JMIR Aging最新文献

{"title":"Factors Influencing the Severity of Urinary and Defecatory Dysfunction Among the Middle-Aged and Older Adult Chinese Population: Longitudinal Study of a 5-Wave Survey Cohort.","authors":"Haoran Zhu, Xiaoming Li, Liwei Jing, Jingli Kou, Lichao Gong, Rui Wang, Guangtian Liu, Chao Zhang, Jiayi Zhao, Jing Zhang","doi":"10.2196/70541","DOIUrl":"10.2196/70541","url":null,"abstract":"<p><strong>Background: </strong>Urinary and defecatory dysfunction (UDD) is a significant concern among the aging population in China. However, there is a lack of longitudinal research exploring the risk factors of UDD severity in Chinese older adults.</p><p><strong>Objective: </strong>This study uses data from the China Health and Retirement Longitudinal Study spanning 2011 to 2020 to explore UDD risk factors in the middle-aged and older adult Chinese population, focusing on epidemiological characteristics and potential influences on severity.</p><p><strong>Methods: </strong>A longitudinal cohort of over 10,000 participants from the China Health and Retirement Longitudinal Study was analyzed across 5 waves using Bayesian logistic regression. This analysis examined associations between UDD severity and factors including demographic, lifestyle, and health-related factors, including comorbidities, BMI, and handgrip strength.</p><p><strong>Results: </strong>Higher UDD prevalence was observed among female population, older adults, those with low education levels, and rural residents. Depression, arthritis, and low handgrip strength emerged as critical predictors of severe UDD. Additionally, abnormal BMI, both underweight (odds ratio [OR] 3.019, 95% CI 1.484-5.951; P=0.002) and obesity (OR 2.697, 95% CI 1.338-5.217; P=0.005), was strongly linked to increased severity and persistence of UDD. Participants aged 66 years and older exhibited the highest UDD prevalence, with both underweight and obese individuals facing the greatest risk of persistent and worsening symptoms.</p><p><strong>Conclusions: </strong>This study is the first to longitudinally examine the risk factors of UDD severity in China's middle-aging and aging population. The findings underscore the need for targeted interventions focusing on muscle strength rehabilitation and comorbidity management to mitigate UDD progression, contributing to improved quality of life for older individuals.</p>","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"8 ","pages":"e70541"},"PeriodicalIF":5.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12129371/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152170","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":"Developing a Dyadic Immersive Virtual Environment Technology Intervention for Persons Living With Dementia and Their Caregivers: Multiphasic User-Centered Design Study.","authors":"Elizabeth A Rochon, Ayush Thacker, Mirelle Phillips, Christine Ritchie, Ana-Maria Vranceanu, Evan Plys","doi":"10.2196/66212","DOIUrl":"10.2196/66212","url":null,"abstract":"<p><strong>Background: </strong>Persons living with dementia and their caregivers experience frequent emotional health challenges. Across the illness spectrum, engaging in shared pleasant activities is an important feature of well-being for persons living with dementia-caregiver dyads. Under the umbrella of virtual reality, immersive virtual environment technology (IVET) offers artificial sensory experiences and shows promise in this population. IVET development benefits from a user-centered design approach, and as an emerging field, preliminary testing of safety, usability, and engagement for person living with dementia-caregiver dyads is required.</p><p><strong>Objective: </strong>We aimed to develop a preliminary IVET intervention for psychosocial health among person living with dementia-caregiver dyads. In doing so, we highlight design considerations and user preferences to ensure the safety and usability of technology-based interventions in the context of dementia.</p><p><strong>Methods: </strong>We engaged 10 clinicians, 8 caregivers, and 3 persons living with dementia in 5 rounds of focus groups to evaluate the safety and usability of preliminary intervention features. Following prototype development, we engaged caregivers and persons living with dementia (n=9 dyads) in beta testing workshops to observe real-time user interaction with the intervention and guide refinements. Rapid data analysis was used to extract themes relevant to intervention development.