JMIR Aging最新文献

{"title":"Employers' Perspectives of Caregiver-Friendly Workplace Policies for Caregiver-Employees Caring for Older Adults in Hong Kong: Thematic Analysis.","authors":"Maggie Man-Sin Lee, Eng-Kiong Yeoh, Eliza Lai-Yi Wong","doi":"10.2196/68061","DOIUrl":"https://doi.org/10.2196/68061","url":null,"abstract":"<p><strong>Background: </strong>Caregiver-friendly workplace policies (CFWPs) are rare in Hong Kong. With Hong Kong facing a \"silver tsunami\" in the near future, it is important to understand the need for such policies and the views of employers for future facilitation.</p><p><strong>Objective: </strong>This study aimed to identify the support that is currently provided or that could be provided to caregiver-employees (CEs) caring for older adults in Hong Kong and assess the challenge and facilitative support for employers to adopt CFWPs in the specific context of Hong Kong.</p><p><strong>Methods: </strong>A qualitative research design with semistructured individual in-depth interviews with employers from Hong Kong was adopted for this study. A purposive snowball sampling method was used to recruit participants from the 7 primary industries mentioned in the Hong Kong census and from all 3 employer types (private, public, and nongovernmental organizations), which allowed the inclusion of participants sensitized to the idea and potential of CFWPs. Thematic framework analysis was used to evaluate the data collected during the interviews.</p><p><strong>Results: </strong>We interviewed 17 employers and managers from 7 major industries in Hong Kong (2.5 to 120,000 employees). There were 4 (24%) male and 13 (76%) female participants, and the participant age ranged from 30 to 50 years. All participants held managerial positions at the time of the interview. Of the 17 participants, 13 were from private companies, 2 were from public institutions, and 2 were from nongovernmental organizations. Four of the companies had a global presence. Four main themes were identified: (1) current support and potential support for CEs (which was limited to discretionary annual leave and unpaid leave when annual leave was exhausted), (2) challenges in adopting CFWPs, (3) facilitating support for adopting CFWPs, and (4) incentives for adopting CFWPs. The participants rated information and resources for CEs (mean 8.56, SD 0.37), bereavement leave (mean 8.47, SD 0.63), flexible working hours (mean 8.32, SD 0.48), and caregiver-inclusive corporate culture (mean 8.32, SD 0.48) as essential CFWPs for CEs in Hong Kong.</p><p><strong>Conclusions: </strong>While several studies have reported the types of CFWPs and their impacts on CEs, stakeholders' perspectives on CFWPs have been rarely investigated. This study found that although employers consider CFWPs as necessary and see them as a catalyst for a long-term win-win situation, the current support for CEs is discretionary and industry-specific. Government leadership is critical for formulating, piloting, and implementing CFWPs to create a friendly environment that encourages disclosure with trust and respect across industrial sectors in Hong Kong. This study identified the current unmet needs and demands of CEs from the employer's perspective, the barriers to large-scale adoption of CFWPs, and the path forward to inform further d","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"8 ","pages":"e68061"},"PeriodicalIF":5.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unsupervised Deep Learning of Electronic Health Records to Characterize Heterogeneity Across Alzheimer Disease and Related Dementias: Cross-Sectional Study.","authors":"Matthew West, You Cheng, Yingnan He, Yu Leng, Colin Magdamo, Bradley T Hyman, John R Dickson, Alberto Serrano-Pozo, Deborah Blacker, Sudeshna Das","doi":"10.2196/65178","DOIUrl":"https://doi.org/10.2196/65178","url":null,"abstract":"<p><strong>Background: </strong>Alzheimer disease and related dementias (ADRD) exhibit prominent heterogeneity. Identifying clinically meaningful ADRD subtypes is essential for tailoring treatments to specific patient phenotypes.</p><p><strong>Objective: </strong>We aimed to use unsupervised learning techniques on electronic health records (EHRs) from memory clinic patients to identify ADRD subtypes.</p><p><strong>Methods: </strong>We used pretrained embeddings of non-ADRD diagnosis codes (International Classification of Diseases, Ninth Revision) and large language model (LLM)-derived embeddings of clinical notes from patient EHRs. Hierarchical clustering of these embeddings was used to identify ADRD subtypes. Clusters were characterized regarding their demographic and clinical features.