253 residents had robot interaction opportunities, and 83 were consented for direct data collection. Results: There was a significant difference in the total change from baseline to follow-up between the intervention and control groups for NPI (P<.001) and occupational disruptiveness (P=.03). Neuropsychiatric symptoms increased in the control group and decreased in the intervention group. No significant difference was seen for communication issues or challenging behavior. For NPI subdomains, there were significant differences from baseline to follow-up in delusions (P=.03), depression (P=.01), anxiety (P=.001), elation (P=.02), and apathy (P=.009), all of which decreased in the intervention group and increased slightly in the control group. The summative impact results suggested that most residents (46/54, 85%) who interacted with robots experienced a positive impact. Those who interacted had significantly higher dementia severity scores (P=.001). The qualitative results suggested good adoption, acceptability, and suitability for subjectively lonely individuals and lack of a novelty effect through sustained use, and demonstrated that the reasons for use were entertainment, anxiety, and agitation. Conclusions: Affordable robot pets hold potential for improving the well-being of care home residents and people with dementia, including reducing neuropsychiatric symptoms and occupational disruptiveness. This work suggests no novelty effect and contributes toward understanding robot pet suitability. Moreover, interactions were more common among residents with more moderate/severe dementia and those subjectively lonely. Trial Registration: ClinicalTrials.gov NCT04168463; https://www.clinicaltrials.gov/ct2/show/NCT04168463 UR - https://aging.jmir.org/2022/3/e38864 UR - http://dx.doi.org/10.2196/38864 UR - http://www.ncbi.nlm.nih.gov/pubmed/35830959 ID - info:doi/10.2196/38864 ER - TY - JOUR AU - Latulippe, Karine AU - Giroux, Dominique AU - Guay, Manon AU - Kairy, Dahlia AU - Vincent, Claude AU - Boivin, Katia AU - Morales, Ernesto AU - Obradovic, Natasa AU - Provencher, Véronique PY - 2022/7/5 TI - Mobile Videoconferencing for Occupational Therapists? Assessments of Patients? Home Environments Prior to Hospital Discharge: Mixed Methods Feasibility and Comparative Study JO - JMIR Aging SP - e24376 VL - 5 IS - 3 KW - caregivers KW - feasibility KW - mixed methods KW - mobile videoconferencing KW - mobile phone KW - occupational therapy KW - discharge planning KW - home assessment N2 - Background: Occupational therapists who work in hospitals need to assess patients? home environment in preparation for hospital discharge in order to provide recommendations (eg, technical aids) to support their independence and safety. Home visits increase performance in everyday activities and decrease the risk of falls; however, in some countries, home visits are rarely made prior to hospital discharge due to the cost and time involved. In most cases, occupational therapists rely on an interview with the patient or a caregiver to assess the home. The use of videoconferencing to assess patients? home environments could be an innovative solution to allow better and more appropriate recommendations. Objective: The aim of this study was (1) to explore the added value of using mobile videoconferencing compared with standard procedure only and (2) to document the clinical feasibility of using mobile videoconferencing to assess patients? home environments. Methods: Occupational therapists assessed home environments using, first, the standard procedure (interview), and then, videoconferencing (with the help of a family caregiver located in patients? homes, using an electronic tablet). We used a concurrent mixed methods design. The occupational therapist's responsiveness to telehealth, time spent on assessment, patient?s occupational performance and satisfaction, and major events influencing the variables were collected as quantitative data. The perceptions of occupational therapists and family caregivers regarding the added value of using this method and the nature of changes made to recommendations as a result of the videoconference (if any) were collected as qualitative data, using questionnaires and semistructured interviews. Results: Eight triads (6 occupational therapists, 8 patients, and 8 caregivers) participated. The use of mobile videoconferencing generally led occupational therapists to modify the initial intervention plan (produced after the standard interview). Occupational therapists and caregivers perceived benefits in using mobile videoconferencing (eg, the ability to provide real-time comments or feedback), and they also perceived disadvantages (eg, videoconferencing requires additional time and greater availability of caregivers). Some occupational therapists believed that mobile videoconferencing added value to assessments, while others did not. Conclusions: The use of mobile videoconferencing in the context of hospital discharge planning has raised questions of clinical feasibility. Although mobile videoconferencing provides multiple benefits to hospital discharge, including more appropriate occupational therapist recommendations, time constraints made it more difficult to perceive the added value. However, with smartphone use, interdisciplinary team involvement, and patient participation in the videoconference visit, mobile videoconferencing can become an asset to hospital discharge planning. International Registered Report Identifier (IRRID): RR2-10.2196/11674 UR - https://aging.jmir.org/2022/3/e24376 UR - http://dx.doi.org/10.2196/24376 UR - http://www.ncbi.nlm.nih.gov/pubmed/35787486 ID - info:doi/10.2196/24376 ER - TY - JOUR AU - Hechinger, Mareike AU - Hentschel, Diana AU - Aumer, Christine AU - Rester, Christian PY - 2022/9/9 TI - A Conceptual Model of Experiences With Digital Technologies in Aging in Place: Qualitative Systematic Review and Meta-synthesis JO - JMIR Aging SP - e34872 VL - 5 IS - 3 KW - older adults KW - old age KW - assistive device KW - aging in place KW - home modification KW - independent living KW - telemedicine KW - assistive technology KW - ambient assisted living KW - assisted living KW - community living KW - chronic disease KW - chronic condition KW - chronic illness KW - elder KW - older adult KW - systematic review KW - meta-synthesis KW - digital technology KW - mobile phone N2 - Background: Older adults with chronic illnesses or dependency on care who strive to age in place need support and care depending on their illness. Digital technology has enabled the possibility of supporting older adults in their wishes to age in place. However, current studies have mainly focused on the solitary evaluation of individual technologies or on evaluating technologies for specific illnesses. Objective: This study aimed to synthesize research on the experiences of older people from the Western culture with chronic illnesses or care needs and their families with digital technology for aging in place. From the meta-synthesis, a model was derived that can be useful for the development of assistive devices in old age and that can support health care providers and professionals in their work with affected individuals. Methods: A systematic review and qualitative meta-synthesis was performed using an inductive approach, as proposed by Sandelowski and Barroso. We performed a systematic literature search in 6 databases from 2000 to 2019, with an update in 2021 and, in addition, conducted a hand search in 2 databases, relevant journals, and reference lists. The results of each study were analyzed using initial and axial coding, followed by theoretical coding. A conceptual model was derived. Results: A total of 7776 articles were identified. Articles were screened independently by 2 authors based on the eligibility criteria. Finally, of the 7776 studies, 18 (0.23%) were included in the meta-synthesis. The derived conceptual model describes older adults with chronic illnesses or dependency on care and their family members in an individual process of reflection and decision-making, starting with the use of a digital device. Older adults live in times of change. They experience stable and unstable times of illness as they are part of a changing digital world. Hence, older adults and their families consider digital technology a solution to their current situation. As they become familiar with a specific digital technology, they refine their needs and demands, gain confidence in its use, and note its advantages and disadvantages. They weigh hopes, needs, demands, and experiences in a process of reflection to decide on convenience and inconvenience. Independent of their decision, they achieve peace of mind either with or without digital technology. This process can restart repeatedly during the illness trajectory of older adults. Conclusions: This study promotes a differentiated understanding of older adults? experiences with digital technology. The conceptual model can be useful for the development of assistive technology in old age. Moreover, it can guide health care professionals in their work with older adults and their families to provide individual counseling to find the appropriate digital technology for their respective situations. UR - https://aging.jmir.org/2022/3/e34872 UR - http://dx.doi.org/10.2196/34872 UR - http://www.ncbi.nlm.nih.gov/pubmed/36083625 ID - info:doi/10.2196/34872 ER - TY - JOUR AU - Berridge, Clara AU - Turner, R. Natalie AU - Liu, Liu AU - Karras, W. Sierramatice AU - Chen, Amy AU - Fredriksen-Goldsen, Karen AU - Demiris, George PY - 2022/7/27 TI - Advance Planning for Technology Use in Dementia Care: Development, Design, and Feasibility of a Novel Self-administered Decision-Making Tool JO - JMIR Aging SP - e39335 VL - 5 IS - 3 KW - Alzheimer disease KW - advance care planning KW - dyadic intervention KW - technology KW - remote monitoring KW - artificial intelligence KW - older adult KW - seniors KW - human-computer interaction KW - aging KW - elderly population KW - digital tool KW - educational tool KW - dementia care KW - ethics KW - informed consent N2 - Background: Monitoring technologies are used to collect a range of information, such as one?s location out of the home or movement within the home, and transmit that information to caregivers to support aging in place. Their surveilling nature, however, poses ethical dilemmas and can be experienced as intrusive to people living with Alzheimer disease (AD) and AD-related dementias. These challenges are compounded when older adults are not engaged in decision-making about how they are monitored. Dissemination of these technologies is outpacing our understanding of how to communicate their functions, risks, and benefits to families and older adults. To date, there are no tools to help families understand the functions of monitoring technologies or guide them in balancing their perceived need for ongoing surveillance and the older adult?s dignity and wishes. Objective: We designed, developed, and piloted a communication and education tool in the form of a web application called Let?s Talk Tech to support family decision-making about diverse technologies used in dementia home care. The knowledge base about how to design online interventions for people living with mild dementia is still in development, and dyadic interventions used in dementia care remain rare. We describe the intervention?s motivation and development process, and the feasibility of using this self-administered web application intervention in a pilot sample of people living with mild AD and their family care partners. Methods: We surveyed 29 mild AD dementia care dyads living together before and after they completed the web application intervention and interviewed each dyad about their experiences with it. We report postintervention measures of feasibility (recruitment, enrollment, and retention) and acceptability (satisfaction, quality, and usability). Descriptive statistics were calculated for survey items, and thematic analysis was used with interview transcripts to illuminate participants? experiences and recommendations to improve the intervention. Results: The study enrolled 33 people living with AD and their