JMIR Aging最新文献

Background: In long-term care (LTC) for older adults, data on client, employee, and organization levels are collected in various ways, covering quality of care, life, and work. There is, however, a lack of understanding of how to introduce data-informed care in LTC and thus create value from data.

Objective: This study aims to investigate the experiences and perceptions of various stakeholders in LTC regarding data and data-informed care.

Methods: A qualitative study using the World Café cocreation technique was conducted with a diverse group of LTC stakeholders. Four questions were addressed: (1) What thoughts do you have when you hear the term "data" in relation to LTC? (2) What purposes do data have (in the future) in LTC? (3) What knowledge and skills are needed to enable data-informed care? (4) How can data contribute to and improve multidisciplinary learning? Stakeholders' notes and the plenary summary were analyzed using conventional content analysis.

Results: Stakeholders included nurses, members of client councils, data specialists, researchers, and managers (N=20; mean age 50, SD 13 years). Five themes were identified: (1) despite uncertainty, the benefits of using data outweigh the associated risks; (2) the lack of accessibility and uniformity hinders integrating data-informed care; (3) human resources and finance departments pioneer data usage; however, potential lies in clinical decision-making; (4) data-informed care demands individual, collective, and organizational prerequisites; and (5) multidisciplinary collaboration enriches collective knowledge regarding data.

Conclusions: Introducing data-informed care requires enhancing data literacy of health care professionals, establishing clear communication about the role of data within the organization, and introducing new job positions, such as data scientists. Data-informed care was considered a multidisciplinary approach in which data have a supportive role to enhance collective understanding and are considered crucial for improving quality of care. .

Background: Frailty is a common issue among hospitalized older adult patients and is associated with numerous adverse health outcomes. Assessing frailty facilitates better decision-making for treatment plans, patient placement, and discharge planning. Approximately a decade ago, the frailty index based on laboratory tests (FI-Lab) metric was introduced. Although this index has been shown in numerous studies to predict adverse medical outcomes, including mortality, it has not been extensively evaluated among patients hospitalized in internal medicine departments for diverse indications.

Objective: The aim of the study was to investigate the relationship between FI-Lab at admission and all-cause mortality during hospitalization and after discharge in patients aged 65 years and older admitted for diverse clinical indications to internal medicine departments.

Methods: This retrospective cohort study included patients aged 65 years and older hospitalized in the internal medicine departments of a large tertiary hospital. Data included demographic variables, comorbidity, and all-cause mortality. The FI-Lab was calculated based on 16 available blood tests, as well as blood pressure and heart rate measurements. We used Cox proportional hazards regression models to evaluate associations with mortality. Model performance was assessed using the C-index and time-dependent receiver operating characteristic (ROC) curves. Hospitalization data were collected from December 25, 2016, to January 7, 2023.

Results: During the study period, 31,443 patients were hospitalized in internal medicine departments, and FI-Lab was calculable for 31,398 of them. The mean age of the patients was 77.6 (SD 8.2) years, and 52.1% (16,346/31,443) were women. The mean FI-Lab score was 0.38 (SD 0.15). Based on FI-Lab scores, patients were categorized into 4 groups: robust, mildly prefrail, moderately prefrail, and frail. After adjusting for age, sex, and comorbidities, frail and prefrail patients exhibited higher mortality rates than robust patients. For each 0.01 increase in the FI-Lab score (as a continuous variable), adjusted analyses revealed a 5.5% increase in in-hospital mortality, a 2.9% increase in mortality within the first year after hospitalization, and a 1.9% increase in mortality beyond the first year.

Conclusions: The FI-Lab is a readily available and informative metric of frailty in older hospitalized patients. Calculating this index can assist physicians with identifying patients at high risk of mortality and provide meaningful information to support clinical decision-making.

Background: Sarcopenia is associated with cardiovascular diseases (CVDs). However, whether changes in sarcopenia status affect CVD risk remains unclear. In addition, how indoor fuel use impacts the sarcopenia transition process is less well studied.

Objective: This study prospectively examined the association of sarcopenia transitions with CVD risk, while exploring the effect of indoor fuel on these transitions.

Methods: In this prospective observational study, we used data from the China Health and Retirement Longitudinal Study waves 1 to 4 (2011 to 2018). In total, 8739 participants with complete data on sarcopenia and indoor fuel use were included for the indoor fuel use and sarcopenia transition analysis, and 6385 participants without previous CVDs were included for the sarcopenia transition and CVD risk analysis. Sarcopenia transition was defined according to the sarcopenia status at wave 1 (2011) and wave 2 (2013). Incident CVDs included heart diseases, stroke, and composite CVDs. Information on indoor fuel use was obtained at wave 1. Cox proportional hazards models were used to examine the effect of sarcopenia transition on incident CVDs. Logistic regression models were used to investigate the impact of indoor fuel use on these transitions.

Results: During a median of 7.0 years of follow-up, 1233 incident CVDs were documented. Compared to stably normal participants, progressing from a normal state to possible or confirmed sarcopenia brought increased risk of incident CVD (hazard ratio 1.42, 95% CI 1.15-1.77). Conversely, recovering to a normal state was associated with decreased risk (hazard ratio 0.72, 95% CI 0.55-0.95) for baseline participants with possible sarcopenia. In addition, clean fuel use increased the odds of achieving a possible-to-normal transformation (odds ratio 1.32, 95% CI 1.06-1.64), while both solid cooking and heating fuel use were associated with a higher risk of deterioration in sarcopenia status.

