JMIR Aging最新文献

Background: Dementia presents substantial challenges for informal caregivers. A gap remains in technology-driven personalized support tailored to caregivers' needs.

Objective: This study aimed to develop a theory-driven, multicomponent mobile app specifically designed for caregivers of individuals with dementia and test its usability among end users.

Methods: We developed CareBuddy, a mobile care ecosystem based on the stress process model and user-centered design. The app includes personalized assessments and tailored solutions, an artificial intelligence-driven chatbot, GPS-based location monitoring, peer support, a helpline, telemedicine, health care provider integration, and caregiver self-care resources. Development was informed by interviews with caregivers and stakeholders, followed by a 2-phase pilot test involving 18 and 10 participants, respectively, to assess usability and acceptability.

Results: In phase 1, the mean system usability scores increased from 65.4 (SD 11.8) in round 1 to 73.8 (SD 15.9) in round 3, exceeding the benchmark of 68. In phase 2, caregivers rated the app highly, with an overall mean score of 95.4 (SD 8.5) on the Mobile Health App Usability Questionnaire. The domains of ease of use (mean 24.1, SD 2.9), user interface and satisfaction (mean 40.3, SD 3.4), and usefulness (mean 31, SD 3.9) received high Mobile Health App Usability Questionnaire ratings. Participants valued the content focused on dementia management and caregiver well-being. Caregivers appreciated the interactive features: social networking portal, service directory, and conversational large language model. Feedback highlighted areas for improvement, including reducing textual overload and addressing navigational challenges.

Conclusions: CareBuddy offers a multifaceted digital solution for dementia caregivers, with high usability and satisfaction. An ongoing trial is evaluating the app's effectiveness in improving caregiver outcomes.

Background: The health and economic burden of dementia has led the World Health Organization to recognize it as a public health priority. Although there currently does not exist a cure for dementia, there are multiple interventions aimed at preventing the risk of dementia and improving the quality of life of people with dementia. Voice assistants (VAs), particularly those using large language models (LLMs), have emerged as promising tools to deliver these interventions to older adults due to their accessible and natural interface.

Objective: This pilot study aimed to evaluate the technical feasibility (ie, functional performance and usability) and user acceptance of the embodied rule-based and LLM VA GRACE, as well as the perceived strength of the collaborative relationship or working alliance, between GRACE and healthy older adults during the delivery of cognitive stimulation interventions.

Methods: A pilot study was conducted with 21 healthy German-speaking adults aged 60 years and older. Participants interacted with GRACE in a laboratory setting for 10-15 minutes. The interaction involved a structured cognitive stimulation session using rule-based and LLM components. Data were collected using pre- and postinteraction questionnaires and semistructured interviews. Quantitative analysis included descriptive statistics and Wilcoxon signed rank tests. Qualitative data were analyzed thematically.

Results: Participants rated GRACE positively, with statistically significant scores above neutral (P<.001 for perceived ease of use, usefulness, enjoyment, and working alliance; P=.009 for perceived control; and P=.009 for intention to continue interacting). Thematic analysis revealed that GRACE was perceived as easy to understand and unambiguous, friendly, and supportive, with intervention components viewed as enjoyable and appropriately challenging. Areas for improvement included personalization, response delays, and voice quality.

Conclusions: The results suggest that embodied rule-based and LLM VAs like GRACE are feasible and well-received tools for delivering cognitive interventions to older adults. Future iterations will incorporate feedback and extend testing to individuals at risk for dementia.

Background: Baseline sarcopenia has been linked to cognitive decline in older adults; however, the impact of longitudinal changes in sarcopenia status on cognitive trajectories remains unclear.

Objective: This aims to examine the association between 2-year transitions in sarcopenia status and subsequent 5-year cognitive trajectories among middle-aged and older adults in China.

Methods: We analyzed data from 8189 participants (median age 58, IQR y; n=432952.9% female) in the China Health and Retirement Longitudinal Study. Sarcopenia status was determined in 2011 and 2013 according to the 2019 Asian Working Group for Sarcopenia criteria, and participants were classified into 7 transition groups based on status changes. Cognitive function was assessed from 2013 to 2018 using standardized z scores for executive function and episodic memory. Linear mixed-effects models were applied to evaluate associations between sarcopenia transitions and cognitive trajectories, adjusting for demographic, lifestyle, and health-related covariates.

Results: Progression from a nonsarcopenic state was associated with greater cognitive decline compared to stable nonsarcopenia (β=-0.016, 95% CI -0.026 to -0.007; P<.001), with greater decline observed among those progressing from possible sarcopenia to sarcopenia (β=-0.027, 95% CI -0.054 to -0.001; P=.04). In contrast, regression from possible sarcopenia was associated with improved cognitive performance (β=0.028, 95% CI 0.015-0.041; P<.001). No significant improvement was observed among individuals regressing from established sarcopenia. Subgroup analyses showed consistent benefits of regression from possible sarcopenia across sex, age, residence, and education groups, except among urban residents (P=.05).

Conclusions: Progression in sarcopenia status was independently associated with accelerated cognitive decline, whereas regression from possible sarcopenia predicted cognitive benefit. These findings highlight possible sarcopenia as a clinically actionable and potentially reversible stage and underscore the importance of early identification and intervention to preserve cognitive health in aging populations.

Background: Research on the effects of social and intellectual activities on frailty remains limited, particularly longitudinal studies examining how these activities influence the dynamic progression of frailty over time. We aimed to examine this association in a nationally longitudinal study.

