Background: Sarcopenia is characterized by the loss of skeletal muscle mass and muscle function with increasing age. The skeletal muscle mass of older people who endure sarcopenia may be improved via the practice of strength training and tai chi. However, it remains unclear if the hybridization of strength exercise training and traditional Chinese exercise will have a better effect.
Objective: We designed a strength training and tai chi exercise hybrid program to improve sarcopenia in older people. Moreover, explainable artificial intelligence was used to predict postintervention sarcopenic status and quantify the feature contribution.
Methods: To assess the influence of sarcopenia in the older people group, 93 participated as experimental participants in a 24-week randomized controlled trial and were randomized into 3 intervention groups, namely the tai chi exercise and strength training hybrid group (TCSG; n=33), the strength training group (STG; n=30), and the control group (n=30). Abdominal computed tomography was used to evaluate the skeletal muscle mass at the third lumbar (L3) vertebra. Analysis of demographic characteristics of participants at baseline used 1-way ANOVA and χ2 tests, and repeated-measures ANOVA was used to analyze experimental data. In addition, 10 machine-learning classification models were used to calculate if these participants could reverse the degree of sarcopenia after the intervention.
Results: A significant interaction effect was found in skeletal muscle density at the L3 vertebra, skeletal muscle area at the L3 vertebra (L3 SMA), grip strength, muscle fat infiltration, and relative skeletal muscle mass index (all P values were <.05). Grip strength, relative skeletal muscle mass index, and L3 SMA were significantly improved after the intervention for participants in the TCSG and STG (all P values were <.05). After post hoc tests, we found that participants in the TCSG experienced a better effect on L3 SMA than those in the STG and participants in the control group. The LightGBM classification model had the greatest performance in accuracy (88.4%), recall score (74%), and F1-score (76.1%).
Conclusions: The skeletal muscle area of older adults with sarcopenia may be improved by a hybrid exercise program composed of strength training and tai chi. In addition, we identified that the LightGBM classification model had the best performance to predict the reversion of sarcopenia.
{"title":"Quantifying the Enhancement of Sarcopenic Skeletal Muscle Preservation Through a Hybrid Exercise Program: Randomized Controlled Trial.","authors":"Hongzhi Guo, Jianwei Cao, Shichun He, Meiqi Wei, Deyu Meng, Ichen Yu, Ziyi Wang, Xinyi Chang, Guang Yang, Ziheng Wang","doi":"10.2196/58175","DOIUrl":"10.2196/58175","url":null,"abstract":"<p><strong>Background: </strong>Sarcopenia is characterized by the loss of skeletal muscle mass and muscle function with increasing age. The skeletal muscle mass of older people who endure sarcopenia may be improved via the practice of strength training and tai chi. However, it remains unclear if the hybridization of strength exercise training and traditional Chinese exercise will have a better effect.</p><p><strong>Objective: </strong>We designed a strength training and tai chi exercise hybrid program to improve sarcopenia in older people. Moreover, explainable artificial intelligence was used to predict postintervention sarcopenic status and quantify the feature contribution.</p><p><strong>Methods: </strong>To assess the influence of sarcopenia in the older people group, 93 participated as experimental participants in a 24-week randomized controlled trial and were randomized into 3 intervention groups, namely the tai chi exercise and strength training hybrid group (TCSG; n=33), the strength training group (STG; n=30), and the control group (n=30). Abdominal computed tomography was used to evaluate the skeletal muscle mass at the third lumbar (L3) vertebra. Analysis of demographic characteristics of participants at baseline used 1-way ANOVA and χ2 tests, and repeated-measures ANOVA was used to analyze experimental data. In addition, 10 machine-learning classification models were used to calculate if these participants could reverse the degree of sarcopenia after the intervention.</p><p><strong>Results: </strong>A significant interaction effect was found in skeletal muscle density at the L3 vertebra, skeletal muscle area at the L3 vertebra (L3 SMA), grip strength, muscle fat infiltration, and relative skeletal muscle mass index (all P values were <.05). Grip strength, relative skeletal muscle mass index, and L3 SMA were significantly improved after the intervention for participants in the TCSG and STG (all P values were <.05). After post hoc tests, we found that participants in the TCSG experienced a better effect on L3 SMA than those in the STG and participants in the control group. The LightGBM classification model had the greatest performance in accuracy (88.4%), recall score (74%), and F1-score (76.1%).</p><p><strong>Conclusions: </strong>The skeletal muscle area of older adults with sarcopenia may be improved by a hybrid exercise program composed of strength training and tai chi. In addition, we identified that the LightGBM classification model had the best performance to predict the reversion of sarcopenia.</p>","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"7 ","pages":"e58175"},"PeriodicalIF":5.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11587998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p><strong>Background: </strong>Health care systems are increasingly encouraging patients to use patient portals and participate in video visits. However, there is limited information about how portal use differs among older adults.</p><p><strong>Objective: </strong>This study aimed to understand how patient portal and video visit use differed by age, race, and ethnicity among older adult patients with access to the same digital health resources.</p><p><strong>Methods: </strong>This cross-sectional study used electronic health record and survey data for adults aged 65 to 85 years who were members of a large Northern California health care delivery system throughout 2019 and 2020. The electronic health record cohort (N=471,152) included 320,686 White, 35,892 Black, 44,922 Latino, 20,786 Chinese, 28,732 Filipino, 8473 South Asian, 6716 Japanese, 2930 Vietnamese, and 2015 Korean adults. Racial and ethnic group and age group (65 to 75 years vs 76 to 85 years) differences in having a patient portal account by December 2020, the performance of 2 portal activities (sending ≥1 message to a clinician in 2019 or 2020 and viewing ≥1 laboratory test result in 2020), and having ≥1 video visit during 2020 were examined. Modified log-Poisson regression was used to examine prevalence ratios for portal and video visit use, comparing racial and ethnic groups to White adults and Asian ethnic groups to Chinese adults after adjusting for sex and age. Data from a 2020 member survey were used to compare internet use factors among 2867 White, 306 Black, 343 Latino, 225 Chinese, and 242 Filipino adults.</p><p><strong>Results: </strong>Black, Latino, and Filipino adults were less likely to have a patient portal account than White adults, and Filipino adults were less likely to have a patient portal account than Chinese adults. Black, Latino, Filipino, Korean, Vietnamese, and South Asian adults were less likely to have sent messages and viewed test results than White adults, while Chinese and Japanese adults' use of these features was similar to that of White adults. Filipino, Vietnamese, and Korean adults were less likely to have performed the aforementioned activities than Chinese adults. Video visit use was lower among Black and Latino adults and higher among Chinese and South Asian adults compared with White adults (aged 76 to 85 years) and lower among Filipino, Korean, and Vietnamese adults compared to Chinese adults. Survey data suggested that underlying differences in internet use may partially explain the lower use of messaging by Black, Latino, and Filipino adults compared with White and Chinese adults.</p><p><strong>Conclusions: </strong>Patient portal and video visit use differed by race, ethnicity, and age group among older adult patients with access to the same patient portal. Internet use factors may contribute to these differences. Differences in patient portal and video visit use across Asian subgroups underscore the importance of disaggregating use data by
