JMIR Aging最新文献

Background: The aging population and the accompanying rise in chronic diseases have intensified the need to study the adoption of telehealth services. However, the success of telehealth services depends not only on their ease and usefulness but also on addressing broader concerns. Despite being a substantial user group in traditional health services, older adults may encounter barriers to adopting telehealth services. Increasing the adoption of telehealth among the older adult population is crucial for enhancing their access to care and managing the challenges of aging effectively.

Objective: We aimed to explore factors influencing the adoption of telehealth services among older adults in Malaysia, going beyond the conventional framework by incorporating transition cost and subjective well-being as additional constructs.

Methods: A cross-sectional survey was conducted among 119 adults aged ≥60 years in Malaysia, using 39 survey items adapted from existing studies. Data analysis was performed using partial least squares structural equation modeling, with both the measurement model and structural model being evaluated. To determine the predictive relevance of the model, PLSpredict was applied. In addition, importance-performance map analysis was conducted to further expand on the structural model results by assessing the performance of each variable.

Results: Of the 119 participants, 52 (43.7%) were women and 67 (56.3%) were men. The study found that subjective well-being (β=0.448; P<.001) was the most significant factor, followed by attitude (β=0.242; P<.001), transition cost (β=-0.163; P<.001), and perceived usefulness (β=0.100, P=.02) in influencing telehealth service intention. Furthermore, perceived ease of use (β=0.271; P<.001), availability (β=0.323; P<.001), subjective well-being (β=0.261; P<.001), and trust (β=0.156, P=.004) positively influenced perceived usefulness, while inertia (β=0.024, P=.22) did not. In addition, availability (β=0.420; P<.001) and subjective well-being (β=0.260; P<.001) were positively related to perceived ease of use, with inertia (β=-0.246; P<.001) having a negative impact. The importance-performance map analysis results showed that subjective well-being (importance=0.532) was the most crucial factor for older adult users, while availability (importance=70.735) had the highest performance in telehealth services.

Conclusions: This research underscores the importance of catering to the subjective well-being of older adults and optimizing the availability of telehealth services to encourage adoption, ultimately advancing health care accessibility and quality for this vulnerable demographic.

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.

Background: The Timed Up and Go test (TUG) is recommended as an evidence-based tool for measuring physical capacity. Instrumented TUG (iTUG) approaches expand classical supervised clinical applications offering the potential of self-assessment for older adults.

Objective: This study aimed to evaluate the concurrent validity and test-retest reliability of a smartphone-based TUG self-assessment "up&go app."

Methods: A total of 52 community-dwelling older adults (>67 years old) were recruited. A validated and medically certified system attached with a belt at the lower back was used as a reference system to validate the "up&go app" algorithm. The participants repeated the TUG 5 times wearing, a smartphone with the "up&go app" in their front trouser pocket and an inertial sensor to test the concurrent validity. A subsample of 37 participants repeated the "up&go app" measurement 2 weeks later to examine the test-retest reliability.

Results: The correlation between the "up&go app" and the reference measurement was r=0.99 for the total test duration and r=0.97 for the 5 single repetitions. Agreement between the 5 repetitions was intraclass correlation coefficient (ICC)=0.9 (0.84-0.94). Leaving out the first repetition, the agreement was ICC=0.95 (0.92-0.97). Test-retest agreement had an ICC=0.79 (0.53-0.9).

Conclusions: The duration of 5 repetitions of the TUG test, measured with the pocket-worn "up&go app," was very consistent with the results of a lower-back sensor system, indicating excellent concurrent validity. Participants walked slower in the first round than in the other 4 repetitions within a test run. Test-retest reliability was also excellent. The "up&go app" provides a useful smartphone-based approach to measure 5 repetitions of the TUG. The app could be used by older adults as a self-screening and monitoring tool of physical capacity at home and thereby help to early identify functional limitations and take interventions when necessary.

Background: Due to the progressive nature of dementia, concerns about the safety of nursing home residents are frequently raised. Surveillance technology, enabling visual and auditory monitoring, is often seen as a solution for ensuring safe and efficient care. However, tailoring surveillance technology to individual needs is challenging due to the complex and dynamic care environment involving multiple formal and informal stakeholders, each with unique perspectives.