Conclusions: An unfavorable transition in sarcopenia status is associated with higher CVD risk, while reversion from possible sarcopenia to a normal state could reduce the risk. Therefore, early intervention for sarcopenia is imperative for CVD prevention, and promoting clean indoor fuel use is recommended.

Background: The transition of social and health services to digital platforms has significant implications for the inclusion and well-being of older adults. Digital literacy is a key determinant of health and equity, particularly as services shift to digital platforms. For older adults, this is crucial for accessing essential services and information, aiding in emergency resource navigation and information access.

Objective: This study examines how Canadian news media portray older adults' digital literacy, using the Unified Theory of Acceptance and Use of Technology 2 (UTAUT2) framework to guide the analysis.

Methods: News media articles from Canada, published from May 4, 2023, to July 4, 2024, were analyzed. Articles were identified through database searches and manual reviews, with inclusion criteria focusing on mentions of older adults and digital literacy. Critical discourse analysis was conducted using UTAUT2 factors to interpret the media narratives.

Results: Of the 103 articles reviewed, 54 met the inclusion criteria. Four key themes emerged: (1) Performance and effort expectancy: media frequently depicted older adults as needing significant help with digital technologies, indicating potential digital ageism. (2) Social influence: fearmongering narratives suggest insufficient technological skills could result in social exclusion and limited access to essential services. (3) Facilitating conditions: articles highlighted older adults' susceptibility to digital scams and fraud, reinforcing digital ageism. (4) Hedonic motivation: media portrayals emphasized active aging, illustrating how digital tools, such as home security systems, can enhance independence and quality of life.

Conclusions: Many media narratives on older adults' digital literacy perpetuate digital ageism. The study highlights how negative portrayals of older adults' digital skills and their exclusion from digital spaces underscore the need for more inclusive media representations. Findings suggest that media outlets could play a crucial role in shifting to more supportive portrayals of older adults' engagement with technology. Improving media portrayals can enhance digital engagement and preparedness among aging populations, contributing to better overall quality of life.

Background: Most older Americans have not saved enough to cover long-term care costs. Medicaid-a public health care program for low-income individuals-can help Americans with qualifying care needs pay for assistance in a nursing home or for services in the home. Determining financial eligibility for Medicaid is complicated, and the application process is often managed by family caregivers with limited knowledge of Medicaid programs.

Objective: A one-stop digital solution is needed to help family caregivers plan for the cost of long-term care services and learn about getting help paying for services through Medicaid. We aimed to develop a web application that (1) educates informal caregivers about Medicaid programs and eligibility criteria, (2) informs them about the cost of home and institutional care in their local area with and without Medicaid coverage, and (3) uses a custom algorithm to provide personalized financial eligibility information based on the care recipient's income, assets, and monthly spending.

Methods: We first interviewed aging services providers and informal family caregivers, then developed a web application that was refined based on user experience interviews with English- and Spanish-speaking caregivers. In the final validation phase, asynchronous usability sessions were recorded with 109 informal caregivers who completed a series of tasks. Participants viewed and rated animated Medicaid "explainer" videos, input financial information to enable the custom algorithm to determine the care recipient's eligibility for Medicaid, adjusted settings on a care cost calculator to estimate the regional cost of home and institutional care services, and completed a Medicaid knowledge quiz before and after using the website.

Results: After engaging with the website and watching the videos, scores on a Medicaid knowledge quiz increased by 61.2% (2-tailed t92=12.9, P<.001). Participants found it easy to enter the care recipient's financial information to determine Medicaid eligibility (out of 7; mean 5.9, SD 1.3) and perceived the care cost calculator as very helpful (out of 7; mean 6.3, SD 1.2). The website received a very high System Usability Scale rating of 88.3 out of 100 (SD 13.1). Caregivers verbalized wanting more education on complex financial concepts that impact Medicaid eligibility and asset preservation.

Conclusions: A comprehensive Medicaid planning website can significantly improve caregivers' knowledge of Medicaid and provide them with a personalized roadmap for accessing care services. The custom algorithm powering the Medicaid eligibility determination could be further refined to account for state-based exceptions. This application may reduce caregiver burden and help support the long-term care planning process.

Background: Stair negotiation (ascending and descending) and transitions to level walking are complex motor tasks influenced by aging; yet the impact of functional disability on these changes remains underexplored.

Objective: This study aimed to evaluate the lower limb joint positions, velocities, and the center of mass (CoM) displacement and velocity during stair negotiation and transitions in older adults with and without functional disability.

Methods: Sixty community-dwelling adults, aged 60 years and older, were assessed for lower limb tridimensional joint positions and velocities during the instances of foot contact or leaving the step and foot contact or leaving the floor; the joint range of motion, angular velocity range, and the CoM displacement and angular velocity range were assessed during stair ascend and descend and transitions floor-to-stair and stair-to-floor through an optoelectronic system. Principal component analysis was used to assess 8 groups of variables to compute principal component models (I-VIII). Participants were classified as with or without disability based on functional disability indicators. Group differences were assessed using the Mann-Whitney U test.

Results: From 240 variables, 41 key parameters were identified, mainly related to hip and knee angular velocities in the sagittal plane. Significant differences between older adults with disability (n=25) and without disability (n=35) were found in 12 principal components.

Conclusions: Older adults with functional disability showed changes in the sagittal plane hip as well as in the knee angular velocity and mediolateral and vertical CoM displacement and velocity during stair negotiation and transitions. These findings can inform targeted strategies to improve mobility and stability in this population.