JMIR Aging最新文献

{"title":"Practice Effects on Repeated Self-Administered Digital Cognitive Assessments in Cognitively Intact Older Adults from the Framingham Heart Study: Longitudinal Observational Study.","authors":"Kieffer Christianson, Chenglin Lyu, Cody Karjadi, Sherral Devine, Ting Fang Alvin Ang, Ileana De Anda-Duran, Vijaya B Kolachalama, Honghuang Lin, Huitong Ding, Katherine A Gifford, Rhoda Au, Phillip H Hwang, Preeti Sunderaraman","doi":"10.2196/87208","DOIUrl":"https://doi.org/10.2196/87208","url":null,"abstract":"<p><strong>Background: </strong>Remote, self-administered digital assessments provide scalable approaches for monitoring cognition in older adults. Practice effects (PEs), once viewed as measurement noise, are increasingly recognized as potential markers of cognitive decline. As disease-modifying therapies for neurodegenerative conditions emerge, longitudinal digital assessments may capture subtle cognitive changes. Although the majority of PE studies have focused on memory tasks, it is critical to determine whether PEs occur in other domains. Clarifying the potential presence of PEs across multiple time points on the Food and Drug Administration-cleared Defense Automated Neurocognitive Assessment (DANA) platform remains critical for determining whether PEs can serve as a measure of cognitive decline longitudinally.</p><p><strong>Objective: </strong>This study aimed to examine whether PEs occur and whether demographics moderate them across quarterly self-administrations of digital cognitive tasks spanning different cognitive domains in cognitively intact older adults.</p><p><strong>Methods: </strong>Cognitively intact older adults from the Framingham Heart Study self-administered DANA tasks at baseline and every 3 months for 1 year (4 assessments: T1-T4). Tasks included Simple Reaction Time (SRT), Go/No-Go (GNG), and Code Substitution (CS). These tasks varied in complexity, from simple motor responding (SRT) to inhibitory control (GNG) and associative learning with working memory demands (CS). The primary outcome was Cognitive Efficiency, a derived measure of speed and accuracy, which are also recorded as secondary measures. PEs were quantified using linear mixed-effects models, and the change in mean score across time points was expressed in pooled SD units as Cohen <i>d</i>.</p><p><strong>Results: </strong>A total of 717 participants completed all 4 time points (mean age 64.1, SD 9.5 years; n=469, 65.4% female participants; n=481, 67.1% college-educated). PEs were observed on all tasks, with small effects on CS (<i>d</i>=0.43) and GNG (<i>d</i>=0.32) and a below-threshold effect on SRT (<i>d</i>=0.16). Demographics influenced baseline performance: older age predicted lower baseline scores on all tasks, females scored lower on SRT and GNG, and higher education predicted better performance on all tasks. Age was the only demographic moderator of PEs, with smaller improvements on CS among participants aged 65 years or older (B=-0.39; <i>P</i><.001).</p><p><strong>Conclusions: </strong>Quarterly self-administered digital cognitive assessments elicited measurable PEs across processing speed, inhibitory control, and visual scanning, with stronger effects on more complex tasks. Demographics influenced baseline performance, while age moderated PEs on the most demanding task. These findings provide baseline data against which PEs in clinical populations can be compared in future work, complementing prior evidence on other cognitive instruments.</p>","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"9 ","pages":"e87208"},"PeriodicalIF":4.6,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225112","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":"Motivations, Barriers, and the Potential of AI in Physical Activity Apps for US Older Adults: Interview Study.","authors":"Abhinav Choudhry, Jonathan Mshvelidze, Sean P Mullen, Devorah Kletenik, Rachel F Adler","doi":"10.2196/96114","DOIUrl":"10.2196/96114","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The older adult population is increasing rapidly and experiences a multitude of chronic conditions affecting quality of life. Physical activity and reduced sedentary behavior reduce adverse health conditions and help preserve functional independence and cognitive abilities, but the older adult age group has much lower levels of physical activity than recommended compared with other population demographics.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The study aimed to understand older adults' motivations toward health and physical activity and the role of technology in achieving their health and physical activity goals and to explore the attitudes toward the use of generative AI in health apps.