{"title":"Examining Whether Patient Portal and Video Visit Use Differs by Race and Ethnicity Among Older Adults in a US Integrated Health Care Delivery System: Cross-Sectional Electronic Health Record and Survey-Based Study.","authors":"Nancy P Gordon, Chelsea Yin, Joan C Lo","doi":"10.2196/63814","DOIUrl":"10.2196/63814","url":null,"abstract":"<p><strong>Background: </strong>Health care systems are increasingly encouraging patients to use patient portals and participate in video visits. However, there is limited information about how portal use differs among older adults.</p><p><strong>Objective: </strong>This study aimed to understand how patient portal and video visit use differed by age, race, and ethnicity among older adult patients with access to the same digital health resources.</p><p><strong>Methods: </strong>This cross-sectional study used electronic health record and survey data for adults aged 65 to 85 years who were members of a large Northern California health care delivery system throughout 2019 and 2020. The electronic health record cohort (N=471,152) included 320,686 White, 35,892 Black, 44,922 Latino, 20,786 Chinese, 28,732 Filipino, 8473 South Asian, 6716 Japanese, 2930 Vietnamese, and 2015 Korean adults. Racial and ethnic group and age group (65 to 75 years vs 76 to 85 years) differences in having a patient portal account by December 2020, the performance of 2 portal activities (sending ≥1 message to a clinician in 2019 or 2020 and viewing ≥1 laboratory test result in 2020), and having ≥1 video visit during 2020 were examined. Modified log-Poisson regression was used to examine prevalence ratios for portal and video visit use, comparing racial and ethnic groups to White adults and Asian ethnic groups to Chinese adults after adjusting for sex and age. Data from a 2020 member survey were used to compare internet use factors among 2867 White, 306 Black, 343 Latino, 225 Chinese, and 242 Filipino adults.</p><p><strong>Results: </strong>Black, Latino, and Filipino adults were less likely to have a patient portal account than White adults, and Filipino adults were less likely to have a patient portal account than Chinese adults. Black, Latino, Filipino, Korean, Vietnamese, and South Asian adults were less likely to have sent messages and viewed test results than White adults, while Chinese and Japanese adults' use of these features was similar to that of White adults. Filipino, Vietnamese, and Korean adults were less likely to have performed the aforementioned activities than Chinese adults. Video visit use was lower among Black and Latino adults and higher among Chinese and South Asian adults compared with White adults (aged 76 to 85 years) and lower among Filipino, Korean, and Vietnamese adults compared to Chinese adults. Survey data suggested that underlying differences in internet use may partially explain the lower use of messaging by Black, Latino, and Filipino adults compared with White and Chinese adults.</p><p><strong>Conclusions: </strong>Patient portal and video visit use differed by race, ethnicity, and age group among older adult patients with access to the same patient portal. Internet use factors may contribute to these differences. Differences in patient portal and video visit use across Asian subgroups underscore the importance of disaggregating use data by","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"7 ","pages":"e63814"},"PeriodicalIF":5.0,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11582487/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shahabeddin Abhari, Josephine McMurray, Tanveer Randhawa, Gaya Bin Noon, Thokozani Hanjahanja-Phiri, Heather McNeil, Fiona Manning, Patricia Debergue, Jennifer Teague, Plinio Pelegrini Morita
<p><strong>Background: </strong>AgeTech (technology for older people) offers digital solutions for older adults supporting aging in place, including digital health, assistive technology, Internet of Things, medical devices, robotics, wearables, and sensors. This study underscores the critical role of standards and guidelines in ensuring the safety and effectiveness of these technologies for the health of older adults. As the aging demographic expands, the focus on robust standards becomes vital, reflecting a collective commitment to improving the overall quality of life for older individuals through thoughtful and secure technology integration.</p><p><strong>Objective: </strong>This scoping review aims to investigate the current state of standards and guidelines applied in AgeTech design and development as reported in academic literature. We explore the existing knowledge of these standards and guidelines and identify key gaps in the design and development of AgeTech guidelines and standards in scholarly publications.</p><p><strong>Methods: </strong>The literature review adhered to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Searches were carried out across multiple databases, including Scopus, IEEE, PubMed, Web of Science, EBSCO, CINAHL, Cochrane, and Google Scholar, using a search string incorporating concepts such as "older people," "technology," and "standards or guidelines." Alternative terms, Boolean operators, and truncation were used for comprehensive coverage in each database. The synthesis of results and data analysis involved both quantitative and qualitative methods.</p><p><strong>Results: </strong>Initially, 736 documents were identified across various databases. After applying specific inclusion and exclusion criteria and a screening process, 58 documents were selected for full-text review. The findings highlight that the most frequently addressed aspect of AgeTech standards or guidelines is related to "design and development," constituting 36% (21/58) of the literature; "usability and user experience" was the second most prevalent aspect, accounting for 19% (11/58) of the documents. In contrast, "privacy and security" (1/58, 2%) and "data quality" (1/58, 2%) were the least addressed aspects. Similarly, "ethics," "integration and interoperability," "accessibility," and "acceptance or adoption" each accounted for 3% (2/58) of the documents. In addition, a thematic analysis identified qualitative themes that warrant further exploration of variables.</p><p><strong>Conclusions: </strong>This study investigated the available knowledge regarding standards and guidelines in AgeTech design and development to evaluate their current status in academic literature. The substantial focus on assistive technologies and ambient assisted living technologies confirmed their vital role in AgeTech. The findings provide valuable insights for interested parties and point to