</p><p><strong>Results: </strong>The following themes emerged from focus groups to inform prototype development: (1) designing flexibly to allow users to tailor the intervention experience to their own environmental context and circumstance, (2) designing with the dyad's clinical and relational needs in mind, and (3) accounting for illness and aging-related challenges in design. The following themes emerged from workshops to inform prototype refinements: (1) increasing user support through more feedback and (2) increasing variety of visual and auditory feedback.</p><p><strong>Conclusions: </strong>Using user feedback throughout the development process, we developed a prototype of an IVET intervention, Toolkit for Experiential Well-Being in Dementia (the Isle of TEND), tailored to the needs of persons living with dementia and their caregivers. Our prototype uses specific design features to promote safety, usability, and engagement in the context of dementia. Future feasibility testing of the intervention is warranted.</p><p><strong>International registered report identifier (irrid): </strong>RR2-10.2196/52799.</p>","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"8 ","pages":"e66212"},"PeriodicalIF":5.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12138290/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120964","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":"Cyberchondria in Older Adults and Its Relationship With Cognitive Fusion, Health-Related Quality of Life, and Mental Well-Being: Mediation Analysis.","authors":"Richard Huan Xu, Vladan Starcevic","doi":"10.2196/70302","DOIUrl":"10.2196/70302","url":null,"abstract":"<p><strong>Background: </strong>Cyberchondria is the compulsive searching for health information online that continues despite harmful effects. It leads to increased health anxiety and lower health-related quality of life (HRQOL). Older adults face higher risks of cyberchondria due to their limited digital literacy skills and more frequent health concerns. However, researchers have not thoroughly studied how cyberchondria affects this age group.</p><p><strong>Objective: </strong>This study aimed to explore cyberchondria in the older population and investigate its relationship with cognitive fusion (ie, the tendency to become entangled with thoughts and perceive them as literal truths that dictate behavior), HRQOL, and mental well-being.</p><p><strong>Methods: </strong>A web-based, cross-sectional survey was conducted in May 2024 with a sample of 638 participants from China aged ≥60 years recruited through the online panel of a survey company. The participants completed questionnaires assessing cyberchondria (using the Cyberchondria Severity Scale-12 [CSS-12]), cognitive fusion, HRQOL, and mental well-being. Structural equation modeling (SEM) was used to assess the hypothesized mediation model, and standardized estimates and their 95% CIs were calculated for all structural paths.</p><p><strong>Results: </strong>Participants had a mean CSS-12 score of 40 (SD 8.5), suggesting a fairly high level of cyberchondria in this sample. Participants with a higher socioeconomic status tended to report lower levels of cyberchondria. The SEM showed that cyberchondria was positively associated with cognitive fusion (β=0.505, P<.001 for both models) and negatively associated with HRQOL (β=-0.221, P<.001) and mental well-being (β=-0.212, P<.001). The mediation model showed a good fit and demonstrated that cognitive fusion fully mediated the total effect of cyberchondria on HRQOL and mental well-being.</p><p><strong>Conclusions: </strong>Cyberchondria may be more prominent in older Chinese adults, especially those residing in rural areas and with a lower socioeconomic status. Additionally, cyberchondria can enhance cognitive fusion, contributing to poor HRQOL and mental well-being. Interventions focused on \"defusing\" cyberchondria-relevant thoughts may help reduce maladaptive behaviors associated with cyberchondria and improve the overall well-being of older populations.</p>","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"8 ","pages":"e70302"},"PeriodicalIF":5.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12138317/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120963","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":"Online Group-Based Dual-Task Training to Improve Cognitive Function of Community-Dwelling Older Adults: Randomized Controlled Feasibility Study.","authors":"Pui Hing Chau, Denise Shuk Ting Cheung, Jojo Yan Yan Kwok, Wai Chi Chan, Doris Sau Fung Yu","doi":"10.2196/67267","DOIUrl":"10.2196/67267","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Cognitive training for older adults is crucial before cognitive impairment emerges. During periods of social distancing like the COVID-19 pandemic, cognitive stimuli are lacking. Online dual-task training is proposed as a solution to address these needs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;We aimed to explore the feasibility, acceptance, and potential effects of online group-based dual-task training as an intervention for enhancing cognitive function among community-dwelling older adults.