Objective: This study aims to explore the scientific literature on the perspectives and values of stakeholders involved in applying surveillance technology for people with dementia in nursing homes.

Methods: We conducted a scoping review and systematically searched 5 scientific databases. We identified 31 articles published between 2005 and 2024. Stakeholder characteristics were extracted and synthesized according to the theory of basic human values by Schwartz.

Results: In total, 12 stakeholder groups were identified, with nursing staff, residents, and informal caregivers being the most frequently mentioned. Among stakeholder groups close to residents, values related to benevolence, security, conformity, and tradition were most commonly addressed. Furthermore, values such as self-direction, power, and achievement seemed important to most stakeholder groups.

Conclusions: Several stakeholder groups emphasized the importance of being and feeling involved in the application of surveillance technologies. In addition, they acknowledged the necessity of paying attention to stakeholders' perspectives and values. Across these stakeholder groups, values related to benevolence, security, and self-direction were represented, although various stakeholders assigned different meanings to these values. Awareness of stakeholders' perspectives demands a willingness to acknowledge each other's values and bridge differences.

Background: Disturbed sleep patterns are common among older adults and may contribute to cognitive and physical declines. However, evidence for the relationship between sleep duration and cognitive frailty, a concept combining physical frailty and cognitive impairment in older adults is lacking.

Objective: The objective of our study was to examine the associations of sleep duration and its changes with cognitive frailty.

Methods: We analyzed data from the 2008-2018 waves of the Chinese Longitudinal Healthy Longevity Survey. Cognitive frailty was rendered based on the modified Fried frailty phenotype and Mini-Mental State Examination. Sleep duration was categorized as short (<6 h), moderate (6-9 h), and long (>9 h). We examined the association of sleep duration with cognitive frailty status at baseline using logistic regressions and with future incidence of cognitive frailty using Cox proportional hazards models. Restricted cubic splines were employed to explore potential non-linear associations.

Results: Among 11,303 participants, 1,298 (11.5%) had cognitive frailty at baseline. Compared to participants who had moderate sleep duration, the odds of having cognitive frailty were higher in those with long sleep duration (odds ratio [OR] =1.71, 95% confidence interval [CI] =1.48-1.97, p<0.001). A J-shaped association between sleep duration and cognitive frailty was also observed (p<0.001). Additionally, during a median follow-up of 6.7 years among 5,201 participants who were not cognitively frail at baseline, 521 (10.0%) developed cognitive frailty. A higher risk of cognitive frailty was observed in participants with long sleep duration (hazard ratio [HR] =1.32, 95% CI =1.07-1.62, p=0.008).

Conclusions: Long sleep duration was associated with cognitive frailly in older Chinese adults. These findings provide insights into the relationship between sleep duration and cognitive frailty, with potential implications for public health policies and clinical practice.

Clinicaltrial:

Background: Cognitive impairment in older adults reduces independence and raises health care costs but can be mitigated through stimulating activities. Based on network theory, intricate relationships within and between clusters of instrumental activities of daily living (IADLs) and cognitive domains suggest the existence of central IADLs and cognitive domains, as well as bridge IADLs. Modifying these can significantly enhance daily living activities and cognitive functions holistically.

Objective: This study aims to identify central IADLs (key activities within the IADL network), central cognitive domains (key domains within the cognitive network), and bridge IADLs (linking IADL and cognitive networks). These insights will inform targeted interventions to effectively improve IADL and cognitive well-being in older adults.

Methods: A cross-sectional analysis of adults aged 65 years and older in the United States focused on 5 IADLs and 6 cognitive domains from the National Health and Aging Trends Study (NHATS). Network analysis identified central and bridge variables. Nonparametric and case-dropping bootstrap methods checked network stability. Network comparison tests assessed sex differences with Benjamini-Hochberg adjustments.

Results: Of the 2239 participants, 56.4% were female (n=976). We computed and tested 3 networks: IADL, cognition, and bridge-with correlation stability coefficients of 0.67, 0.75, and 0.44, respectively (all>0.25). Meal preparation was identified as the central IADL, with a centrality index of 3.87, which was significantly higher than that of other IADLs (all P<.05). Visual attention emerged as the central cognition domain, with a centrality index of 0.86, which was significantly higher than that of other cognition domains (all P<.05). Shopping was determined to be the bridge IADL, with a centrality index of 0.41, which was significantly higher than that of other IADLs (all P<.05). Notably, gender differences emerged in the IADL network, with stronger associations between laundry and meal preparation in females (1.69 vs males: 0.74; P=.001) and higher centrality in meal preparation among females (difference=1.99; P=.007).