{"title":"Exploring the Landscape of Standards and Guidelines in AgeTech Design and Development: Scoping Review and Thematic Analysis.","authors":"Shahabeddin Abhari, Josephine McMurray, Tanveer Randhawa, Gaya Bin Noon, Thokozani Hanjahanja-Phiri, Heather McNeil, Fiona Manning, Patricia Debergue, Jennifer Teague, Plinio Pelegrini Morita","doi":"10.2196/58196","DOIUrl":"10.2196/58196","url":null,"abstract":"<p><strong>Background: </strong>AgeTech (technology for older people) offers digital solutions for older adults supporting aging in place, including digital health, assistive technology, Internet of Things, medical devices, robotics, wearables, and sensors. This study underscores the critical role of standards and guidelines in ensuring the safety and effectiveness of these technologies for the health of older adults. As the aging demographic expands, the focus on robust standards becomes vital, reflecting a collective commitment to improving the overall quality of life for older individuals through thoughtful and secure technology integration.</p><p><strong>Objective: </strong>This scoping review aims to investigate the current state of standards and guidelines applied in AgeTech design and development as reported in academic literature. We explore the existing knowledge of these standards and guidelines and identify key gaps in the design and development of AgeTech guidelines and standards in scholarly publications.</p><p><strong>Methods: </strong>The literature review adhered to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Searches were carried out across multiple databases, including Scopus, IEEE, PubMed, Web of Science, EBSCO, CINAHL, Cochrane, and Google Scholar, using a search string incorporating concepts such as \"older people,\" \"technology,\" and \"standards or guidelines.\" Alternative terms, Boolean operators, and truncation were used for comprehensive coverage in each database. The synthesis of results and data analysis involved both quantitative and qualitative methods.</p><p><strong>Results: </strong>Initially, 736 documents were identified across various databases. After applying specific inclusion and exclusion criteria and a screening process, 58 documents were selected for full-text review. The findings highlight that the most frequently addressed aspect of AgeTech standards or guidelines is related to \"design and development,\" constituting 36% (21/58) of the literature; \"usability and user experience\" was the second most prevalent aspect, accounting for 19% (11/58) of the documents. In contrast, \"privacy and security\" (1/58, 2%) and \"data quality\" (1/58, 2%) were the least addressed aspects. Similarly, \"ethics,\" \"integration and interoperability,\" \"accessibility,\" and \"acceptance or adoption\" each accounted for 3% (2/58) of the documents. In addition, a thematic analysis identified qualitative themes that warrant further exploration of variables.</p><p><strong>Conclusions: </strong>This study investigated the available knowledge regarding standards and guidelines in AgeTech design and development to evaluate their current status in academic literature. The substantial focus on assistive technologies and ambient assisted living technologies confirmed their vital role in AgeTech. The findings provide valuable insights for interested parties and point to","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"7 ","pages":"e58196"},"PeriodicalIF":5.0,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11565081/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lynne M Cotter, Dhavan Shah, Kaitlyn Brown, Marie-Louise Mares, Gina Landucci, Sydney Saunders, Darcie C Johnston, Klaren Pe-Romashko, David Gustafson, Adam Maus, Kasey Thompson, David H Gustafson
Background: Older adults adopt and use eHealth systems to build autonomy, competence, and relatedness and engage in healthy behaviors. The motivational technology model posits that technology features, such as those on websites, smart displays, and mobile phones, must allow for navigability, interactivity, and customizability, which spur feelings of self-determination and intrinsic motivation. We studied ElderTree, an online system for older adults that provides on-demand videos of healthy living content, self-monitoring, and weekly researcher-hosted video meetings.
Objective: We aimed to understand the theoretical crossover between the motivational technology model and self-determination theory using features of ElderTree to understand the usability of the technology and how it may support older adults' autonomy, competence, and relatedness.
Methods: Drawing participants from a randomized controlled trial of a mobile health app for older adults with multiple chronic conditions, we conducted qualitative interviews with 22 older adults about their use of the app; the interviews were coded using qualitative thematic analysis.
Results: Older adults did find that features within ElderTree such as content available on demand, good navigation, and weekly researcher-led video calls supported feelings of autonomy, competence, and relatedness, respectively. Individual differences such as a background using computers also influenced participants' experiences with the smart displays.
Conclusions: Participants confirmed the features that increased internal motivation, such as interactivity correlating with feelings of relatedness, but they also found other ways to support autonomous health behavior change beyond narrow views of navigability, interactivity, and customization.
{"title":"Decoding the Influence of eHealth on Autonomy, Competence, and Relatedness in Older Adults: Qualitative Analysis of Self-Determination Through the Motivational Technology Model.","authors":"Lynne M Cotter, Dhavan Shah, Kaitlyn Brown, Marie-Louise Mares, Gina Landucci, Sydney Saunders, Darcie C Johnston, Klaren Pe-Romashko, David Gustafson, Adam Maus, Kasey Thompson, David H Gustafson","doi":"10.2196/56923","DOIUrl":"10.2196/56923","url":null,"abstract":"<p><strong>Background: </strong>Older adults adopt and use eHealth systems to build autonomy, competence, and relatedness and engage in healthy behaviors. The motivational technology model posits that technology features, such as those on websites, smart displays, and mobile phones, must allow for navigability, interactivity, and customizability, which spur feelings of self-determination and intrinsic motivation. We studied ElderTree, an online system for older adults that provides on-demand videos of healthy living content, self-monitoring, and weekly researcher-hosted video meetings.</p><p><strong>Objective: </strong>We aimed to understand the theoretical crossover between the motivational technology model and self-determination theory using features of ElderTree to understand the usability of the technology and how it may support older adults' autonomy, competence, and relatedness.</p><p><strong>Methods: </strong>Drawing participants from a randomized controlled trial of a mobile health app for older adults with multiple chronic conditions, we conducted qualitative interviews with 22 older adults about their use of the app; the interviews were coded using qualitative thematic analysis.</p><p><strong>Results: </strong>Older adults did find that features within ElderTree such as content available on demand, good navigation, and weekly researcher-led video calls supported feelings of autonomy, competence, and relatedness, respectively. Individual differences such as a background using computers also influenced participants' experiences with the smart displays.</p><p><strong>Conclusions: </strong>Participants confirmed the features that increased internal motivation, such as interactivity correlating with feelings of relatedness, but they also found other ways to support autonomous health behavior change beyond narrow views of navigability, interactivity, and customization.</p>","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"7 ","pages":"e56923"},"PeriodicalIF":8.3,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11561439/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Boris Wernli, Henk Verloo, Armin von Gunten, Filipa Pereira