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This study was qualitative and based on hour-long interviews with 20 older adults living in the United States. To elicit specific design preferences, participants were presented with visual probes of AI-generated avatars. The interviews were analyzed using thematic analysis, and the coding process drew on reflexive and grounded theory techniques.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Older adults primarily wished to maintain functional independence, both physical and cognitive, prioritizing baseline maintenance rather than continuous optimization. They reported satisfaction with levels of physical activity, adjusting them to chronic conditions and injuries. They were active through everyday functions of living as well as structured exercise programs with many participants using wearable devices and smartphones to help monitor their activity. They reported being motivated by social accountability and gamification, although some found the latter condescending or anxiety-inducing. Accessibility issues were mentioned frequently, including problems with touchscreens, limited viewing, difficulty navigating interfaces with clutter, complex multitouch processes for undertaking actions, and steep learning curves. Computers were preferred for certain tasks over mobile phones due to easier viewability, keyboard access, and greater security features. Personalization was highly desired in health apps. There was a willingness to use more health technology, including generative AI, and they were willing to consider AI in both motivational and informational roles in apps as long as it was personalized. AI embodiment preferences varied widely but with an emphasis on relatability. However, there was marked skepticism toward data privacy, concerns about the loss of independence and self-efficacy, and doubts about AI's accuracy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Older adults are primarily motivated by sustaining functional independence, although accessibility barriers in current health apps remain. Participants were open to AI for physical activity support, but expectations varied. They viewed AI as a passive \"tool,\" a directive \"coach,\" or a relational \"companion.\" Considerable variation in preferences for gamification and vi","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"9 ","pages":"e96114"},"PeriodicalIF":4.6,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13674519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207425","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":"Gaps Between Self-Reported and Documented Use of a Health Care Service Portal Among Older Adults: Cross-Sectional Survey and Retrospective Electronic Data Study.","authors":"Efrat Neter, Diane Levin-Zamir, Ester Eliyahu, Peter W S Chang, Tuyen V Duong, Orna Baron-Epel","doi":"10.2196/93057","DOIUrl":"https://doi.org/10.2196/93057","url":null,"abstract":"<p><strong>Background: </strong>Health care systems increasingly offer services to citizens through online portals, which have been found to be associated with patient satisfaction and better management of health concerns. Few studies have compared self-reported use with objectively documented portal use, especially among older adults.</p><p><strong>Objective: </strong>This study aimed to examine differences between documented and self-reported health portal use, and their associations with background variables and digital health literacy (DHL) among older adults.</p><p><strong>Methods: </strong>A cross-sectional telephone survey was conducted among 600 participants aged 60 years and older, who were sampled from a registry of members of a national health maintenance organization (HMO). The participants reported their use of the HMO's portal, their DHL, and demographic and background variables. Participants' use of the portal was retrospectively retrieved from the HMO's administrative database.</p><p><strong>Results: </strong>A large gap between self-reported use and documented use of the health portal was found: for example, while only 8.1% (46/566) reported not using the portal, the HMO's records indicated that 62% (372/600) did not make use of the portal. However, a positive correlation was found between self-reported use and documented use (<i>r</i>=0.22; <i>P</i><.001). Significant positive associations were found between administrative and physician-related online services, both reported use (<i>r</i>=0.41; <i>P</i><.001) and documented use (<i>r</i>=0.56; <i>P</i><.001). A multivariate analysis, where documented use was the dependent variable, explained 12.5% of the variance. Experience with computers (β=0.13; <i>P</i>=.02) and ethnicity (β=-0.22; <i>P</i><.001) were significantly associated with documented use. DHL, though significantly associated with documented use at the bivariate level (<i>r</i>=0.09; <i>P=</i>.04), was not significantly associated with documented use in this analysis (β=0.02; <i>P</i>=.97).