care partners, and 29 (88%) dyads completed the study (all but one were spousal dyads). Participants were asked to complete 4 technology modules, and all completed them. The majority of participants rated the tool as having the right length (>90%), having the right amount of information (>84%), being very clearly worded (>74%), and presenting information in a balanced way (>90%). Most felt the tool was easy to use and helpful, and would likely recommend it to others. Conclusions: This study demonstrated that our intervention to educate and facilitate conversation and documentation of preferences is preliminarily feasible and acceptable to mild AD care dyads. Effectively involving older adults in these decisions and informing care partners of their preferences could enable families to avoid conflicts or risks associated with uninformed or disempowered use and to personalize use so both members of the dyad can experience benefits. UR - https://aging.jmir.org/2022/3/e39335 UR - http://dx.doi.org/10.2196/39335 UR - http://www.ncbi.nlm.nih.gov/pubmed/35896014 ID - info:doi/10.2196/39335 ER - TY - JOUR AU - Boutilier, J. Justin AU - Loganathar, Priya AU - Linden, Anna AU - Scheer, Eleanore AU - Noejovich, Sofia AU - Elliott, Christian AU - Zuraw, Matthew AU - Werner, E. Nicole PY - 2022/8/4 TI - A Web-Based Platform (CareVirtue) to Support Caregivers of People Living With Alzheimer Disease and Related Dementias: Mixed Methods Feasibility Study JO - JMIR Aging SP - e36975 VL - 5 IS - 3 KW - Alzheimer disease and related dementias KW - mHealth KW - caregivers KW - dementia caregiving KW - eHealth KW - telehealth N2 - Background: People living with Alzheimer disease and related dementias (ADRD) require prolonged and complex care that is primarily managed by informal caregivers who face significant unmet needs regarding support for communicating and coordinating across their informal care network. To address this unmet need, we developed CareVirtue, which provides (1) the ability to invite care network members; (2) a care guide detailing the care plan; (3) a journal where care network members can document, communicate, and coordinate; (4) a shared calendar; and (5) vetted geolocated caregiver resources. Objective: This study aims to evaluate CareVirtue?s feasibility based on: (1) Who used CareVirtue? (2) How did caregivers use CareVirtue? (3) How did caregivers perceive the acceptability of CareVirtue? (4) What factors were associated with CareVirtue use? Methods: We conducted a feasibility study with 51 care networks over a period of 8 weeks and used a mixed methods approach that included both quantitative CareVirtue usage data and semistructured interviews. Results: Care networks ranged from 1 to 8 members. Primary caregivers were predominantly female (38/51, 75%), White (44/51, 86%), married (37/51, 73%), college educated (36/51, 71%), and were, on average, 60.3 (SD 9.8) years of age, with 18% (9/51) living in a rural area. CareVirtue usage varied along 2 axes (total usage and type of usage), with heterogeneity in how the most engaged care networks interacted with CareVirtue. Interviews identified a range of ways CareVirtue was useful, including practically, organizationally, and emotionally. On the Behavioral Intention Scale, 72% (26/36) of primary caregivers reported an average score of at least 3, indicating an above average intention to use. The average was 81.8 (SD 12.8) for the System Usability Scale score, indicating ?good? usability, and 3.4 (SD 1.0) for perceived usefulness, suggesting above average usefulness. The average confidence score increased significantly over the study duration from 7.8 in week 2 to 8.9 in week 7 (P=.005; r=0.91, 95% CI 0.84-0.95). The following sociodemographic characteristics were associated with posting in the journal: retired (mean 59.5 posts for retired caregivers and mean 16.9 for nonretired caregivers), income (mean 13 posts for those reporting >US $100K and mean 55.4 for those reporting 20%) were randomly recruited from each state using Nursing Home Compare data. Investigators used a validated HIT maturity survey with 9 subscales including HIT capabilities, extent of HIT use, and degree of HIT integration in resident care, clinical support, and administrative activities. Each subscale had a possible HIT maturity score of 0-100. Total HIT maturity, with a possible score of 0-900, was calculated using the 9 subscales (3 x 3 matrix). Total HIT maturity scores equate 1 of 7 HIT maturity stages (stages 0-6) for each facility. Dependent variables included HIT maturity scores. We included 5 independent variables (ie, ownership, chain status, location, number of beds, and occupancy rates). Unadjusted and adjusted cumulative odds ratios were calculated using regression models. Results: Our sample (n=719) had a larger proportion of smaller facilities and a smaller proportion of larger facilities than the national nursing home population. Integrated clinical support technology had the lowest HIT maturity score compared to resident care HIT capabilities. The majority (n=486, 60.7%) of NHs report stage 3 or lower with limited capabilities to communicate about care delivery outside their facility. Larger NHs in metropolitan areas had higher odds of HIT maturity. The number of certified beds and NH location were significantly associated with HIT maturity stage while ownership, chain status, and occupancy rate were not. Conclusions: NH structural disparities were recognized through differences in HIT maturity stage. Structural disparities in this sample appear most evident in HIT maturity, measuring integration of clinical support technologies for laboratory, pharmacy, and radiology services. Ongoing assessments of NH structural disparities is crucial given 1.35 million Americans receive care in these facilities annually. Leaders must be willing to promote equal opportunities across the spectrum of health care services to incentivize and enhance HIT adoption to balance structural disparities and improve resident outcomes. UR - https://aging.jmir.org/2022/3/e37482 UR - http://dx.doi.org/10.2196/37482 UR - http://www.ncbi.nlm.nih.gov/pubmed/35998030 ID - info:doi/10.2196/37482 ER - TY - JOUR AU - Boucher, Eliane AU - Honomichl, Ryan AU - Ward, Haley AU - Powell, Tyler AU - Stoeckl, Elizabeth Sarah AU - Parks, Acacia PY - 2022/9/2 TI - The Effects of a Digital Well-being Intervention on Older Adults: Retrospective Analysis of Real-world User Data JO - JMIR Aging SP - e39851 VL - 5 IS - 3 KW - mobile apps KW - mental health KW - older adults KW - technology adoption KW - digital health KW - mobile phone N2 - Background: Digital interventions have been shown to be effective for a variety of mental health disorders and problems. However, few studies have examined the effects of digital interventions in older adults; therefore, little is known about how older adults engage with or benefit from these interventions. Given that adoption rates for technology among people aged ?65 years remain substantially lower than in the general population and that approximately 20% of older adults are affected by mental health disorders, research exploring whether older adults will use and benefit from digital interventions is needed. Objective: This study aimed to examine the extent to which older adults engaged with a digital well-being intervention (Happify) and whether engaging with this program led to improvements in both subjective well-being and anxiety symptoms. Methods: In this retrospective analysis, we analyzed data from 375 real-world Happify users aged ?65 years who signed up for the platform between January 1, 2019, and December 23, 2021. Changes in well-being and anxiety symptoms across 42 to 182 days were assessed using responses to the in-app assessment, which users were prompted to take every 2 weeks, and were compared among users who engaged with the program at the recommended level (ie, 2 or more activities per week) or below the recommended level. Results: In all, 30% (113/375) of the sample engaged with the platform at the recommended level (ie, completed an average of 2 or more activities per week), and overall, users completed an average of 43.35 (SD 87.80) activities, ranging from 1 to 786, between their first and last assessment. Users were also active on the platform for an average of 19.36 (SD 27.16) days, ranging from 1 to 152 days. Moreover, older adults who engaged at the recommended level experienced significantly greater improvements in subjective well-being (P=.002) and anxiety symptoms (P<.001) relative to those who completed fewer activities. Conclusions: These data provide preliminary evidence that older adults engage with and benefit from digital well-being interventions. We believe that these findings highlight the importance of considering older adult populations in digital health research. More research is needed to understand potential barriers to using digital interventions among older adults and whether digital interventions should be modified to account for this population?s particular needs (eg, ensuring that the intervention is accessible using a variety of devices). However, these results are an important step in demonstrating the feasibility of such interventions in a population that is assumed to be less inclined toward digital approaches. UR - https://aging.jmir.org/2022/3/e39851 UR - http://dx.doi.org/10.2196/39851 UR - http://www.ncbi.nlm.nih.gov/pubmed/36053569 ID - info:doi/10.2196/39851 ER - TY - JOUR AU - Massougbodji, José AU - Zomahoun, Vignon Hervé Tchala AU - Adisso, Lionel Evehouenou AU - Sawadogo, Jasmine AU - Borde, Valérie AU - Cameron, Cynthia AU - Moisan, Hélène AU - Paquette, Jean-Sébastien AU - Akbaraly, Zamzam AU - Châteauneuf, Lëa-Kim AU - David, Geneviève AU - AU - Légaré, France PY - 2022/8/19 TI - Scaling Up Citizen Workshops in Public Libraries to Disseminate and Discuss Primary Care Research Results: Quasi-Experimental Study JO - JMIR Aging SP - e39016 VL - 5 IS - 3 KW - scaling up KW - knowledge translation KW - dissemination strategies KW - integrated knowledge translation KW - public libraries KW - citizen workshops KW - potentially inappropriate medicines N2 - Background: Little is known about engaging patients and stakeholders in the process of scaling up effective knowledge translation interventions targeting the public. Objective: Using an integrated knowledge translation approach, we aimed to scale up and evaluate an effective pilot program to disseminate research results in public libraries. Methods: We conducted a scaling-up study targeting the public. On the basis of our successful pilot project, we codeveloped and implemented a large-scale program of free citizen workshops in public libraries, in a close research partnership with stakeholders and patient representatives. Citizen workshops, each facilitated by 1 participating physician and 1 science communicator, consisted of a 45-minute computer-assisted presentation and a 45-minute open exchange. The intervention outcome was knowledge gained. The scale-up outcomes were satisfaction, appropriateness, coverage, and costs. An evaluation questionnaire was used to collect data of interest. Both quantitative and qualitative analyses were performed. Results: The workshop theme chosen by the patient and stakeholder representatives was the high prevalence of medication overuse among people aged ?65 years. From April to May 2019, 26 workshops were conducted in 25 public libraries reaching 362 people. The mean age of participants was 64.8 (SD 12.5) years. In total, 18 participating physicians and 6 science communicators facilitated the workshops. Participants reported significant knowledge gain (mean difference 2.1, 95% CI 2.0-2.2; P<.001). The median score for overall public satisfaction was 9 out of 10 (IQR 8-10). The public participants globally rated the workshops as having a high level of appropriateness. Coverage was 92% (25/27) of the total number of public libraries targeted. Costs were CAD $6051.84 (US $4519.69) for workshop design and CAD $22,935.41 (US $17,128.85) for scaling them up. Conclusions: This project successfully established a large-scale and successful implementation science or knowledge translation bridge