<p><strong>Background: </strong>Frailty is a widespread geriatric syndrome among older adults, including hospitalized older inpatients. Some countries use electronic frailty measurement tools to identify frailty at the primary care level, but this method has rarely been investigated during hospitalization in acute care hospitals. An electronic frailty measurement instrument based on population-based hospital electronic health records could effectively detect frailty, frailty-related problems, and complications as well be a clinical alert. Identifying frailty among older adults using existing patient health data would greatly aid the management and support of frailty identification and could provide a valuable public health instrument without additional costs.</p><p><strong>Objective: </strong>We aim to explore a data-driven frailty measurement instrument for older adult inpatients using data routinely collected at hospital admission and discharge.</p><p><strong>Methods: </strong>A retrospective electronic patient register study included inpatients aged ≥65 years admitted to and discharged from a public hospital between 2015 and 2017. A dataset of 53,690 hospitalizations was used to customize this data-driven frailty measurement instrument inspired by the Edmonton Frailty Scale developed by Rolfson et al. A 2-step hierarchical cluster procedure was applied to compute e-Frail-CH (Switzerland) scores at hospital admission and discharge. Prevalence, central tendency, comparative, and validation statistics were computed.</p><p><strong>Results: </strong>Mean patient age at admission was 78.4 (SD 7.9) years, with more women admitted (28,018/53,690, 52.18%) than men (25,672/53,690, 47.81%). Our 2-step hierarchical clustering approach computed 46,743 inputs of hospital admissions and 47,361 for discharges. Clustering solutions scored from 0.5 to 0.8 on a scale from 0 to 1. Patients considered frail comprised 42.02% (n=19,643) of admissions and 48.23% (n=22,845) of discharges. Within e-Frail-CH's 0-12 range, a score ≥6 indicated frailty. We found a statistically significant mean e-Frail-CH score change between hospital admission (5.3, SD 2.6) and discharge (5.75, SD 2.7; P<.001). Sensitivity and specificity cut point values were 0.82 and 0.88, respectively. The area under the receiver operating characteristic curve was 0.85. Comparing the e-Frail-CH instrument to the existing Functional Independence Measure (FIM) instrument, FIM scores indicating severe dependence equated to e-Frail-CH scores of ≥9, with a sensitivity and specificity of 0.97 and 0.88, respectively. The area under the receiver operating characteristic curve was 0.92. There was a strong negative association between e-Frail-CH scores at hospital discharge and FIM scores (r<sub>s</sub>=-0.844; P<.001).</p><p><strong>Conclusions: </strong>An electronic frailty measurement instrument was constructed and validated using patient data routinely collected during hospitalization, especially at admiss
{"title":"Using Existing Clinical Data to Measure Older Adult Inpatients' Frailty at Admission and Discharge: Hospital Patient Register Study.","authors":"Boris Wernli, Henk Verloo, Armin von Gunten, Filipa Pereira","doi":"10.2196/54839","DOIUrl":"10.2196/54839","url":null,"abstract":"<p><strong>Background: </strong>Frailty is a widespread geriatric syndrome among older adults, including hospitalized older inpatients. Some countries use electronic frailty measurement tools to identify frailty at the primary care level, but this method has rarely been investigated during hospitalization in acute care hospitals. An electronic frailty measurement instrument based on population-based hospital electronic health records could effectively detect frailty, frailty-related problems, and complications as well be a clinical alert. Identifying frailty among older adults using existing patient health data would greatly aid the management and support of frailty identification and could provide a valuable public health instrument without additional costs.</p><p><strong>Objective: </strong>We aim to explore a data-driven frailty measurement instrument for older adult inpatients using data routinely collected at hospital admission and discharge.</p><p><strong>Methods: </strong>A retrospective electronic patient register study included inpatients aged ≥65 years admitted to and discharged from a public hospital between 2015 and 2017. A dataset of 53,690 hospitalizations was used to customize this data-driven frailty measurement instrument inspired by the Edmonton Frailty Scale developed by Rolfson et al. A 2-step hierarchical cluster procedure was applied to compute e-Frail-CH (Switzerland) scores at hospital admission and discharge. Prevalence, central tendency, comparative, and validation statistics were computed.</p><p><strong>Results: </strong>Mean patient age at admission was 78.4 (SD 7.9) years, with more women admitted (28,018/53,690, 52.18%) than men (25,672/53,690, 47.81%). Our 2-step hierarchical clustering approach computed 46,743 inputs of hospital admissions and 47,361 for discharges. Clustering solutions scored from 0.5 to 0.8 on a scale from 0 to 1. Patients considered frail comprised 42.02% (n=19,643) of admissions and 48.23% (n=22,845) of discharges. Within e-Frail-CH's 0-12 range, a score ≥6 indicated frailty. We found a statistically significant mean e-Frail-CH score change between hospital admission (5.3, SD 2.6) and discharge (5.75, SD 2.7; P<.001). Sensitivity and specificity cut point values were 0.82 and 0.88, respectively. The area under the receiver operating characteristic curve was 0.85. Comparing the e-Frail-CH instrument to the existing Functional Independence Measure (FIM) instrument, FIM scores indicating severe dependence equated to e-Frail-CH scores of ≥9, with a sensitivity and specificity of 0.97 and 0.88, respectively. The area under the receiver operating characteristic curve was 0.92. There was a strong negative association between e-Frail-CH scores at hospital discharge and FIM scores (r<sub>s</sub>=-0.844; P<.001).</p><p><strong>Conclusions: </strong>An electronic frailty measurement instrument was constructed and validated using patient data routinely collected during hospitalization, especially at admiss","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"7 ","pages":"e54839"},"PeriodicalIF":5.0,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11555450/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142523265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: China's rapidly aging population necessitates effective strategies for ensuring older adults' quality of life (QOL). While individual factors (IF) and family factors (FF) are known to influence QOL, existing research often examines these factors in isolation or focuses on specific subpopulations, overlooking potential interactions and mediating pathways.
Objective: This study aims to examine both direct and indirect pathways connecting IF and FF to older adults' QOL, focusing on the mediating roles of health risks (HR) and health care service demand (HSD).
Methods: This study uses structural equation modeling (SEM) to analyze cross-sectional data from 8600 older participants in the 2015 China Health and Retirement Longitudinal Study (CHARLS), a nationally representative study using a multistage probability proportional to size sampling method.