</p><p><strong>Results: </strong>We analyzed a cohort of 3454 patients with ADRD from a memory clinic at Massachusetts General Hospital, each with a specialist diagnosis. Clustering pretrained embeddings of the non-ADRD diagnosis codes in patient EHRs revealed the following 3 patient subtypes: one with skin conditions, another with psychiatric disorders and an earlier age of onset, and a third with diabetes complications. Similarly, using LLM-derived embeddings of clinical notes, we identified 3 subtypes of patients as follows: one with psychiatric manifestations and higher prevalence of female participants (prevalence ratio: 1.59), another with cardiovascular and motor problems and higher prevalence of male participants (prevalence ratio: 1.75), and a third one with geriatric health disorders. Notably, we observed significant overlap between clusters from both data modalities (χ²₄=89.4; P<.001).</p><p><strong>Conclusions: </strong>By integrating International Classification of Diseases, Ninth Revision codes and LLM-derived embeddings, our analysis delineated 2 distinct ADRD subtypes with sex-specific comorbid and clinical presentations, offering insights for potential precision medicine approaches.</p>","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"8 ","pages":"e65178"},"PeriodicalIF":5.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determinants of Telehealth Adoption Among Older Adults: Cross-Sectional Survey Study.","authors":"Siow-Hooi Tan, Yee-Yann Yap, Siow-Kian Tan, Chee-Kuan Wong","doi":"10.2196/60936","DOIUrl":"10.2196/60936","url":null,"abstract":"<p><strong>Background: </strong>The aging population and the accompanying rise in chronic diseases have intensified the need to study the adoption of telehealth services. However, the success of telehealth services depends not only on their ease and usefulness but also on addressing broader concerns. Despite being a substantial user group in traditional health services, older adults may encounter barriers to adopting telehealth services. Increasing the adoption of telehealth among the older adult population is crucial for enhancing their access to care and managing the challenges of aging effectively.</p><p><strong>Objective: </strong>We aimed to explore factors influencing the adoption of telehealth services among older adults in Malaysia, going beyond the conventional framework by incorporating transition cost and subjective well-being as additional constructs.</p><p><strong>Methods: </strong>A cross-sectional survey was conducted among 119 adults aged ≥60 years in Malaysia, using 39 survey items adapted from existing studies. Data analysis was performed using partial least squares structural equation modeling, with both the measurement model and structural model being evaluated. To determine the predictive relevance of the model, PLSpredict was applied. In addition, importance-performance map analysis was conducted to further expand on the structural model results by assessing the performance of each variable.</p><p><strong>Results: </strong>Of the 119 participants, 52 (43.7%) were women and 67 (56.3%) were men. The study found that subjective well-being (β=0.448; P<.001) was the most significant factor, followed by attitude (β=0.242; P<.001), transition cost (β=-0.163; P<.001), and perceived usefulness (β=0.100, P=.02) in influencing telehealth service intention. Furthermore, perceived ease of use (β=0.271; P<.001), availability (β=0.323; P<.001), subjective well-being (β=0.261; P<.001), and trust (β=0.156, P=.004) positively influenced perceived usefulness, while inertia (β=0.024, P=.22) did not. In addition, availability (β=0.420; P<.001) and subjective well-being (β=0.260; P<.001) were positively related to perceived ease of use, with inertia (β=-0.246; P<.001) having a negative impact. The importance-performance map analysis results showed that subjective well-being (importance=0.532) was the most crucial factor for older adult users, while availability (importance=70.735) had the highest performance in telehealth services.</p><p><strong>Conclusions: </strong>This research underscores the importance of catering to the subjective well-being of older adults and optimizing the availability of telehealth services to encourage adoption, ultimately advancing health care accessibility and quality for this vulnerable demographic.</p>","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"8 ","pages":"e60936"},"PeriodicalIF":5.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Edentulousness and the Likelihood of Becoming a Centenarian: Longitudinal Observational Study.","authors":"Xindi Wei, Longfei Zhuang, Yuan Li, Junyu Shi, Yijie Yang, Hongchang Lai, Beilei Liu","doi":"10.2196/68444","DOIUrl":"10.2196/68444","url":null,"abstract":"<p><strong>Background: </strong>In recent decades, the global life expectancy has risen notably to approximately 73.5 years worldwide, coinciding with a rapid growth in the older adult population, which presents a significant public health challenge in promoting healthy aging and longevity.</p><p><strong>Objective: </strong>This study aimed to prospectively investigate the link between edentulousness and the likelihood of reaching centenarian status among individuals aged 80 years and older.