Objective: This study aimed to investigate the relationship between social and intellectual and frailty trajectories in the middle-aged and older Chinese population. Specifically, it sought to identify distinct frailty trajectories and quantify the longitudinal protective effects of social and intellectual activities against adverse frailty progression, while exploring differential impacts across age, sex, and residence subgroups.

Methods: This study used data from the China Health and Retirement Longitudinal Study and group-based trajectory modeling identified frailty trajectories over seven years. Frailty was assessed using a 38-item frailty index. The frequency of social activities and intellectual activity were quantified separately. Multivariate ordinal logistic regression analyzed associations between activity frequencies and trajectory membership.

Results: Three different trajectories of frailty were identified in this study: "low progressive trajectories" (n=7208, 65.8%), "moderate progressive trajectories" (n=3061, 28.5%), and "high progressive trajectories" (n=609, 5.7%). Compared to nonparticipants, frequent social activity participation reduced the likelihood of transitioning to the "moderate progressive" trajectory (odds ratio [OR] 0.84, 95% CI 0.75-0.94; P=.004). Intellectual activity engagement lowered risks of both "moderate" (OR 0.77, 95% CI 0.63-0.94; P=.01) and "high progressive" trajectories (OR 0.63, 95% CI 0.40-0.99; P=.04). Subgroup analyses revealed differential effects by age, sex, and residence.

Conclusions: This study confirms the existence of heterogeneous long-term frailty trajectories among middle-aged and older Chinese adults, social and intellectual activities significantly mitigate frailty progression in Chinese middle-aged and older adults. Regular participation in structured social and intellectual activities can effectively delay frailty development in this population.

Background: Spatial navigation impairment is prevalent in people with Alzheimer disease (AD) and may appear in its initial clinical stage. Detecting this deficit in people at risk may not only help prevent them from getting lost or going missing but also provide a useful clinical aid to accurate diagnosis. Traditional assessments for spatial navigation impairment include questionnaires, paper-and-pencil and maze tests, or video games. While a real-world setting is more valid, direct, and accurate, it is plagued by unpredictable conditions such as weather, obstacles, or accidents. Owing to modern technology, virtual reality (VR) offers a new way to test spatial navigation impairment.

Objective: The aims of this study were to test the feasibility of a VR setting to assess sense of location in people with mild cognitive impairment (MCI) and the power of VR to discriminate among groups with different clinical conditions.

Methods: We used the Pai-Jan virtual reality (PJVR) device to test spatial navigation ability in those who were cognitively unimpaired (CU) and those who experienced subjective cognitive decline (SCD) and MCI. The PJVR device is the VR version (VIVE Pro Eye head-mounted display) of the Pai-Jan device, which has demonstrated its power to discriminate among CU, AD MCI, and mild AD dementia. With a map provided and using joysticks or handles, participants were asked to reach 5 points on a 660-m path. Linear deviation (LD; in meters) from each target point and vector deviation (in degrees) from the direction to the start point at each location were treated as the variables for comparison.

Results: A total of 113 participants provided informed consent to initiate the study. Of these 113 participants, 93 (82.3%) completed the trials, including 22 (24%) who were CU, 39 (42%) with SCD, and 32 (34%) with MCI. In total, 17.7% (20/113) failed the trials due to cybersickness. The mean LD of the CU, SCD, and MCI groups was 38.2 (SD 39.5), 50.4 (SD 40.7), and 100.4 (SD 46.2) meters, respectively (P<.001). The MCI group showed greater vector deviation (mean 63.2, SD 42.4 degrees) than either the SCD (mean 39.4, SD 33.0 degrees) or CU (mean 38.6, SD 37.4 degrees; P=.02) group. The LD of the PJVR device was correlated with the total scores on the caregiver version of the Questionnaire on Everyday Navigational Ability (P<.001), indicating good ecological validity.

Conclusions: The PJVR device is feasible for older adults and participants with MCI. It can detect spatial navigation deficits related to AD pathology, and the results show a close correlation with real-world navigation ability.

Background: Virtual reality (VR) technology is increasingly applied in aging-related research. Although existing bibliometric studies have focused on specific applications, such as older adults' acceptance of VR and its use in cognitive rehabilitation, no comprehensive mapping of the global research landscape on VR for older populations has been conducted. This study fills this gap by providing a holistic bibliometric and thematic analysis of VR applications in older adults, mapping research trends, intellectual structures, and emerging frontiers.

Objective: This study aims to explore the current applications, potential benefits, and future directions of virtual reality technology for older adults, based on literature published between January 1, 2015, and April 30, 2025.

Methods: This study used bibliometric methods to systematically examine the current status and developmental trends in VR research for older adults. We searched the Web of Science Core Collection for research articles and reviews published in English. A total of 1609 publications were included in the final analysis. Using CiteSpace and VOSviewer, we conducted coauthorship network analysis, keyword clustering, and burst detection to map research hot spots, academic collaboration patterns, and emerging trends in the field.

Results: Our analysis of 1609 publications revealed a steady growth in the application of VR technology for older adults. The predominant research areas included meta-analysis, rehabilitation, dementia, and gait. The United States and China were the two most productive countries, with Tel Aviv University emerging as the leading institution. Frontiers in Aging Neuroscience and Applied Sciences Basel were the most prolific journals, each publishing 40 papers. The most cited article evaluated the effects of VR-based physical and cognitive training on executive function and dual-task gait performance in older adults with mild cognitive impairment. Emerging research themes include artificial intelligence, association, and depression.

Conclusions: VR research for older adults is rapidly expanding and globally collaborative. Although applications span multiple geriatric domains, future efforts should prioritize mental health, disease integration, and artificial intelligence-enhanced VR technologies.