Results: Among the 8600 participants, the majority (5586/8502, 65.7%) were aged 60-70 years, with a near-equal distribution of males and females at around 50%. The average PCS score was 76.77, while the MCS score averaged 59.70. Both IF (β=0.165, P<.001) and FF (β=0.189, P<.001) had a direct positive effect on QOL. Furthermore, the indirect effects of IF (β=0.186, P<.001) and FF (β=0.211, P<.001) through HR and HSD were also significant. In the direct model, IF and FF had a greater impact on MCS (β=0.841) than on PCS (β=0.639). However, after including the 2 mediating factors, HR and HSD, the influence of IF and FF on MCS (β=0.739) became consistent with that on PCS (β=0.728). Subgroup analyses revealed that the direct effect of IF on QOL was significant in the 60-70 age group (β=0.151, P<.001) but not in those over 70 years old (β=0.122, P=.074). Comorbidity status significantly influenced the pathway from HR to HSD, with older adults having 2 or more chronic diseases (β=0.363) showing a greater impact compared to those with fewer than 2 chronic diseases (β=0.358).
Conclusions: Both IF (education, per capita disposable income, and endowment insurance) and FF (satisfaction with a spouse and children) directly impact the QOL in older people. Meanwhile, IF and FF have equal influence on QOL through the mediating role of HR and HSD. Recognizing the interplay among these factors is crucial for targeted interventions to enhance the well-being of older adults in China.
背景：中国人口迅速老龄化，需要采取有效策略确保老年人的生活质量（QOL）。众所周知，个人因素（IF）和家庭因素（FF）会影响老年人的生活质量，但现有研究往往孤立地研究这些因素，或只关注特定的亚人群，而忽略了潜在的相互作用和中介途径：本研究旨在探讨 IF 和 FF 与老年人 QOL 之间的直接和间接联系，重点关注健康风险（HR）和医疗服务需求（HSD）的中介作用：本研究采用结构方程模型（SEM）分析了2015年中国健康与退休纵向研究（CHARLS）中8600名老年参与者的横断面数据：在8600名参与者中，大多数（5586/8502，65.7%）年龄在60-70岁之间，男女比例接近均等，约为50%。PCS 平均分为 76.77 分，而 MCS 平均分为 59.70 分。两个 IF（β=0.165，PConclusions：IF（教育、人均可支配收入和捐赠保险）和 FF（对配偶和子女的满意度）都直接影响老年人的 QOL。同时，通过 HR 和 HSD 的中介作用，IF 和 FF 对 QOL 具有同等影响。认识到这些因素之间的相互作用对于采取有针对性的干预措施以提高中国老年人的幸福感至关重要。
{"title":"Interrelationships Among Individual Factors, Family Factors, and Quality of Life in Older Chinese Adults: Cross-Sectional Study Using Structural Equation Modeling.","authors":"Yuting Wu, Cong Gong, Lifang Pi, Meixin Zheng, Weifang Liu, Yamei Wang","doi":"10.2196/59818","DOIUrl":"10.2196/59818","url":null,"abstract":"<p><strong>Background: </strong>China's rapidly aging population necessitates effective strategies for ensuring older adults' quality of life (QOL). While individual factors (IF) and family factors (FF) are known to influence QOL, existing research often examines these factors in isolation or focuses on specific subpopulations, overlooking potential interactions and mediating pathways.</p><p><strong>Objective: </strong>This study aims to examine both direct and indirect pathways connecting IF and FF to older adults' QOL, focusing on the mediating roles of health risks (HR) and health care service demand (HSD).</p><p><strong>Methods: </strong>This study uses structural equation modeling (SEM) to analyze cross-sectional data from 8600 older participants in the 2015 China Health and Retirement Longitudinal Study (CHARLS), a nationally representative study using a multistage probability proportional to size sampling method.</p><p><strong>Results: </strong>Among the 8600 participants, the majority (5586/8502, 65.7%) were aged 60-70 years, with a near-equal distribution of males and females at around 50%. The average PCS score was 76.77, while the MCS score averaged 59.70. Both IF (β=0.165, P<.001) and FF (β=0.189, P<.001) had a direct positive effect on QOL. Furthermore, the indirect effects of IF (β=0.186, P<.001) and FF (β=0.211, P<.001) through HR and HSD were also significant. In the direct model, IF and FF had a greater impact on MCS (β=0.841) than on PCS (β=0.639). However, after including the 2 mediating factors, HR and HSD, the influence of IF and FF on MCS (β=0.739) became consistent with that on PCS (β=0.728). Subgroup analyses revealed that the direct effect of IF on QOL was significant in the 60-70 age group (β=0.151, P<.001) but not in those over 70 years old (β=0.122, P=.074). Comorbidity status significantly influenced the pathway from HR to HSD, with older adults having 2 or more chronic diseases (β=0.363) showing a greater impact compared to those with fewer than 2 chronic diseases (β=0.358).</p><p><strong>Conclusions: </strong>Both IF (education, per capita disposable income, and endowment insurance) and FF (satisfaction with a spouse and children) directly impact the QOL in older people. Meanwhile, IF and FF have equal influence on QOL through the mediating role of HR and HSD. Recognizing the interplay among these factors is crucial for targeted interventions to enhance the well-being of older adults in China.</p>","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"7 ","pages":"e59818"},"PeriodicalIF":5.0,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11555452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142523264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Huitong Ding, Kristi Ho, Edward Searls, Spencer Low, Zexu Li, Salman Rahman, Sanskruti Madan, Akwaugo Igwe, Zachary Popp, Alexa Burk, Huanmei Wu, Ying Ding, Phillip H Hwang, Ileana De Anda-Duran, Vijaya B Kolachalama, Katherine A Gifford, Ludy C Shih, Rhoda Au, Honghuang Lin
Background: Physical activity has emerged as a modifiable behavioral factor to improve cognitive function. However, research on adherence to remote monitoring of physical activity in older adults is limited.
Objective: This study aimed to assess adherence to remote monitoring of physical activity in older adults within a pilot cohort from objective user data, providing insights for the scalability of such monitoring approaches in larger, more comprehensive future studies.
Methods: This study included 22 participants from the Boston University Alzheimer's Disease Research Center Clinical Core. These participants opted into wearing the Verisense watch as part of their everyday routine during 14-day intervals every 3 months. Eighteen continuous physical activity measures were assessed. Adherence was quantified daily and cumulatively across the follow-up period. The coefficient of variation was used as a key metric to assess data consistency across participants over multiple days. Day-to-day variability was estimated by calculating intraclass correlation coefficients using a 2-way random-effects model for the baseline, second, and third days.
Results: Adherence to the study on a daily basis outperformed cumulative adherence levels. The median proportion of adherence days (wearing time surpassed 90% of the day) stood at 92.1%, with an IQR spanning from 86.9% to 98.4%. However, at the cumulative level, 32% (7/22) of participants in this study exhibited lower adherence, with the device worn on fewer than 4 days within the requested initial 14-day period. Five physical activity measures have high variability for some participants. Consistent activity data for 4 physical activity measures might be attainable with just a 3-day period of device use.