</p><p><strong>Conclusions: </strong>The findings indicate that users tend to overestimate their health portal use. Interpretations vary from measurement issues, such as social desirability bias regarding digital functioning or the perception that assisted use also constitutes usage, to signaling their identity as engaged digital health consumers. Future studies on digital health use should also include measures of electronically documented use and not only self-reported use.</p>","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"9 ","pages":"e93057"},"PeriodicalIF":4.6,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661037/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184847","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":"Association Between a Hybrid Video-Guided Multicomponent Exercise Program With Staff Assistance and Free-Living Gait in Older Adults With Knee and Low Back Pain: Secondary Analysis of a Randomized Controlled Trial.","authors":"Shuichi P Obuchi, Tomoyuki Arai, Hideaki Ishibashi, Takashi Amari, Hisashi Kawai","doi":"10.2196/97414","DOIUrl":"10.2196/97414","url":null,"abstract":"<p><strong>Background: </strong>Older adults with chronic joint pain often exhibit decreased mobility. Daily walking measures are being increasingly used in aging research as objective indicators of mobility.</p><p><strong>Objective: </strong>In this study, we aimed to examine the effects of a 12-week hybrid exercise-based program on daily-life walking characteristics.</p><p><strong>Methods: </strong>A total of 59 community-dwelling older adults (aged ≥65 years) with mild to moderate knee and/or low back pain were randomized to either a hybrid exercise group or an educational control group. Daily-life walking was monitored using an ankle sensor. Daily observation data were collected within 2 planned 7-day windows. Primary parameters included activity volume and gait characteristics. Statistical analyses were conducted based on a modified intention-to-treat principle using linear mixed-effects models, with a per-protocol set used for sensitivity analyses.</p><p><strong>Results: </strong>The mixed-effects analysis based on the modified intention-to-treat principle (n=52 participants; 696 observations) suggested an effect of the intervention on improving walking quality, particularly step length (β=2.39 cm; <i>P</i>=.04; Hedges <i>g</i>=0.493), with a smaller effect with borderline statistical significance observed on improving walking speed (β=0.05 m/s; <i>P</i>=.06; Hedges <i>g</i>=0.496). Cadence, daily distance, daily steps, active energy expenditure, and accumulated 3 or more metabolic equivalent of task activities showed no clear difference between the groups. In the per-protocol sensitivity analysis (n=44), the same directional pattern of improvement was observed for step length (β=1.95 cm; <i>P</i>=.13; Hedges <i>g</i>=0.365) and walking speed (β=0.04 m/s; <i>P</i>=.14; Hedges <i>g</i>=0.368); however, the estimates were imprecise.</p><p><strong>Conclusions: </strong>A 12-week hybrid exercise program may improve the quality of daily-life walking, with the clearest effect observed on step length. Given the attenuation after multiplicity-aware interpretation and in sensitivity analyses, these findings should be interpreted as suggestive rather than definitive.</p>","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"9 ","pages":"e97414"},"PeriodicalIF":4.6,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13649242/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138612","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":"Large Language Model-Based Identification of Subjective Cognitive Decline in Electronic Health Records Among Older Adults With Normal Cognitive Testing: Retrospective Cohort Study.","authors":"Liqin Wang, Rebecca E Amariglio, Sheril Varghese, Jiazi Tian, Diane Seger, Li Zhou, Gad A Marshall","doi":"10.2196/93011","DOIUrl":"10.2196/93011","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Subjective cognitive decline (SCD) typically refers to self- or informant-reported decline in cognition despite the absence of objective impairment on standardized testing. Older adults with documented normal cognitive test performance provide