among researchers, clinicians, and citizens via public libraries. This study provides a model for a dissemination practice that benefits the public by both engaging them in the dissemination process and targeting them directly. UR - https://aging.jmir.org/2022/3/e39016 UR - http://dx.doi.org/10.2196/39016 UR - http://www.ncbi.nlm.nih.gov/pubmed/35690963 ID - info:doi/10.2196/39016 ER - TY - JOUR AU - Boateng, George AU - Petersen, L. Curtis AU - Kotz, David AU - Fortuna, L. Karen AU - Masutani, Rebecca AU - Batsis, A. John PY - 2022/8/10 TI - A Smartwatch Step-Counting App for Older Adults: Development and Evaluation Study JO - JMIR Aging SP - e33845 VL - 5 IS - 3 KW - step tracking KW - step counting KW - pedometer KW - wearable KW - smartwatch KW - older adults KW - physical activity KW - machine learning KW - walking KW - mHealth KW - mobile health KW - mobile app KW - mobile application KW - app KW - uHealth N2 - Background: Older adults who engage in physical activity can reduce their risk of mobility impairment and disability. Short amounts of walking can improve quality of life, physical function, and cardiovascular health. Various programs have been implemented to encourage older adults to engage in physical activity, but sustaining their motivation continues to be a challenge. Ubiquitous devices, such as mobile phones and smartwatches, coupled with machine-learning algorithms, can potentially encourage older adults to be more physically active. Current algorithms that are deployed in consumer devices (eg, Fitbit) are proprietary, often are not tailored to the movements of older adults, and have been shown to be inaccurate in clinical settings. Step-counting algorithms have been developed for smartwatches, but only using data from younger adults and, often, were only validated in controlled laboratory settings. Objective: We sought to develop and validate a smartwatch step-counting app for older adults and evaluate the algorithm in free-living settings over a long period of time. Methods: We developed and evaluated a step-counting app for older adults on an open-source wrist-worn device (Amulet). The app includes algorithms to infer the level of physical activity and to count steps. We validated the step-counting algorithm in the lab (counting steps from a video recording, n=20) and in free-living conditions?one 2-day field study (n=6) and two 12-week field studies (using the Fitbit as ground truth, n=16). During app system development, we evaluated 4 walking patterns: normal, fast, up and down a staircase, and intermittent speed. For the field studies, we evaluated 5 different cut-off values for the algorithm, using correlation and error rate as the evaluation metrics. Results: The step-counting algorithm performed well. In the lab study, for normal walking (R2=0.5), there was a stronger correlation between the Amulet steps and the video-validated steps; for all activities, the Amulet?s count was on average 3.2 (2.1%) steps lower (SD 25.9) than the video-validated count. For the 2-day field study, the best parameter settings led to an association between Amulet and Fitbit (R2=0.989) and 3.1% (SD 25.1) steps lower than Fitbit, respectively. For the 12-week field study, the best parameter setting led to an R2 value of 0.669. Conclusions: Our findings demonstrate the importance of an iterative process in algorithm development before field-based deployment. This work highlights various challenges and insights involved in developing and validating monitoring systems in real-world settings. Nonetheless, our step-counting app for older adults had good performance relative to the ground truth (a commercial Fitbit step counter). Our app could potentially be used to help improve physical activity among older adults. UR - https://aging.jmir.org/2022/3/e33845 UR - http://dx.doi.org/10.2196/33845 UR - http://www.ncbi.nlm.nih.gov/pubmed/35947445 ID - info:doi/10.2196/33845 ER - TY - JOUR AU - Skirrow, Caroline AU - Meszaros, Marton AU - Meepegama, Udeepa AU - Lenain, Raphael AU - Papp, V. Kathryn AU - Weston, Jack AU - Fristed, Emil PY - 2022/9/30 TI - Validation of a Remote and Fully Automated Story Recall Task to Assess for Early Cognitive Impairment in Older Adults: Longitudinal Case-Control Observational Study JO - JMIR Aging SP - e37090 VL - 5 IS - 3 KW - neurology KW - memory KW - episodic KW - speech KW - psychometrics KW - reliability KW - validity KW - aging KW - elder KW - older adult KW - Alzheimer disease KW - mild cognitive impairment KW - mobile apps KW - mobile health KW - mHealth KW - smartphone KW - cognition KW - cognitive decline KW - cognitive impairment KW - development KW - validation KW - recall KW - story KW - stories KW - observational study KW - acceptability KW - usability KW - semantic KW - cognitive test KW - linguistic KW - mobile phone N2 - Background: Story recall is a simple and sensitive cognitive test that is commonly used to measure changes in episodic memory function in early Alzheimer disease (AD). Recent advances in digital technology and natural language processing methods make this test a candidate for automated administration and scoring. Multiple parallel test stimuli are required for higher-frequency disease monitoring. Objective: This study aims to develop and validate a remote and fully automated story recall task, suitable for longitudinal assessment, in a population of older adults with and without mild cognitive impairment (MCI) or mild AD. Methods: The ?Amyloid Prediction in Early Stage Alzheimer?s disease? (AMYPRED) studies recruited participants in the United Kingdom (AMYPRED-UK: NCT04828122) and the United States (AMYPRED-US: NCT04928976). Participants were asked to complete optional daily self-administered assessments remotely on their smart devices over 7 to 8 days. Assessments included immediate and delayed recall of 3 stories from the Automatic Story Recall Task (ASRT), a test with multiple parallel stimuli (18 short stories and 18 long stories) balanced for key linguistic and discourse metrics. Verbal responses were recorded and securely transferred from participants? personal