Conclusions: This study revealed that while older adults generally showed high daily adherence to the wearable device, consistent usage across consecutive days proved difficult. These findings underline the effectiveness of wearables in monitoring physical activity in older populations and emphasize the ongoing necessity to simplify usage protocols and enhance user engagement to guarantee the collection of precise and comprehensive data.
{"title":"Assessment of Wearable Device Adherence for Monitoring Physical Activity in Older Adults: Pilot Cohort Study.","authors":"Huitong Ding, Kristi Ho, Edward Searls, Spencer Low, Zexu Li, Salman Rahman, Sanskruti Madan, Akwaugo Igwe, Zachary Popp, Alexa Burk, Huanmei Wu, Ying Ding, Phillip H Hwang, Ileana De Anda-Duran, Vijaya B Kolachalama, Katherine A Gifford, Ludy C Shih, Rhoda Au, Honghuang Lin","doi":"10.2196/60209","DOIUrl":"10.2196/60209","url":null,"abstract":"<p><strong>Background: </strong>Physical activity has emerged as a modifiable behavioral factor to improve cognitive function. However, research on adherence to remote monitoring of physical activity in older adults is limited.</p><p><strong>Objective: </strong>This study aimed to assess adherence to remote monitoring of physical activity in older adults within a pilot cohort from objective user data, providing insights for the scalability of such monitoring approaches in larger, more comprehensive future studies.</p><p><strong>Methods: </strong>This study included 22 participants from the Boston University Alzheimer's Disease Research Center Clinical Core. These participants opted into wearing the Verisense watch as part of their everyday routine during 14-day intervals every 3 months. Eighteen continuous physical activity measures were assessed. Adherence was quantified daily and cumulatively across the follow-up period. The coefficient of variation was used as a key metric to assess data consistency across participants over multiple days. Day-to-day variability was estimated by calculating intraclass correlation coefficients using a 2-way random-effects model for the baseline, second, and third days.</p><p><strong>Results: </strong>Adherence to the study on a daily basis outperformed cumulative adherence levels. The median proportion of adherence days (wearing time surpassed 90% of the day) stood at 92.1%, with an IQR spanning from 86.9% to 98.4%. However, at the cumulative level, 32% (7/22) of participants in this study exhibited lower adherence, with the device worn on fewer than 4 days within the requested initial 14-day period. Five physical activity measures have high variability for some participants. Consistent activity data for 4 physical activity measures might be attainable with just a 3-day period of device use.</p><p><strong>Conclusions: </strong>This study revealed that while older adults generally showed high daily adherence to the wearable device, consistent usage across consecutive days proved difficult. These findings underline the effectiveness of wearables in monitoring physical activity in older populations and emphasize the ongoing necessity to simplify usage protocols and enhance user engagement to guarantee the collection of precise and comprehensive data.</p>","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"7 ","pages":"e60209"},"PeriodicalIF":5.0,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11530080/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142509605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p><strong>Background: </strong>Growing evidence suggests cognitive and social health benefits can be derived from digital storytelling for older adults with cognitive impairment. Digital storytelling apps offer the potential to serve as an on-demand, easy-to-access platform for enhancing cognitive abilities and promoting social well-being. Yet, despite the increasing quantity of such apps being available on the market, there is a gap in research investigating their quality.</p><p><strong>Objective: </strong>This app review aims to assess the digital storytelling apps available in the Chinese market and evaluate them in accordance with the Mobile Application Rating Scale (MARS). The goal was to identify key features and evaluate the overall quality in the context of cognitively impaired users.</p><p><strong>Methods: </strong>A systematic search was conducted in both the Google Play store (Google LLC) and iTunes store (Apple Inc), using English and Chinese keywords. Apps were chosen according to specific criteria that included features, including (but not limited to) memory capture, story saving, cue-based reminiscing, and the ability to share stories or memories with others. The MARS was used by 3 individual researchers to independently assess app quality across several domains, such as engagement, functionality, aesthetics, and information quality, for both Android and iOS apps.</p><p><strong>Results: </strong>From an initial screening of 297 apps, only 9 (3%) met the criteria for detailed evaluation using MARS. The reviewed apps featured capture memory, save, reminisce, and share functions, which are critical in supporting cognitive functions and enhancing user engagement. The analysis revealed patterns in platform diversity and geographical distribution of developers, with apps available on both iOS and Android. Memoirs of Life and Memorize: Diaries, Memories, Notes, Ideas, Timelines, Categories (Fair Apps Mobile) had the highest mean MARS scores of 3.35, indicating strong engagement, functionality, and information quality, while the lowest score was 2.33. The overall mean score across all apps was only 3.03 (SD 0.60), highlighting significant variation, particularly in information quality. User feedback also showed considerable variability, ranging from 0 comments for apps such as Grand Storyteller (VarIT Inc) and PWI Storyteller (Project World Impact, LLC) to as many as 5361 comments for FamilySearch, which received extensive positive reviews. This wide range of user feedback underscores the importance of continuous improvement and user-centered design, particularly in enhancing information quality and content accuracy.</p><p><strong>Conclusions: </strong>The systematic search and evaluation highlight the diverse capabilities yet variable quality of digital storytelling apps available within the Chinese market, reflecting user experiences, satisfaction levels, and efficacy in supporting cognitively impaired users. While some apps excel in en
背景：越来越多的证据表明，数字故事可以为有认知障碍的老年人带来认知和社会健康方面的益处。数字故事应用程序有可能成为一个按需使用、易于访问的平台，用于提高认知能力和促进社会福祉。然而，尽管市场上此类应用程序的数量越来越多，但对其质量的调查研究却存在空白：本应用程序综述旨在评估中国市场上的数字故事应用程序，并根据移动应用程序评级量表（MARS）对其进行评价。目的：本应用程序综述旨在评估中国市场上的数字故事应用程序，并根据《移动应用程序评分表》（MARS）对其进行评价。目标是确定关键功能，并评估认知障碍用户的整体质量：使用中英文关键词在 Google Play 商店（Google LLC）和 iTunes 商店（Apple Inc）进行了系统搜索。选择应用程序的具体标准包括功能，包括（但不限于）记忆捕捉、故事保存、基于线索的回忆以及与他人分享故事或记忆的能力。3 位研究人员使用 MARS 对安卓和 iOS 应用程序的参与度、功能、美观度和信息质量等多个方面进行了独立评估：在初步筛选的 297 个应用程序中，只有 9 个（3%）符合使用 MARS 进行详细评估的标准。这些应用程序具有捕捉记忆、保存、回忆和分享功能，这些功能对于支持认知功能和提高用户参与度至关重要。分析显示了平台多样性和开发者地理分布的模式，iOS 和 Android 平台上都有应用程序。生活回忆录》和《记忆》：Diaries, Memories, Notes, Ideas, Timelines, Categories (Fair Apps Mobile)的MARS平均得分最高，达到3.35分，表明用户参与度高、功能强大、信息质量高，而得分最低的是2.33分。所有应用程序的总体平均得分仅为 3.03（标准差为 0.60），突出显示了显著的差异，尤其是在信息质量方面。用户反馈也显示出相当大的差异，从对 Grand Storyteller (VarIT Inc) 和 PWI Storyteller (Project World Impact, LLC) 等应用程序的 0 条评论到对 FamilySearch 的多达 5361 条评论，FamilySearch 获得了广泛的好评。这种广泛的用户反馈强调了持续改进和以用户为中心的设计的重要性，尤其是在提高信息质量和内容准确性方面：此次系统性搜索和评估凸显了中国市场上的数字故事应用程序功能多样但质量参差不齐，反映了用户体验、满意度以及在支持认知障碍用户方面的功效。有些应用程序在参与性和功能性方面表现出色，而另一些则需要在信息质量和用户界面设计方面进行重大改进，以便更好地为认知障碍者提供服务。建议今后开展研究，调查地区局限性和功能，从而开发出更具包容性和更有效的数字故事应用程序。