a pragmatic anchor cohort for electronic health record (EHR)-based SCD phenotyping. However, cognitive concerns are primarily recorded in unstructured notes and are inconsistently documented, making it unclear how often and in whom concerns are captured in routine care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aims to operationalize EHR-based SCD phenotyping in an objectively normal-testing cohort using a large language model (LLM)-based natural language processing approach and to examine the frequency and clinical and sociodemographic correlates of cognitive concern documentation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted an EHR-based observational study of patients aged 65 years or older with a first normal cognitive test recorded in EHR flowsheets between January 2019 and April 2024 in a large health care system. We developed and iteratively refined a 2-stage LLM-based natural language processing pipeline to identify documented cognitive concerns in unstructured notes during the 12 months prior to the index date, and evaluated performance against manual review. We quantified the frequency of documented concerns within this normal-testing cohort and used multivariable logistic regression to assess associations with sociodemographic factors (age, marital status, insurance, and neighborhood Area Deprivation Index), sequentially adjusting for clinical comorbidities and relevant medications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 15,750 older adults with normal cognitive test scores, 13.8% (n=2175) had at least 1 documented cognitive concern in the prior year, captured in 1.2% (7394/605,177) of notes. On manual validation, the 2-stage pipeline (Med42-v2-8B screening followed by GPT-4o confirmation) achieved a sensitivity of 0.957, positive predictive value of 0.935, specificity of 0.985, and &lt;i&gt;F&lt;/i&gt;&lt;sub&gt;1&lt;/sub&gt;-score of 0.945 for cognitive concern identification. Documentation was more likely in older individuals, those with commercial (vs Medicare) insurance, and those with neurological and psychiatric conditions. In fully adjusted models, Parkinson disease (adjusted odds ratio [aOR] 5.29, 95% CI 3.60-7.77), traumatic brain injury (aOR 4.63, 95% CI 3.15-6.81), stroke or transient ischemic attack (aOR 3.46, 95% CI 3.15-4.18), epilepsy (aOR 2.52, 95% CI 1.83-3.49), depression (aOR 1.54, 95% CI 1.36-1.75), and excessive alcohol use (aOR 1.48, 95% CI 1.06-2.06) were among the strongest correlates of cognitive concern documentation. In contrast, obesity (aOR 0.73, 95% CI 0.65-0.82), hyperlipidemia (aOR 0.59, 95% CI 0.51-0.67), and residence in more deprived neighborhoods (higher Area Deprivation Index) were associated with lower odds of documented cognitive concerns.&lt;/p&gt;&lt;p&gt;&lt;","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"9 ","pages":"e93011"},"PeriodicalIF":4.6,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13645317/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128686","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":"Associations of Midlife Gait Speed and Muscle Performance With Falls in Later Life: Secondary Analysis of the MIDUS Cohort.","authors":"Roee Hayek, Yaniv Nudelman, Dan Keren, Shmuel Springer","doi":"10.2196/103917","DOIUrl":"https://doi.org/10.2196/103917","url":null,"abstract":"<p><strong>Background: </strong>Falls are a major cause of morbidity among older adults, yet fall risk may begin to emerge during midlife. Physical performance measures may identify early functional vulnerability associated with later-life health outcomes.</p><p><strong>Objective: </strong>This study examined whether midlife gait speed and muscle performance were associated with recurrent falls later in life.</p><p><strong>Methods: </strong>This study was a secondary analysis of prospectively collected data from the Midlife in the United States (MIDUS) cohort. Independent adults (n=309) aged 45 to 64 years at wave 2 (2004-2009) who completed physical performance assessments were followed to wave 3 (2013-2021). Baseline measures included gait speed from a 50-foot walk test, grip strength, sit-to-stand time, and calculated lower-extremity power. The primary analysis examined associations between baseline physical performance and recurrent falls at follow-up (≥2 falls in the previous 12 months). A sensitivity analysis repeated the primary models but was restricted to participants without a baseline history of recurrent falls.