devices and automatically transcribed and scored using text similarity metrics between the source text and retelling to derive a generalized match score. Group differences in adherence and task performance were examined using logistic and linear mixed models, respectively. Correlational analysis examined parallel-forms reliability of ASRTs and convergent validity with cognitive tests (Logical Memory Test and Preclinical Alzheimer?s Cognitive Composite with semantic processing). Acceptability and usability data were obtained using a remotely administered questionnaire. Results: Of the 200 participants recruited in the AMYPRED studies, 151 (75.5%)?78 cognitively unimpaired (CU) and 73 MCI or mild AD?engaged in optional remote assessments. Adherence to daily assessment was moderate and did not decline over time but was higher in CU participants (ASRTs were completed each day by 73/106, 68.9% participants with MCI or mild AD and 78/94, 83% CU participants). Participants reported favorable task usability: infrequent technical problems, easy use of the app, and a broad interest in the tasks. Task performance improved modestly across the week and was better for immediate recall. The generalized match scores were lower in participants with MCI or mild AD (Cohen d=1.54). Parallel-forms reliability of ASRT stories was moderate to strong for immediate recall (mean rho 0.73, range 0.56-0.88) and delayed recall (mean rho=0.73, range=0.54-0.86). The ASRTs showed moderate convergent validity with established cognitive tests. Conclusions: The unsupervised, self-administered ASRT task is sensitive to cognitive impairments in MCI and mild AD. The task showed good usability, high parallel-forms reliability, and high convergent validity with established cognitive tests. Remote, low-cost, low-burden, and automatically scored speech assessments could support diagnostic screening, health care, and treatment monitoring. UR - https://aging.jmir.org/2022/3/e37090 UR - http://dx.doi.org/10.2196/37090 UR - http://www.ncbi.nlm.nih.gov/pubmed/36178715 ID - info:doi/10.2196/37090 ER - TY - JOUR AU - Soroski, Thomas AU - da Cunha Vasco, Thiago AU - Newton-Mason, Sally AU - Granby, Saffrin AU - Lewis, Caitlin AU - Harisinghani, Anuj AU - Rizzo, Matteo AU - Conati, Cristina AU - Murray, Gabriel AU - Carenini, Giuseppe AU - Field, S. Thalia AU - Jang, Hyeju PY - 2022/9/21 TI - Evaluating Web-Based Automatic Transcription for Alzheimer Speech Data: Transcript Comparison and Machine Learning Analysis JO - JMIR Aging SP - e33460 VL - 5 IS - 3 KW - Alzheimer disease KW - mild cognitive impairment KW - speech KW - natural language processing KW - speech recognition software KW - machine learning KW - neurodegenerative disease KW - transcription software KW - memory N2 - Background: Speech data for medical research can be collected noninvasively and in large volumes. Speech analysis has shown promise in diagnosing neurodegenerative disease. To effectively leverage speech data, transcription is important, as there is valuable information contained in lexical content. Manual transcription, while highly accurate, limits the potential scalability and cost savings associated with language-based screening. Objective: To better understand the use of automatic transcription for classification of neurodegenerative disease, namely, Alzheimer disease (AD), mild cognitive impairment (MCI), or subjective memory complaints (SMC) versus healthy controls, we compared automatically generated transcripts against transcripts that went through manual correction. Methods: We recruited individuals from a memory clinic (?patients?) with a diagnosis of mild-to-moderate AD, (n=44, 30%), MCI (n=20, 13%), SMC (n=8, 5%), as well as healthy controls (n=77, 52%) living in the community. Participants were asked to describe a standardized picture, read a paragraph, and recall a pleasant life experience. We compared transcripts generated using Google speech-to-text software to manually verified transcripts by examining transcription confidence scores, transcription error rates, and machine learning classification accuracy. For the classification tasks, logistic regression, Gaussian naive Bayes, and random forests were used. Results: The transcription software showed higher confidence scores (P<.001) and lower error rates (P>.05) for speech from healthy controls compared with patients. Classification models using human-verified transcripts significantly (P<.001) outperformed automatically generated transcript models for both spontaneous speech tasks. This comparison showed no difference in the reading task. Manually adding pauses to transcripts had no impact on classification performance. However, manually correcting both spontaneous speech tasks led to significantly higher performances in the machine learning models. Conclusions: We found that automatically transcribed speech data could be used to distinguish patients with a diagnosis of AD, MCI, or SMC from controls. We recommend a human verification step to improve the performance of automatic transcripts, especially for spontaneous tasks. Moreover, human verification can focus on correcting errors and adding punctuation to transcripts. However, manual addition of pauses is not needed, which can simplify the human verification step to more efficiently process large volumes of speech data. UR - https://aging.jmir.org/2022/3/e33460 UR - http://dx.doi.org/10.2196/33460 UR - http://www.ncbi.nlm.nih.gov/pubmed/36129754 ID - info:doi/10.2196/33460 ER - TY - JOUR AU - Garnett, Anna AU - Northwood, Melissa AU - Ting, Justine AU - Sangrar, Ruheena PY - 2022/7/8 TI - mHealth Interventions to Support Caregivers of Older Adults: Equity-Focused Systematic Review JO - JMIR Aging SP - e33085 VL - 5 IS - 3 KW - caregivers KW - older adults KW - mobile health KW - social determinants of health KW - intervention KW - mobile phone N2 - Background: Informal caregivers, hereafter referred to as caregivers, provide support to older adults so that they can age safely at home. The decision to become a caregiver can be influenced by individual factors, such as personal choice, or