{"title":"Digital Storytelling for People With Cognitive Impairment Using Available Mobile Apps: Systematic Search in App Stores and Content Analysis.","authors":"Di Zhu, Abdullah Al Mahmud, Wei Liu, Dahua Wang","doi":"10.2196/64525","DOIUrl":"10.2196/64525","url":null,"abstract":"<p><strong>Background: </strong>Growing evidence suggests cognitive and social health benefits can be derived from digital storytelling for older adults with cognitive impairment. Digital storytelling apps offer the potential to serve as an on-demand, easy-to-access platform for enhancing cognitive abilities and promoting social well-being. Yet, despite the increasing quantity of such apps being available on the market, there is a gap in research investigating their quality.</p><p><strong>Objective: </strong>This app review aims to assess the digital storytelling apps available in the Chinese market and evaluate them in accordance with the Mobile Application Rating Scale (MARS). The goal was to identify key features and evaluate the overall quality in the context of cognitively impaired users.</p><p><strong>Methods: </strong>A systematic search was conducted in both the Google Play store (Google LLC) and iTunes store (Apple Inc), using English and Chinese keywords. Apps were chosen according to specific criteria that included features, including (but not limited to) memory capture, story saving, cue-based reminiscing, and the ability to share stories or memories with others. The MARS was used by 3 individual researchers to independently assess app quality across several domains, such as engagement, functionality, aesthetics, and information quality, for both Android and iOS apps.</p><p><strong>Results: </strong>From an initial screening of 297 apps, only 9 (3%) met the criteria for detailed evaluation using MARS. The reviewed apps featured capture memory, save, reminisce, and share functions, which are critical in supporting cognitive functions and enhancing user engagement. The analysis revealed patterns in platform diversity and geographical distribution of developers, with apps available on both iOS and Android. Memoirs of Life and Memorize: Diaries, Memories, Notes, Ideas, Timelines, Categories (Fair Apps Mobile) had the highest mean MARS scores of 3.35, indicating strong engagement, functionality, and information quality, while the lowest score was 2.33. The overall mean score across all apps was only 3.03 (SD 0.60), highlighting significant variation, particularly in information quality. User feedback also showed considerable variability, ranging from 0 comments for apps such as Grand Storyteller (VarIT Inc) and PWI Storyteller (Project World Impact, LLC) to as many as 5361 comments for FamilySearch, which received extensive positive reviews. This wide range of user feedback underscores the importance of continuous improvement and user-centered design, particularly in enhancing information quality and content accuracy.</p><p><strong>Conclusions: </strong>The systematic search and evaluation highlight the diverse capabilities yet variable quality of digital storytelling apps available within the Chinese market, reflecting user experiences, satisfaction levels, and efficacy in supporting cognitively impaired users. While some apps excel in en","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"7 ","pages":"e64525"},"PeriodicalIF":5.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11544346/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142509666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Claire M Timon, Emma Heffernan, Sophia Kilcullen, Louise Hopper, Hyowon Lee, Pamela Gallagher, Alan F Smeaton, Kieran Moran, Pamela Hussey, Catriona Murphy
<p><strong>Background: </strong>The number of older people with unmet health care and support needs is increasing substantially due to the challenges facing health care systems worldwide. There are potentially great benefits to using the Internet of Things coupled with artificial intelligence to support independent living and the measurement of health risks, thus improving quality of life for the older adult population. Taking a co-design approach has the potential to ensure that these technological solutions are developed to address specific user needs and requirements.</p><p><strong>Objective: </strong>The aim of this study was to investigate stakeholders' perceptions of independent living and technology solutions, identify stakeholders' suggestions on how technology could assist older adults to live independently, and explore the acceptability and usefulness of a prototype Internet of Things solution called the NEX system to support independent living for an older adult population.</p><p><strong>Methods: </strong>The development of the NEX system was carried out in 3 key phases with a strong focus on diverse stakeholder involvement. The initial predesign exploratory phase recruited 17 stakeholders, including older adults and family caregivers, using fictitious personas and scenarios to explore initial perceptions of independent living and technology solutions. The subsequent co-design and testing phase expanded this to include a comprehensive web-based survey completed by 380 stakeholders, encompassing older adults, family caregivers, health care professionals, and home care support staff. This phase also included prototype testing at home by 7 older adults to assess technology needs, requirements, and the initial acceptability of the system. Finally, in the postdesign phase, workshops were held between academic and industry partners to analyze data collected from the earlier stages and to discuss recommendations for the future development of the system.</p><p><strong>Results: </strong>The predesign phase revealed 3 broad themes: loneliness and technology, aging and technology, and adopting and using technology. The co-design phase highlighted key areas where technology could assist older adults to live independently: home security, falls and loneliness, remote monitoring by family members, and communication with clients. Prototype testing revealed that the acceptability aspects of the prototype varied across technology types. Ambient sensors and voice-activated assistants were described as the most acceptable technology by participants. Last, the postdesign analysis process highlighted that ambient sensors have the potential for automatic detection of activities of daily living, resulting in key recommendations for future developments and deployments in this area.</p><p><strong>Conclusions: </strong>This study demonstrates the significance of incorporating diverse stakeholder perspectives in developing solutions that support independent livin