</p><p><strong>Results: </strong>At follow-up, 20.4% (63/309) of participants reported recurrent falls. Slower midlife gait speed was associated with higher odds of recurrent falls (odds ratio 1.43, 95% CI 1.05-1.95; P=.02), whereas muscle performance measures were not associated with falls in the primary analysis. The association between slower gait speed and recurrent falls remained significant in the sensitivity analysis. Over follow-up, muscle performance declined, whereas gait speed remained stable.</p><p><strong>Conclusions: </strong>Slower midlife gait speed was associated with higher odds of recurrent falls, suggesting that fall vulnerability may be detectable as early as midlife. Given the exploratory nature of this study, further studies are warranted to confirm these findings.</p>","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"9 ","pages":"e103917"},"PeriodicalIF":4.6,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115805","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":"Rethinking the Prevention of Cognitive Decline in Healthy Older Adults: The Motor-Cognitive Active Gamified Immersive Cultural (MAGIC) Exergames.","authors":"Jean-Jacques Temprado","doi":"10.2196/100013","DOIUrl":"https://doi.org/10.2196/100013","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Unlabelled: &lt;/strong&gt;Though exergames attract considerable research interest as tools for preserving cognitive function in older adults, a decade of meta-analytic evidence reveals a persistent gap between theoretical promise and empirical demonstration: exergames rarely outperform conventional motor-cognitive training and do not generate the sustained engagement that preventive benefit requires. These results reflect limitations that are structural: the field focused predominantly on clinical populations rather than primary prevention; training concepts borrowed from rehabilitation protocols rather than grounded in the specific neuroplastic mechanisms of the exergaming medium; and virtual environments that are digitally sophisticated but culturally and esthetically neutral, systematically excluding the stimulation that converging evidence from neuroaesthetics, cultural epidemiology, and narrative neuroscience identifies as a core active ingredient of brain health promotion. To address these limitations simultaneously, this viewpoint introduces Motor-Cognitive Active Gamified Immersive Cultural (MAGIC) exergames, defined as \"virtual reality solutions in which motor-cognitive interactions are embedded in artistic content, cultural heritage, or historically situated narrative to exploit optimal neurobiological substrates of the intervention.\" Drawing on an integrated theoretical framework, we develop mutually reinforcing mechanistic pillars: multimodal sensorimotor engagement within ecologically valid immersive environments; semantic and narrative activation of memory systems; emotional and autobiographical resonance as a dopaminergic driver of learning consolidation and sustained participation; and the re-engineering of physical effort evaluation from aversive to appetitive through aesthetic pleasure and narrative absorption. A fundamental implication is that in MAGIC exergames, motivation is not engineered through gamification mechanics-it is released by the intrinsic value of inhabiting a culturally meaningful world. We further argue MAGIC exergames correspond to a specific use that is, Cultural Snacking, which consists of the serialization of MAGIC content into brief, narratively open daily episodes of 5 to 10 minutes, designed for 3 to 5 daily consumptions across varied contexts. This dosing architecture is compatible with the motivational profile of healthy older adults who do not identify as patients or trainees. The paper opens perspectives with a design and research agenda structured around three priorities: characterizing MAGIC exergames by the type of motor-cognitive interactions they deliver rather than by the technology platform; conducting mechanistic neuroimaging investigations targeting the specific biomarkers of neuroplastic benefit that creative cultural engagement is expected to produce; and building the intersectoral innovation ecosystem that brings cultural institutions, digital health teams, and older adults together","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"9 ","pages":"e100013"},"PeriodicalIF":4.6,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13626641/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115803","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":"Knowledge Performance, User Experience, and Cybersickness With Immersive Virtual Reality for Tai Chi Movement-Encoding in Older Adults: Randomized Comparison Study.","authors":"XiaCheng Song, Lu Sun, Yaqing Song, Huafeng Qu, Jing Jin, Junfeng Zhu, Wenwen Song, Huirong Huang","doi":"10.2196/96867","DOIUrl":"https://doi.org/10.2196/96867","url":null,"abstract":"<p><strong>Background: </strong>Immersive virtual reality (VR) is increasingly used for embodied training, but its practical value for older adults depends on whether the experiential benefits can be achieved without unacceptable discomfort or overstated claims about motor learning.