societal factors such as social determinants of health, including household income, employment status, and culture-specific gender roles. Over time, caregivers? health can be negatively affected by their caregiving roles. Although programs exist to support caregivers, the availability and appropriateness of services do not match caregivers? expressed needs. Research suggests that supportive interventions offered through mobile health (mHealth) technologies have the potential to increase caregivers? access to supportive services. However, a knowledge gap remains regarding the extent to which social determinants of health are considered in the design, implementation, and evaluation of mHealth interventions intended to support the caregivers of older adults. Objective: This study aimed to conduct a systematic review to determine how health equity is considered in the design, implementation, and evaluation of mHealth interventions for caregivers of older adults using Cochrane Equity?s PROGRESS-Plus (place of residence, race, ethnicity, culture, language, occupation, gender, religion, education, social capital, socioeconomic status?plus age, disability, and sexual orientation) framework and synthesize evidence of the impacts of the identified caregiver-focused mHealth interventions. Methods: A systematic review was conducted using 5 databases. Articles published between January 2010 and June 2021 were included if they evaluated or explored the impact of mHealth interventions on the health and well-being of informal caregivers of older adults. mHealth interventions were defined as supportive services, for example, education, that caregivers of older adults accessed via mobile or wireless devices. Results: In total, 28 articles met the inclusion criteria and were included in the review. The interventions evaluated sought to connect caregivers with services, facilitate caregiving, and promote caregivers? health and well-being. The PROGRESS-Plus framework factors were mainly considered in the results, discussion, and limitations sections of the included studies. Some PROGRESS-Plus factors such as sexual orientation, religion, and occupation, received little to no consideration across any phase of the intervention design, implementation, or evaluation. Overall, the findings of this review suggest that mHealth interventions were positively received by study participants. Such interventions have the potential to reduce caregiver burden and positively affect caregivers? physical and mental health while supporting them as caregivers. The study findings highlight the importance of making support available to help facilitate caregivers? use of mHealth interventions, as well as in the use of appropriate language and text. Conclusions: The successful uptake and spread of mHealth interventions to support caregivers of older adults will depend on creating opportunities for the inclusive involvement of a broad range of stakeholders at all stages of design, implementation, and evaluation. UR - https://aging.jmir.org/2022/3/e33085 UR - http://dx.doi.org/10.2196/33085 UR - http://www.ncbi.nlm.nih.gov/pubmed/35616514 ID - info:doi/10.2196/33085 ER - TY - JOUR AU - Gerritzen, Vera Esther AU - Lee, Rebecca Abigail AU - McDermott, Orii AU - Coulson, Neil AU - Orrell, Martin PY - 2022/7/27 TI - Online Peer Support for People With Parkinson Disease: Narrative Synthesis Systematic Review JO - JMIR Aging SP - e35425 VL - 5 IS - 3 KW - Parkinson disease KW - web-based health community KW - online peer support KW - narrative synthesis KW - systematic review N2 - Background: Parkinson disease (PD) significantly impacts the lives of people with the diagnosis and their families. In addition to the physical symptoms, living with PD also has an emotional impact. This can result in withdrawal from social roles, increasing the risk for social isolation and loneliness. Peer support is a way to stay socially connected, share experiences, and learn new coping skills. Peer support can be provided both in person and on the internet. Some of the advantages of online peer support are that it overcomes geographical barriers and provides a form of anonymity; moreover, support can be readily available when needed. However, the psychosocial impact of PD is still underresearched, and there is no systematic synthesis of online peer support for people with PD. Objective: This review aims to explore the benefits and challenges of online peer support and identify successful elements of online peer support for people with PD. Methods: The method selected for this systematic review is narrative synthesis. A total of 6 databases were systematically searched in April 2020 for articles published between 1989 and 2020. The quality of the included studies was assessed using the Critical Appraisal Skills Programme qualitative research checklist and the Downs and Black quality checklist. Results: A total of 10,987 unique articles were identified through a systematic database search. Of these 10,987 articles, 8 (0.07%) were included in this review. Of the 8 studies, 5 (63%) were of good or high quality, 2 (25%) were of medium or fair quality, and 1 (13%) study was of poor quality. Web-based platforms included discussion forums, a web-based virtual world, and Facebook groups. Most papers reported on text-based communication. The included studies reported on sharing social support and personal experiences. Successful elements included increasing similarity between members and offering the opportunity to directly ask questions to a physician. Challenges included members leaving without a warning and PD symptoms hindering the use of technology. Conclusions: Peer support can improve social support and help people with PD in living meaningful and satisfying lives. Peer support is unique and cannot be replaced by family members, friends, or health care professionals. Online peer support can be a solution for those who do not have access to an in-person support group or whose PD symptoms restrict them from travelling. However, research on the personal experiences of those who engage in online peer