{"title":"Developing Independent Living Support for Older Adults Using Internet of Things and AI-Based Systems: Co-Design Study.","authors":"Claire M Timon, Emma Heffernan, Sophia Kilcullen, Louise Hopper, Hyowon Lee, Pamela Gallagher, Alan F Smeaton, Kieran Moran, Pamela Hussey, Catriona Murphy","doi":"10.2196/54210","DOIUrl":"10.2196/54210","url":null,"abstract":"<p><strong>Background: </strong>The number of older people with unmet health care and support needs is increasing substantially due to the challenges facing health care systems worldwide. There are potentially great benefits to using the Internet of Things coupled with artificial intelligence to support independent living and the measurement of health risks, thus improving quality of life for the older adult population. Taking a co-design approach has the potential to ensure that these technological solutions are developed to address specific user needs and requirements.</p><p><strong>Objective: </strong>The aim of this study was to investigate stakeholders' perceptions of independent living and technology solutions, identify stakeholders' suggestions on how technology could assist older adults to live independently, and explore the acceptability and usefulness of a prototype Internet of Things solution called the NEX system to support independent living for an older adult population.</p><p><strong>Methods: </strong>The development of the NEX system was carried out in 3 key phases with a strong focus on diverse stakeholder involvement. The initial predesign exploratory phase recruited 17 stakeholders, including older adults and family caregivers, using fictitious personas and scenarios to explore initial perceptions of independent living and technology solutions. The subsequent co-design and testing phase expanded this to include a comprehensive web-based survey completed by 380 stakeholders, encompassing older adults, family caregivers, health care professionals, and home care support staff. This phase also included prototype testing at home by 7 older adults to assess technology needs, requirements, and the initial acceptability of the system. Finally, in the postdesign phase, workshops were held between academic and industry partners to analyze data collected from the earlier stages and to discuss recommendations for the future development of the system.</p><p><strong>Results: </strong>The predesign phase revealed 3 broad themes: loneliness and technology, aging and technology, and adopting and using technology. The co-design phase highlighted key areas where technology could assist older adults to live independently: home security, falls and loneliness, remote monitoring by family members, and communication with clients. Prototype testing revealed that the acceptability aspects of the prototype varied across technology types. Ambient sensors and voice-activated assistants were described as the most acceptable technology by participants. Last, the postdesign analysis process highlighted that ambient sensors have the potential for automatic detection of activities of daily living, resulting in key recommendations for future developments and deployments in this area.</p><p><strong>Conclusions: </strong>This study demonstrates the significance of incorporating diverse stakeholder perspectives in developing solutions that support independent livin","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"7 ","pages":"e54210"},"PeriodicalIF":5.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11527418/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142509665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Remote programming enables physicians to adjust implantable pulse generators over the internet for patients with Parkinson disease who have undergone deep brain stimulation (DBS) surgery. Despite these technological advances, the demand for and attitudes toward remote programming compared with standard programming among patients with Parkinson disease are still not well understood.
Objective: This study aims to investigate the preferences and perceptions associated with these 2 programming methods among patients with Parkinson disease through a web-based survey.
Methods: A web-based survey was administered to 463 patients with Parkinson disease who have undergone DBS surgery. The survey aimed to assess the burdens associated with postoperative programming and to compare patients' attitudes toward the 2 different programming methods.
Results: A total of 225 patients completed the survey, all of whom had undergone standard programming, while 132 patients had also experienced remote programming. Among those who received standard programming, 191 (85%) patients required the support of more than 1 caregiver, 129 (58%) patients experienced over 2 days of lost work time, 98 (42%) patients incurred expenses ranging from US $42 to US $146, and 14 (6%) patients spent over US $421. Of the 132 patients who had used remote programming, 81 (62%) patients indicated a preference for remote programming in the future. However, challenges with remote programming persisted, including difficulties in obtaining official prescriptions, a lack of medical insurance coverage, and limited medical resources.
Conclusions: Postoperative programming of DBS imposes significant burdens on patients and their caregivers during standard programming sessions-burdens that could be mitigated through remote programming. While patient satisfaction with remote programming is high, it is imperative for clinicians to develop personalized programming strategies tailored to the needs of different patients.
{"title":"Comparison of the Burdens and Attitudes Between Standard and Web-Based Remote Programming for Deep Brain Stimulation in Parkinson Disease: Survey Study.","authors":"Xiaonan Wan, Zhengyu Lin, Chengcheng Duan, Zhitong Zeng, Chencheng Zhang, Dianyou Li","doi":"10.2196/57503","DOIUrl":"10.2196/57503","url":null,"abstract":"<p><strong>Background: </strong>Remote programming enables physicians to adjust implantable pulse generators over the internet for patients with Parkinson disease who have undergone deep brain stimulation (DBS) surgery. Despite these technological advances, the demand for and attitudes toward remote programming compared with standard programming among patients with Parkinson disease are still not well understood.</p><p><strong>Objective: </strong>This study aims to investigate the preferences and perceptions associated with these 2 programming methods among patients with Parkinson disease through a web-based survey.</p><p><strong>Methods: </strong>A web-based survey was administered to 463 patients with Parkinson disease who have undergone DBS surgery. The survey aimed to assess the burdens associated with postoperative programming and to compare patients' attitudes toward the 2 different programming methods.</p><p><strong>Results: </strong>A total of 225 patients completed the survey, all of whom had undergone standard programming, while 132 patients had also experienced remote programming. Among those who received standard programming, 191 (85%) patients required the support of more than 1 caregiver, 129 (58%) patients experienced over 2 days of lost work time, 98 (42%) patients incurred expenses ranging from US $42 to US $146, and 14 (6%) patients spent over US $421. Of the 132 patients who had used remote programming, 81 (62%) patients indicated a preference for remote programming in the future. However, challenges with remote programming persisted, including difficulties in obtaining official prescriptions, a lack of medical insurance coverage, and limited medical resources.</p><p><strong>Conclusions: </strong>Postoperative programming of DBS imposes significant burdens on patients and their caregivers during standard programming sessions-burdens that could be mitigated through remote programming. While patient satisfaction with remote programming is high, it is imperative for clinicians to develop personalized programming strategies tailored to the needs of different patients.</p>","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"7 ","pages":"e57503"},"PeriodicalIF":5.0,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11523762/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142509664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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