</p><p><strong>Methods: </strong>Data from the Chinese Longitudinal Healthy Longevity Survey were analyzed. Logistic regression models were used to assess the relationship between edentulousness and the likelihood of becoming a centenarian. Demographic characteristics, lifestyle habits, and disease histories were adjusted as confounding factors. Several sensitivity analyses, including propensity score matching and 2-year lag analyses, were conducted to further assess the association between edentulousness and the likelihood of becoming a centenarian. The correlation between the number of natural teeth as a continuous variable and the likelihood of becoming a centenarian was evaluated as well.</p><p><strong>Results: </strong>The study included 4239 participants aged 80-100 years. After adjusting for all covariates, the likelihood for becoming a centenarian increased in the nonedentulous group compared to the edentulous group (odds ratio [OR] 1.384, 95% CI 1.093-1.751). The relationship persisted after propensity score matching analysis (OR 1.272, 95% CI 1.037-1.561). The association remained statistically significant after excluding participants with a follow-up duration of less than 2 years (OR 1.522, 95% CI 1.083-2.140; P=.02). Furthermore, a significant positive association between the number of natural teeth and the likelihood of becoming a centenarian was found after adjusting for all covariates (OR 1.022, 95% CI 1.002-1.042; P=.03), which aligned with the main results of the study.</p><p><strong>Conclusions: </strong>The findings revealed that the presence of natural teeth was linked to an increased probability of becoming a centenarian, underscoring the importance of maintaining oral health even in advanced age.</p>","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"8 ","pages":"e68444"},"PeriodicalIF":5.0,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674625","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}

{"title":"A Smartphone-Based Timed Up and Go Test Self-Assessment for Older Adults: Validity and Reliability Study.","authors":"Melissa Johanna Böttinger, Sabato Mellone, Jochen Klenk, Carl-Philipp Jansen, Marios Stefanakis, Elena Litz, Anastasia Bredenbrock, Jan-Philipp Fischer, Jürgen M Bauer, Clemens Becker, Katharina Gordt-Oesterwind","doi":"10.2196/67322","DOIUrl":"10.2196/67322","url":null,"abstract":"<p><strong>Background: </strong>The Timed Up and Go test (TUG) is recommended as an evidence-based tool for measuring physical capacity. Instrumented TUG (iTUG) approaches expand classical supervised clinical applications offering the potential of self-assessment for older adults.</p><p><strong>Objective: </strong>This study aimed to evaluate the concurrent validity and test-retest reliability of a smartphone-based TUG self-assessment \"up&go app.\"</p><p><strong>Methods: </strong>A total of 52 community-dwelling older adults (>67 years old) were recruited. A validated and medically certified system attached with a belt at the lower back was used as a reference system to validate the \"up&go app\" algorithm. The participants repeated the TUG 5 times wearing, a smartphone with the \"up&go app\" in their front trouser pocket and an inertial sensor to test the concurrent validity. A subsample of 37 participants repeated the \"up&go app\" measurement 2 weeks later to examine the test-retest reliability.</p><p><strong>Results: </strong>The correlation between the \"up&go app\" and the reference measurement was r=0.99 for the total test duration and r=0.97 for the 5 single repetitions. Agreement between the 5 repetitions was intraclass correlation coefficient (ICC)=0.9 (0.84-0.94). Leaving out the first repetition, the agreement was ICC=0.95 (0.92-0.97). Test-retest agreement had an ICC=0.79 (0.53-0.9).</p><p><strong>Conclusions: </strong>The duration of 5 repetitions of the TUG test, measured with the pocket-worn \"up&go app,\" was very consistent with the results of a lower-back sensor system, indicating excellent concurrent validity. Participants walked slower in the first round than in the other 4 repetitions within a test run. Test-retest reliability was also excellent. The \"up&go app\" provides a useful smartphone-based approach to measure 5 repetitions of the TUG. The app could be used by older adults as a self-screening and monitoring tool of physical capacity at home and thereby help to early identify functional limitations and take interventions when necessary.</p>","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"8 ","pages":"e67322"},"PeriodicalIF":5.0,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951819/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674547","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}