</p><p><strong>Objective: </strong>This randomized study compared head-mounted immersive VR with standardized, content-matched 2D video instruction for Tai Chi movement-encoding in community-dwelling older adults.</p><p><strong>Methods: </strong>A total of 106 older adults were randomized to immersive VR (n=56) or video instruction (n=50). The primary analysis included 92 participants with complete age, pretest, and posttest data (VR: n=45; Video: n=47). The primary outcome was a 5-item movement-encoding knowledge score (range 0-20), analyzed using analysis of covariance, with posttest score as the dependent variable and group, pretest score, and age as predictors. Secondary outcomes were intrinsic motivation, game experience, and learning engagement; safety, tolerability, and feasibility were assessed using the Intrinsic Motivation Inventory, Game Experience Questionnaire, Utrecht Work Engagement Scale-Short Form, participant flow, and Virtual Reality Sickness Questionnaire. VR system telemetry was analyzed descriptively as an exploratory process outcome.</p><p><strong>Results: </strong>Adjusted posttest movement-encoding performance did not differ between VR and video instruction (adjusted difference -0.27, 95% CI -2.25 to 1.72; <i>P</i>=.79; partial η²=0.001). The Game Experience Questionnaire results favored VR for competence (Video: mean 3.36, SD 1.21; VR: mean 4.15, SD 0.92; <i>q</i>=0.009), flow (Video: mean 3.77, SD 1.26; VR: mean 4.46, SD 0.76; <i>q</i>=0.014), and lower tension (Video: mean 1.76, SD 1.04; VR: mean 1.27, SD 0.63; <i>q</i>=0.037), whereas challenge did not remain significant after false discovery rate correction (<i>q</i>=0.073). In the VR Group, recognition accuracy was associated with posttest movement-encoding score (n=44; <i>r</i>=0.317, <i>P</i>=.04), but pose accuracy was not (n=44; <i>r</i>=0.129, <i>P</i>=.41). The Virtual Reality Sickness Questionnaire scores were low among valid VR participants (total score mean 3.77, SD 11.12), and 36 out of 46 (78%) participants reported zero symptoms.</p><p><strong>Conclusions: </strong>With a strong active control, immersive VR did not produce higher short-term Tai Chi movement-encoding performance than video instruction. Among participants who completed the VR session, the immediate game-experience profile was more favorable. These findings indicate that VR may offer experiential benefits, while also highlighting the need to manage cybersickness and technical exclusions and to distinguish movement knowledge from actual motor execution.</p>","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"9 ","pages":"e96867"},"PeriodicalIF":4.6,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13626395/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115738","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":"Social Determinants and Oral Health Among Indigenous and Non-Indigenous Older Adults in La Araucanía, Chile: Cross-Sectional Study.","authors":"Fernanda Muñoz-Sepúlveda, Karen Danke Hausdorf, Víctor Beltrán Varas, Claudia Acevedo Atala, Leonardo López, Alejandro Herrera","doi":"10.2196/85075","DOIUrl":"10.2196/85075","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Social disparities in oral health persist, disproportionately affecting Indigenous populations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aims to compare oral health status, dental care access, treatment needs, and social determinants between Mapuche and non-Mapuche older adults in the La Araucanía Region of Chile, within a hybrid dental care model, and to explore whether ethnicity is associated with these outcomes, guided by the World Health Organization (WHO) Commission on Social Determinants of Health (CSDH) framework.