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A randomized controlled feasibility study was conducted with 76 participants in Hong Kong, randomly assigned to the intervention and attention control groups in a ratio of 2:1 (n=50, 66% and n=26, 34%, respectively). The intervention group underwent 60-minute online dual-task training sessions twice a week for 12 weeks, incorporating cognitive components (upper limb and finger movement, arithmetic operation, and verbal fluency) and physical components (chair-based exercises) developed through a co-design approach. The attention control group received online health talks. Outcomes related to feasibility and acceptance included class attendance and self-reported satisfaction. Main outcomes related to potential effects included the Memory Inventory in Chinese and the Montreal Cognitive Assessment 5 Minutes (Hong Kong Version) at baseline, 6 weeks (midintervention), 12 weeks (postintervention) and 18 weeks (follow-up). Descriptive statistics and linear mixed effects models were used. Effect size was described with Cohen d. Qualitative feedback was collected from 12 informants and analyzed by thematic analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;About 72% (36/50) of the participants in the intervention group and 62% (16/26) in the control group attended over 75% of the classes. In total, 44 (88%) participants from the intervention group provided acceptance feedback; 82% (36/44) were satisfied and 84% (37/44) would recommend the training to others. Improvement in the Memory Inventory in Chinese score in the intervention group was observed at midintervention, postintervention, and follow-up, with a medium-to-large effect size (d=0.65, 0.43 and 0.85, respectively). Adjusting for baseline values, the between-group differences in the Montreal Cognitive Assessment 5 Minutes (Hong Kong Version) score attained a small-to-medium effect size at midintervention (d=0.34) and postintervention (d=0.23). Qualitative feedback highlighted the timesaving and convenient aspects of online dual-task training, with participants finding the sessions challenging and enjoyable, and reporting benefits across cognitive, physical, and psychosocial domains. However, a preference for traditional in-person training was noted among the older adults despite the advantages of online training.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Online dual-task training is a feasible intervention accepted by the older adults, with potential benefits in cognit","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"8 ","pages":"e67267"},"PeriodicalIF":5.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12125557/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080272","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":"Identification of Target Body Composition Parameters by Dual-Energy X-Ray Absorptiometry, Bioelectrical Impedance, and Ultrasonography to Detect Older Adults With Frailty and Prefrailty Status Using a Mobile App in Primary Care Services: Descriptive Cross-Sectional Study.","authors":"Beatriz Ortiz-Navarro, José Losa-Reyna, Veronica Mihaiescu-Ion, Jerónimo Garcia-Romero, Margarita Carrillo de Albornoz-Gil, Alejandro Galán-Mercant","doi":"10.2196/67982","DOIUrl":"10.2196/67982","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Frailty syndrome in older adults represents a significant public health concern, characterized by a reduction in physiological reserves and an increased susceptibility to stressors. This can result in adverse health outcomes, including falls, hospitalization, disability, and mortality. The early identification and management of frailty are essential for improving quality of life and reducing health care costs. Conventional assessment techniques, including dual-energy X-ray absorptiometry (DXA), bioelectrical impedance analysis (BIA), and muscle ultrasound (US), are efficacious but frequently constrained in primary care settings by financial and accessibility limitations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The aim of this study is to analyze the differences in anthropometric characteristics, physical function, nutritional status, cognitive status, and body composition among older adults identified as frail, prefrail, or robust in primary care services using the PowerFrail mobile app. Furthermore, the study assesses the predictive capacity of body composition variables (whole-body phase angle [WBPhA] via BIA, US-measured rectus femoris muscle thickness, and DXA-derived lean mass) in identifying frailty and evaluates their feasibility for implementation in primary care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A descriptive cross-sectional study was conducted with 94 older adult participants aged between 70 and 80 years, recruited through the Andalusian Health Service in Spain. Frailty status was classified using the PowerFrail App, which integrates muscle power assessment and provides personalized physical activity recommendations. Body composition was measured using WBPhA (BIA), muscle US, and DXA. Statistical analyses included 1-way ANOVA for group comparisons, logistic regression to investigate associations, and receiver operating characteristic curve analysis to evaluate the predictive accuracy of the body composition measures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Participants were categorized into frail (n=28), prefrail (n=33), and robust (n=33) groups. All body composition measures exhibited high specificity in detecting frailty, with varying sensitivity. Unadjusted US showed the highest specificity but low sensitivity (10.7%). WBPhA and right leg lean mass (LeanM RL) demonstrated significant predictive capabilities, especially when adjusted for age and sex, with area under the curve values ranging from 0.678 to 0.762. The adjusted LeanM RL model showed a good balance between sensitivity (35.7%) and specificity (93.9%; P=.045), indicating its potential as a reliable frailty predictor. These findings are consistent with previous research emphasizing the importance of muscle mass and cellular health in frailty assessment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Body composition variables, particularly WBPhA, LeanM RL, and US, are effective predictors of frailty in older adults. The PowerFrail mobile app, combined with advanced body","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"8 ","pages":"e67982"},"PeriodicalIF":5.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12097654/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144079749","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":"Advancing Remote Monitoring for Patients With Alzheimer Disease and Related Dementias: Systematic Review.","authors":"Mohmmad Arif Shaik, Fahim Islam Anik, Md Mehedi Hasan, Sumit Chakravarty, Mary Dioise Ramos, Mohammad Ashiqur Rahman, Sheikh Iqbal Ahamed, Nazmus Sakib","doi":"10.2196/69175","DOIUrl":"10.2196/69175","url":null,"abstract":"<p><strong>Background: </strong>Using remote monitoring technology in the context of Alzheimer disease (AD) care presents exciting new opportunities to lessen caregiver stress and improve patient care quality. The application of wearables, environmental sensors, and smart home systems designed specifically for patients with AD represents a promising interdisciplinary approach that integrates advanced technology with health care to enhance patient safety, monitor health parameters in real time, and provide comprehensive support to caregivers.</p><p><strong>Objective: </strong>The objectives of this study included evaluating the effectiveness of various remote sensing technologies in enhancing patient outcomes and identifying strategies to alleviate the burden on health care professionals and caregivers. Critical elements such as regulatory compliance, user-centered design, privacy and security considerations, and the overall efficacy of relevant technologies were comprehensively examined. Ultimately, this study aimed to propose a comprehensive remote monitoring framework tailored to the needs of patients with AD and related dementias.</p><p><strong>Methods: </strong>Guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework, we conducted a systematic review on remote monitoring for patients with AD and related dementias. Our search spanned 4 major electronic databases-Google Scholar, PubMed, IEEE Xplore, and DBLP on February 20, 2024, with an updated search on May 18, 2024.</p><p><strong>Results: </strong>A total of 31 publications met the inclusion criteria, highlighting 4 key research areas: existing remote monitoring technologies, balancing practicality and empathy, security and privacy in monitoring, and technology design for AD care. The studies revealed a strong focus on various remote monitoring methods for capturing behavioral, physiological, and environmental data yet showed a gap in evaluating these methods for patient and caregiver needs, privacy, and usability. The findings also indicated that many studies lacked robust reference standards and did not consistently apply critical appraisal criteria, underlining the need for comprehensive frameworks that better integrate these essential considerations.