{"title":"Values of Stakeholders Involved in Applying Surveillance Technology for People With Dementia in Nursing Homes: Scoping Review.","authors":"Daniëlle van Gaans-Riteco, Annerieke Stoop, Eveline Wouters","doi":"10.2196/64074","DOIUrl":"10.2196/64074","url":null,"abstract":"<p><strong>Background: </strong>Due to the progressive nature of dementia, concerns about the safety of nursing home residents are frequently raised. Surveillance technology, enabling visual and auditory monitoring, is often seen as a solution for ensuring safe and efficient care. However, tailoring surveillance technology to individual needs is challenging due to the complex and dynamic care environment involving multiple formal and informal stakeholders, each with unique perspectives.</p><p><strong>Objective: </strong>This study aims to explore the scientific literature on the perspectives and values of stakeholders involved in applying surveillance technology for people with dementia in nursing homes.</p><p><strong>Methods: </strong>We conducted a scoping review and systematically searched 5 scientific databases. We identified 31 articles published between 2005 and 2024. Stakeholder characteristics were extracted and synthesized according to the theory of basic human values by Schwartz.</p><p><strong>Results: </strong>In total, 12 stakeholder groups were identified, with nursing staff, residents, and informal caregivers being the most frequently mentioned. Among stakeholder groups close to residents, values related to benevolence, security, conformity, and tradition were most commonly addressed. Furthermore, values such as self-direction, power, and achievement seemed important to most stakeholder groups.</p><p><strong>Conclusions: </strong>Several stakeholder groups emphasized the importance of being and feeling involved in the application of surveillance technologies. In addition, they acknowledged the necessity of paying attention to stakeholders' perspectives and values. Across these stakeholder groups, values related to benevolence, security, and self-direction were represented, although various stakeholders assigned different meanings to these values. Awareness of stakeholders' perspectives demands a willingness to acknowledge each other's values and bridge differences.</p>","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":" ","pages":"e64074"},"PeriodicalIF":5.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Sleep Duration and Cognitive Frailty in Older Chinese Adults: Prospective Cohort Study.","authors":"Ruixue Cai, Jianqian Chao, Chenlu Gao, Lei Gao, Kun Hu, Peng Li","doi":"10.2196/65183","DOIUrl":"https://doi.org/10.2196/65183","url":null,"abstract":"<p><strong>Background: </strong>Disturbed sleep patterns are common among older adults and may contribute to cognitive and physical declines. However, evidence for the relationship between sleep duration and cognitive frailty, a concept combining physical frailty and cognitive impairment in older adults is lacking.</p><p><strong>Objective: </strong>The objective of our study was to examine the associations of sleep duration and its changes with cognitive frailty.</p><p><strong>Methods: </strong>We analyzed data from the 2008-2018 waves of the Chinese Longitudinal Healthy Longevity Survey. Cognitive frailty was rendered based on the modified Fried frailty phenotype and Mini-Mental State Examination. Sleep duration was categorized as short (<6 h), moderate (6-9 h), and long (>9 h). We examined the association of sleep duration with cognitive frailty status at baseline using logistic regressions and with future incidence of cognitive frailty using Cox proportional hazards models. Restricted cubic splines were employed to explore potential non-linear associations.</p><p><strong>Results: </strong>Among 11,303 participants, 1,298 (11.5%) had cognitive frailty at baseline. Compared to participants who had moderate sleep duration, the odds of having cognitive frailty were higher in those with long sleep duration (odds ratio [OR] =1.71, 95% confidence interval [CI] =1.48-1.97, p<0.001). A J-shaped association between sleep duration and cognitive frailty was also observed (p<0.001). Additionally, during a median follow-up of 6.7 years among 5,201 participants who were not cognitively frail at baseline, 521 (10.0%) developed cognitive frailty. A higher risk of cognitive frailty was observed in participants with long sleep duration (hazard ratio [HR] =1.32, 95% CI =1.07-1.62, p=0.008).</p><p><strong>Conclusions: </strong>Long sleep duration was associated with cognitive frailly in older Chinese adults. These findings provide insights into the relationship between sleep duration and cognitive frailty, with potential implications for public health policies and clinical practice.