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a cross-sectional exploratory analytic study using data from 480 adults aged 60 years or older who received dental care through a hybrid teledentistry and mobile clinic model (Geriatric Dental Specialties Tele-Platform [TEGO]) in 4 municipalities of La Araucanía. The analytic sample was restricted to community-dwelling, functionally independent older adults. Outcomes included oral health status (nonfunctional dentition, edentulism, cavitated caries, and periodontitis), dental care access (fixed prosthetic rehabilitation and unmet denture need), and dental treatment needs (restorative and prosthetic). Structural (sex, age, education, rurality, and ethnicity) and intermediary determinants (behavioral, biological, psychosocial, and health system access) were analyzed following the WHO-CSDH framework. Bivariate analyses compared outcomes between Mapuche and non-Mapuche participants. Multivariable logistic regression models examined associations between determinants and outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 471 older adults (mean age 72.8, SD 7.7 years) were included; 76.9% (362/471) had nonfunctional dentition, 18% (85/471) were edentulous, 25.6% (98/383) had cavitated caries, and 46% (154/335) had periodontitis. In bivariate analyses, Mapuche participants showed lower educational attainment, higher rural residence, poorer oral health, more behavioral risk factors (eg, infrequent toothbrushing and higher sugar intake), greater restorative needs, and reduced access to complex dental care compared with non-Indigenous peers. In multivariable analyses, female sex was associated with increased odds of edentulism but lower odds of periodontitis. Lower education was associated with nonfunctional dentition (odds ratio [OR] 4.28, 95% CI 2.34-7.88; P&lt;.001) and edentulism (OR 3.04, 95% CI 1.52-6.09; P=.002). Mapuche ethnicity was associated with higher prevalence of cavitated caries (OR 2.40, 95% CI 1.25-4.63; P=.009) and periodontitis (OR 2.43, 95% CI 1.21-4.88; P=.01). Dental care access was associated with behavioral factors (brushing, interproximal hygiene, and sugar intake) and structural determinants (age, sex, and rurality), while restorative and prosthetic needs were linked to sugar consumption and tobacco use, respectively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Oral health inequalities among older adults in La Araucanía were associated with bo","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"9 ","pages":"e85075"},"PeriodicalIF":4.6,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662451/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082079","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":"Domain-Specific Associations of Physical Activity With Phase Angle and Extracellular Water-to-Total Body Water Ratio in Middle-Aged or Older Adults: Cross-Sectional Study.","authors":"Seong-Uk Baek, Jin-Ha Yoon","doi":"10.2196/90158","DOIUrl":"10.2196/90158","url":null,"abstract":"<p><strong>Background: </strong>The phase angle (PhA) and extracellular water (ECW)-to-total body water (TBW) ratio serve as indicators of cell membrane integrity and body fluid balance in older adults.</p><p><strong>Objective: </strong>This study examined the domain-specific associations of physical activity (PA) with PhA and the ECW-to-TBW ratio.</p><p><strong>Methods: </strong>A nationally representative sample of 5211 adults aged 50 years and older was analyzed. Weekly amounts of moderate-to-vigorous PA (MVPA) in leisure-time, occupational, and transport-related domains were assessed using the Global Physical Activity Questionnaire. A bioelectrical impedance analyzer was used to measure PhA (°) and the ECW-to-TBW ratio (%). Linear regression analyses were conducted.</p><p><strong>Results: </strong>For leisure-time PA, compared with 0 min/week, participating in 150 to 299 min/week and ≥300 min/week of MVPA was associated with 0.08 (95% CI 0.02-0.14) and 0.13 (95% CI 0.06-0.20) degrees higher PhA, respectively. Additionally, compared with 0 min/week, engaging in 150 to 299 min/week and ≥300 min/week of MVPA was associated with -0.11 (95% CI -0.19 to -0.03) and -0.15 (95% CI -0.22 to -0.07) percentage points lower ECW-to-TBW ratio, respectively. For transport-related PA, compared with 0 min/week, engaging in ≥300 min/week of MVPA was negatively associated with the ECW-to-TBW ratio (β=-0.07, 95% CI -0.14 to -0.01). Occupational PA showed no clear associations with PhA or the ECW-to-TBW ratio.</p><p><strong>Conclusions: </strong>While the observed associations were modest, the associations of PA with both PhA and the ECW-to-TBW ratio differed across PA domains. Specifically, leisure-time PA was positively associated with PhA and inversely associated with the ECW-to-TBW ratio. These findings highlight the potential role of leisure-time PA in improving bioelectrical markers of cellular health and fluid distribution.</p>","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"9 ","pages":"e90158"},"PeriodicalIF":4.6,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13619118/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149076266","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}