Conclusions: While broad enhancements in all IADL and cognitive domains are beneficial, targeting meal preparation, visual attention, and shopping may leverage their within-network influence to yield a more pronounced improvement in holistic IADL, holistic cognition, and holistic cognition function through IADL interventions among older adults. Notably, meal preparation interventions may be less effective in males, requiring tailored approaches.

Background: Researchers in Nova Scotia and Ontario, Canada, implemented a passive remote monitoring (PRM) model of home care unique to their health system contexts. Each PRM model integrated tailored PRM devices (eg, motion sensors, cameras, and door alarms) into home care patients' residences with the aim of linking patients, family and friend caregivers, and health care providers to support older adults' aging in place.

Objective: The purpose of this study was to examine the use of PRM technologies in the home to support older adults' safe aging in place and avoidance or delay of higher levels of care.

Methods: This multiprovincial pragmatic randomized controlled trial examined how PRM technologies support older adults to safely remain in their home and avoid or delay admission to higher levels of care. Pairs of home care patients and their family and friend caregivers were recruited in Ontario and Nova Scotia. Participant pairs were randomly assigned to one of two conditions: (1) standard home care (ie, control) or (2) standard home care plus study-provided PRM (ie, intervention). Participants provided their provincial health insurance numbers to link with provincial health administrative databases and identify if patients were admitted to higher levels of care after 1 year. Cox proportional hazards models were used to evaluate the primary outcome in each province.

Results: In total, 313 patient-caregiver pairs were recruited: 174 pairs in Ontario (intervention: n=60; control: n=114) and 139 pairs in Nova Scotia (intervention: n=45; control: n=94). Results indicate PRM was associated with a nonsignificant 30% reduction in risk of patients being admitted to higher levels of care in Ontario (hazard ratio 0.7, 95% CI 0.3-1.4) and no reduction in risk in Nova Scotia (hazard ratio 1.1, 95% CI 0.3-3.7). Adjusting for patient sex had no impact on model estimates for either province.

Conclusions: Limitations related, in part, to the impact of the COVID-19 pandemic may have contributed to the effectiveness of the intervention. While our study did not yield statistically significant results (P=.30 and P=.90) regarding the effectiveness of the PRM model in prolonging home stays, the observed trends suggest that technology-assisted aging in place may be a valuable goal for older adults. Further study is required to understand if longer follow-up time allows more effects of PRM on patients' avoidance of higher levels of care to be detected.

Trial registration: ISRCTN ISRCTN79884651; https://www.isrctn.com/ISRCTN79884651.

International registered report identifier (irrid): RR2-10.2196/15027.

Background: Sarcopenia (loss of muscle mass and strength) increases adverse outcomes risk and contributes to cognitive decline in older adults. Accurate methods to quantify muscle mass and predict adverse outcomes, particularly in older persons with dementia, are still lacking.

Objective: This study's main objective was to assess the feasibility of using deep learning techniques for segmentation and quantification of musculoskeletal tissues in magnetic resonance imaging (MRI) scans of the head in patients with neurocognitive disorders. This study aimed to pave the way for using automated techniques for opportunistic detection of sarcopenia in patients with neurocognitive disorder.

Methods: In a cross-sectional analysis of 53 participants, we used 7 U-Net-like deep learning models to segment 5 different tissues in head MRI images and used the Dice similarity coefficient and average symmetric surface distance as main assessment techniques to compare results. We also analyzed the relationship between BMI and muscle and fat volumes.

Results: Our framework accurately quantified masseter and subcutaneous fat on the left and right sides of the head and tongue muscle (mean Dice similarity coefficient 92.4%). A significant correlation exists between the area and volume of tongue muscle, left masseter muscle, and BMI.

Conclusions: Our study demonstrates the successful application of a deep learning model to quantify muscle volumes in head MRI in patients with neurocognitive disorders. This is a promising first step toward clinically applicable artificial intelligence and deep learning methods for estimating masseter and tongue muscle and predicting adverse outcomes in this population.