support and potential barriers in accessing it remains limited. Future research could use qualitative methods to explore these fields further. UR - https://aging.jmir.org/2022/3/e35425 UR - http://dx.doi.org/10.2196/35425 UR - http://www.ncbi.nlm.nih.gov/pubmed/35896025 ID - info:doi/10.2196/35425 ER - TY - JOUR AU - Hackett, Katherine AU - Giovannetti, Tania PY - 2022/9/7 TI - Capturing Cognitive Aging in Vivo: Application of a Neuropsychological Framework for Emerging Digital Tools JO - JMIR Aging SP - e38130 VL - 5 IS - 3 KW - digital phenotyping KW - neuropsychology KW - aging KW - dementia KW - smartphone KW - neurological KW - psychological KW - older adults UR - https://aging.jmir.org/2022/3/e38130 UR - http://dx.doi.org/10.2196/38130 UR - http://www.ncbi.nlm.nih.gov/pubmed/36069747 ID - info:doi/10.2196/38130 ER - TY - JOUR AU - Rottenberg, Shelley AU - Williams, Allison PY - 2022/8/31 TI - Correction: Web-Based Delivery of the Caregiving Essentials Course for Informal Caregivers of Older Adults in Ontario: Mixed Methods Evaluation Study JO - JMIR Aging SP - e42215 VL - 5 IS - 3 UR - https://aging.jmir.org/2022/3/e42215 UR - http://dx.doi.org/10.2196/42215 UR - http://www.ncbi.nlm.nih.gov/pubmed/36044752 ID - info:doi/10.2196/42215 ER - TY - JOUR AU - Lee, Hocheol AU - Chung, Ah Min AU - Kim, Hyeji AU - Nam, Woo Eun PY - 2022/9/14 TI - Correction: The Effect of Cognitive Function Health Care Using Artificial Intelligence Robots for Older Adults: Systematic Review and Meta-analysis JO - JMIR Aging SP - e42312 VL - 5 IS - 3 UR - https://aging.jmir.org/2022/3/e42312 UR - http://dx.doi.org/10.2196/42312 UR - http://www.ncbi.nlm.nih.gov/pubmed/36103706 ID - info:doi/10.2196/42312 ER - TY - JOUR AU - Boutilier, J. Justin AU - Loganathar, Priya AU - Linden, Anna AU - Scheer, Eleanore AU - Noejovich, Sofia AU - Elliott, Christian AU - Zuraw, Matthew AU - Werner, E. Nicole PY - 2022/9/14 TI - Correction: A Web-Based Platform (CareVirtue) to Support Caregivers of People Living With Alzheimer Disease and Related Dementias: Mixed Methods Feasibility Study JO - JMIR Aging SP - e41912 VL - 5 IS - 3 UR - https://aging.jmir.org/2022/3/e41912 UR - http://dx.doi.org/10.2196/41912 UR - http://www.ncbi.nlm.nih.gov/pubmed/36103711 ID - info:doi/10.2196/41912 ER - TY - JOUR AU - Adisso, Lionel Évèhouénou AU - Taljaard, Monica AU - Stacey, Dawn AU - Brière, Nathalie AU - Zomahoun, Vignon Hervé Tchala AU - Durand, Jacob Pierre AU - Rivest, Louis-Paul AU - Légaré, France PY - 2022/9/20 TI - Shared Decision-Making Training for Home Care Teams to Engage Frail Older Adults and Caregivers in Housing Decisions: Stepped-Wedge Cluster Randomized Trial JO - JMIR Aging SP - e39386 VL - 5 IS - 3 KW - shared decision-making KW - home care KW - nursing homes KW - patient engagement N2 - Background: Frail older adults and caregivers need support from their home care teams in making difficult housing decisions, such as whether to remain at home, with or without assistance, or move into residential care. However, home care teams are often understaffed and busy, and shared decision-making training is costly. Nevertheless, overall awareness of shared decision-making is increasing. We hypothesized that distributing a decision aid could be sufficient for providing decision support without the addition of shared decision-making training for home care teams. Objective: We evaluated the effectiveness of adding web-based training and workshops for care teams in interprofessional shared decision-making to passive dissemination of a decision guide on the proportion of frail older adults or caregivers of cognitively-impaired frail older adults reporting active roles in housing decision-making. Methods: We conducted a stepped-wedge cluster randomized trial with home care teams in 9 health centers in Quebec, Canada. Participants were frail older adults or caregivers of cognitively impaired frail older adults facing housing decisions and receiving care from the home care team at one of the participating health centers. The intervention consisted of a 1.5-hour web-based tutorial for the home care teams plus a 3.5-hour interactive workshop in interprofessional shared decision-making using a decision guide that was designed to support frail older adults and caregivers in making housing decisions. The control was passive dissemination of the decision guide. The primary outcome was an active role in decision-making among frail older adults and caregivers, measured using the Control Preferences Scale. Secondary outcomes included decisional conflict and perceptions of how much care teams involved frail older adults and caregivers in decision-making. We performed an intention-to-treat analysis. Results: A total of 311 frail older adults were included in the analysis, including 208 (66.9%) women, with a mean age of 81.2 (SD 7.5) years. Among 339 caregivers of cognitively-impaired frail older adults, 239 (70.5%) were female and their mean age was 66.4 (SD 11.7) years. The intervention increased the proportion of frail older adults reporting an active role in decision-making by 3.3% (95% CI ?5.8% to 12.4%, P=.47) and the proportion of caregivers of cognitively-impaired frail older adults by 6.1% (95% CI -11.2% to 23.4%, P=.49). There was no significant impact on the secondary outcomes. However, the mean score for the frail older adults? perception of how much health professionals involved them in decision-making increased by 5.4 (95% CI ?0.6 to 11.4, P=.07) and the proportion of caregivers who reported decisional conflict decreased by 7.5% (95% CI ?16.5% to 1.6%, P=.10). Conclusions: Although it slightly reduced decisional conflict for caregivers, shared decision-making training did not equip home care teams significantly better than provision of a decision aid for involving frail older adults and their caregivers in decision-making. Trial Registration: ClinicalTrials.gov NCT02592525; https://clinicaltrials.gov/show/NCT02592525 UR - https://aging.jmir.org/2022/3/e39386 UR - http://dx.doi.org/10.2196/39386 UR - http://www.ncbi.nlm.nih.gov/pubmed/35759791 ID - info:doi/10.2196/39386 ER -