</p><p><strong>Clinicaltrial: </strong></p>","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143671137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Network Analysis of Key Instrumental Activities of Daily Living and Cognitive Domains for Targeted Intervention in US Older Adults Without Dementia: Cross-Sectional Study.","authors":"Jiaying Li, Rendong He, Erh-Chi Hsu, Junxin Li","doi":"10.2196/67632","DOIUrl":"10.2196/67632","url":null,"abstract":"<p><strong>Background: </strong>Cognitive impairment in older adults reduces independence and raises health care costs but can be mitigated through stimulating activities. Based on network theory, intricate relationships within and between clusters of instrumental activities of daily living (IADLs) and cognitive domains suggest the existence of central IADLs and cognitive domains, as well as bridge IADLs. Modifying these can significantly enhance daily living activities and cognitive functions holistically.</p><p><strong>Objective: </strong>This study aims to identify central IADLs (key activities within the IADL network), central cognitive domains (key domains within the cognitive network), and bridge IADLs (linking IADL and cognitive networks). These insights will inform targeted interventions to effectively improve IADL and cognitive well-being in older adults.</p><p><strong>Methods: </strong>A cross-sectional analysis of adults aged 65 years and older in the United States focused on 5 IADLs and 6 cognitive domains from the National Health and Aging Trends Study (NHATS). Network analysis identified central and bridge variables. Nonparametric and case-dropping bootstrap methods checked network stability. Network comparison tests assessed sex differences with Benjamini-Hochberg adjustments.</p><p><strong>Results: </strong>Of the 2239 participants, 56.4% were female (n=976). We computed and tested 3 networks: IADL, cognition, and bridge-with correlation stability coefficients of 0.67, 0.75, and 0.44, respectively (all>0.25). Meal preparation was identified as the central IADL, with a centrality index of 3.87, which was significantly higher than that of other IADLs (all P<.05). Visual attention emerged as the central cognition domain, with a centrality index of 0.86, which was significantly higher than that of other cognition domains (all P<.05). Shopping was determined to be the bridge IADL, with a centrality index of 0.41, which was significantly higher than that of other IADLs (all P<.05). Notably, gender differences emerged in the IADL network, with stronger associations between laundry and meal preparation in females (1.69 vs males: 0.74; P=.001) and higher centrality in meal preparation among females (difference=1.99; P=.007).</p><p><strong>Conclusions: </strong>While broad enhancements in all IADL and cognitive domains are beneficial, targeting meal preparation, visual attention, and shopping may leverage their within-network influence to yield a more pronounced improvement in holistic IADL, holistic cognition, and holistic cognition function through IADL interventions among older adults. Notably, meal preparation interventions may be less effective in males, requiring tailored approaches.</p>","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"8 ","pages":"e67632"},"PeriodicalIF":5.0,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11941277/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664667","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}

{"title":"Passive Remote Monitoring Technologies' Influence on Home Care Clients' Ability to Stay Home: Multiprovincial Randomized Controlled Trial.","authors":"Lorie Donelle, Bradley Hiebert, Grace Warner, Michael Reid, Jennifer Reid, Salimah Shariff, Emily Richard, Sandra Regan, Lori Weeks, Kathleen Ledoux","doi":"10.2196/69107","DOIUrl":"https://doi.org/10.2196/69107","url":null,"abstract":"<p><strong>Background: </strong>Researchers in Nova Scotia and Ontario, Canada, implemented a passive remote monitoring (PRM) model of home care unique to their health system contexts. Each PRM model integrated tailored PRM devices (eg, motion sensors, cameras, and door alarms) into home care patients' residences with the aim of linking patients, family and friend caregivers, and health care providers to support older adults' aging in place.</p><p><strong>Objective: </strong>The purpose of this study was to examine the use of PRM technologies in the home to support older adults' safe aging in place and avoidance or delay of higher levels of care.</p><p><strong>Methods: </strong>This multiprovincial pragmatic randomized controlled trial examined how PRM technologies support older adults to safely remain in their home and avoid or delay admission to higher levels of care. Pairs of home care patients and their family and friend caregivers were recruited in Ontario and Nova Scotia. Participant pairs were randomly assigned to one of two conditions: (1) standard home care (ie, control) or (2) standard home care plus study-provided PRM (ie, intervention). Participants provided their provincial health insurance numbers to link with provincial health administrative databases and identify if patients were admitted to higher levels of care after 1 year. Cox proportional hazards models were used to evaluate the primary outcome in each province.