</p><p><strong>Conclusions: </strong>This comprehensive literature review of remote monitoring technologies for patients with AD provides an understanding of remote monitoring technologies, trends, and gaps in the current research and the significance of novel strategies for remote monitoring to enhance patient outcomes and reduce the burden among health professionals and caregivers. The proposed remote monitoring framework aims to inspire the development of new interdisciplinary research models that advance care for patients with AD.</p>","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"8 ","pages":"e69175"},"PeriodicalIF":5.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12120371/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081186","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":"Frailty, Fitness, and Quality of Life Outcomes of a Healthy and Productive Aging Program (GrandMove) for Older Adults With Frailty or Prefrailty: Cluster Randomized Controlled Trial.","authors":"Jennifer Yee Man Tang, Hao Luo, Michael Tse, Joseph Kwan, Angela Yee Man Leung, Teresa Bik-Kwan Tsien Wong, Terry Yat Sang Lum, Gloria Hoi Yan Wong","doi":"10.2196/65636","DOIUrl":"10.2196/65636","url":null,"abstract":"<p><strong>Background: </strong>Exercise interventions can reverse frailty. However, their scalability and sustainability are limited by manpower, which is reducing due to population aging. GrandMove is a program that combines healthy and productive aging strategies to (1) train and employ robust older adults as exercise coaches and (2) improve fitness and motivate the adoption of an exercise habit in older adults with frailty and prefrailty.</p><p><strong>Objective: </strong>The aim of this study is to examine the effectiveness of GrandMove in improving frailty, fitness, and quality of life in older adults with frailty and prefrailty.</p><p><strong>Methods: </strong>This cluster randomized controlled trial recruited older adults with frailty and prefrailty (N=390) living in the community. The 18-month exercise program consisted of three 6-month phases of lifestyle education (E), resistance exercise (R), and aerobic exercise (A). Each group of participants was randomized into 3 intervention sequence arms: the E-R-A group, the A-R-E group, and the R-A-E group.</p><p><strong>Results: </strong>At 6, 12, and 18 months, 346, 305, and 264 participants completed the frailty assessment, respectively. At 6 months, 100 of 346 participants (28.9%) were robust. A-R-E and R-A-E were no better than E-R-A as the active control in addressing frailty over the first 6 months (A-R-E: interaction coefficient 0.07, 95% CI -0.35 to 0.49, P=.68; R-A-E: interaction coefficient -0.02, 95% CI -0.42 to 0.38, P=.90). Compared to lifestyle education, resistance training and aerobic training over the first 6 months were associated with greater improvement in fitness measures of grip strength for the left hand (A-R-E: interaction coefficient 2.99, 95% CI 0.76 to 5.23, P=.009; R-A-E: interaction coefficient 2.21, 95% CI 0.63 to 4.36, P=.04) and right hand (A-R-E: interaction coefficient 3.75, 95% CI 1.54 to 5.97, P=.001; R-A-E: interaction coefficient 2.29, 95% CI 0.16 to 4.42, P=.04) and arm curl test (A-R-E: interaction coefficient 1.42, 95% CI 0.39 to 2.46, P=.007; R-A-E: interaction coefficient 1.11, 95% CI 0.12 to 2.11, P=.03). The sequence of exercise interventions (R-A-E vs A-R-E) did not make a difference in primary outcomes at 12 months, but the R-A-E group showed better quality of life (interaction coefficient 4.50, 95% CI 0.12 to 8.88, P=.008). Improved frailty outcomes were maintained by the end of the study, but the change in overall physical activity level was limited.</p><p><strong>Conclusions: </strong>Combining healthy and productive aging strategies is a scalable and sustainable way to improve frailty, fitness, and quality of life in older adults with frailty and prefrailty. Different combinations of lifestyle education and physical interventions improved frailty.</p>","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"8 ","pages":"e65636"},"PeriodicalIF":5.