</p><p><strong>Results: </strong>In total, 313 patient-caregiver pairs were recruited: 174 pairs in Ontario (intervention: n=60; control: n=114) and 139 pairs in Nova Scotia (intervention: n=45; control: n=94). Results indicate PRM was associated with a nonsignificant 30% reduction in risk of patients being admitted to higher levels of care in Ontario (hazard ratio 0.7, 95% CI 0.3-1.4) and no reduction in risk in Nova Scotia (hazard ratio 1.1, 95% CI 0.3-3.7). Adjusting for patient sex had no impact on model estimates for either province.</p><p><strong>Conclusions: </strong>Limitations related, in part, to the impact of the COVID-19 pandemic may have contributed to the effectiveness of the intervention. While our study did not yield statistically significant results (P=.30 and P=.90) regarding the effectiveness of the PRM model in prolonging home stays, the observed trends suggest that technology-assisted aging in place may be a valuable goal for older adults. Further study is required to understand if longer follow-up time allows more effects of PRM on patients' avoidance of higher levels of care to be detected.</p><p><strong>Trial registration: </strong>ISRCTN ISRCTN79884651; https://www.isrctn.com/ISRCTN79884651.</p><p><strong>International registered report identifier (irrid): </strong>RR2-10.2196/15027.</p>","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"8 ","pages":"e69107"},"PeriodicalIF":5.0,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring Smart Health Wearable Adoption Among Singaporean Older Adults Based on Self-Determination Theory: Web-Based Survey Study.","authors":"Hyunjin Kang, Tingting Yang, Nazira Banu, Sheryl Wei Ting Ng, Jeong Kyu Lee","doi":"10.2196/69008","DOIUrl":"10.2196/69008","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Smart health wearables offer significant benefits for older adults, enabling seamless health monitoring and personalized suggestions based on real-time data. Promoting adoption and sustained use among older adults is essential to empower autonomous health management, leading to better health outcomes, improved quality of life, and reduced strain on health care systems.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study investigates how autonomy-related contextual factors, including artificial intelligence (AI) anxiety, perceived privacy risks, and health consciousness, are related to older adults' psychological needs of competence, autonomy, and relatedness (RQ1). We then examined whether the fulfillment of these needs positively predicts older adults' intentions to adopt these devices (H1), and how they mediate the relationship between these factors and older adults' intentions to use smart health wearables (RQ2). Additionally, it compares experienced and nonexperienced older adult users regarding the influence of these psychological needs on use intentions (RQ3).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A web-based survey was conducted with individuals aged 60 years and above in Singapore, using a Qualtrics survey panel. A total of 306 participants (177 male; mean age of 65.47 years, age range 60-85 years) completed the survey. A structural equation model was used to analyze associations among AI anxiety, perceived privacy risks, and health consciousness, and the mediating factors of competence, autonomy, and relatedness, as well as their relationship to smart health wearable use intention.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Health consciousness positively influenced all intrinsic motivation factors-competence, autonomy, and relatedness-while perceived privacy risks negatively affected all three. AI anxiety was negatively associated with competence only. Both privacy risk perceptions and health consciousness were indirectly linked to older adults' intentions to use smart health wearables through competence and relatedness. No significant differences were found in motivational structures between older adults with prior experience and those without.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study contributes to the application of self-determination theory in promoting the use of smart technology for health management among older adults. The results highlight the critical role of intrinsic motivation-particularly competence-in older adults' adoption of smart health wearables. While privacy concerns diminish motivation, health consciousness fosters it. The study results offer valuable implications for designing technologies that align with older adults' motivations, potentially benefiting aging populations in other technologically advanced societies. Developers should focus on intuitive design, transparent privacy practices, and social features to encourage adoption, empowering older adults to use smart wearables for proactive health m","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"8 ","pages":"e69008"},"PeriodicalIF":5.0,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11939025/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664732","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}