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12094531/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081188","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":"Machine Learning for Predicting Postoperative Functional Disability and Mortality Among Older Patients With Cancer: Retrospective Cohort Study.","authors":"Yuki Hashimoto, Norihiko Inoue, Takuaki Tani, Shinobu Imai","doi":"10.2196/65898","DOIUrl":"10.2196/65898","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The global cancer burden is rapidly increasing, with 20 million new cases estimated in 2022. The world population aged ≥65 years is also increasing, projected to reach 15.9% by 2050, making cancer control for older patients urgent. Surgical resection is important for cancer treatment; however, predicting postoperative disability and mortality in older patients is crucial for surgical decision-making, considering the quality of life and care burden. Currently, no model directly predicts postoperative functional disability in this population.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;We aimed to develop and validate machine-learning models to predict postoperative functional disability (≥5-point decrease in the Barthel Index) or in-hospital death in patients with cancer aged ≥ 65 years.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective cohort study included patients aged ≥65 years who underwent surgery for major cancers (lung, stomach, colorectal, liver, pancreatic, breast, or prostate cancer) between April 2016 and March 2023 in 70 Japanese hospitals across 6 regional groups. One group was randomly selected for external validation, while the remaining 5 groups were randomly divided into training (70%) and internal validation (30%) sets. Predictor variables were selected from 37 routinely available preoperative factors through electronic medical records (age, sex, income, comorbidities, laboratory values, and vital signs) using crude odds ratios (P&lt;.1) and the least absolute shrinkage and selection operator method. We developed 6 machine-learning models, including category boosting (CatBoost), extreme gradient boosting (XGBoost), logistic regression, neural networks, random forest, and support vector machine. Model predictive performance was evaluated using the area under the receiver operating characteristic curve (AUC) with 95% CI. We used the Shapley additive explanations (SHAP) method to evaluate contribution to the predictive performance for each predictor variable.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;This study included 33,355 patients in the training, 14,294 in the internal validation, and 6711 in the external validation sets. In the training set, 1406/33,355 (4.2%) patients experienced worse discharge. A total of 24 predictor variables were selected for the final models. CatBoost and XGBoost achieved the largest AUCs among the 6 models: 0.81 (95% CI 0.80-0.82) and 0.81 (95% CI 0.80-0.82), respectively. In the top 15 influential factors based on the mean absolute SHAP value, both models shared the same 14 factors such as dementia, age ≥85 years, and gastrointestinal cancer. The CatBoost model showed the largest AUCs in both internal (0.77, 95% CI 0.75-0.79) and external validation (0.72, 95% CI 0.68-0.75).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The CatBoost model demonstrated good performance in predicting postoperative outcomes for older patients with cancer using routinely available preoperative factors. The robustness of","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"8 ","pages":"e65898"},"PeriodicalIF":5.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12094529/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144079934","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":"Nonpharmacological Multimodal Interventions for Cognitive Functions in Older Adults With Mild Cognitive Impairment: Scoping Review.","authors":"Raffy Chi-Fung Chan, Joson Hao-Shen Zhou, Yuan Cao, Kenneth Lo, Peter Hiu-Fung Ng, David Ho-Keung Shum, Arnold Yu-Lok Wong","doi":"10.2196/70291","DOIUrl":"10.2196/70291","url":null,"abstract":"<p><strong>Background: </strong>As the global population ages, the prevalence of dementia is expected to rise significantly. To alleviate the burden on health care systems and the economy, it is essential to develop effective strategies to enhance cognitive function in older adults. Previous studies have shown that combined nonpharmacological interventions can improve cognition across various domains in older individuals. However, there is no established gold standard for the exact combination and duration of these interventions, which makes it challenging to assess their overall effectiveness.</p><p><strong>Objective: </strong>Given the diversity of nonpharmacological multimodal interventions aimed at preventing cognitive decline in older adults with mild cognitive impairment (MCI), this scoping review sought to identify and summarize the characteristics and outcomes of these interventions.</p><p><strong>Methods: </strong>We adhered to the Arksey and O'Malley methodological framework and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) and searched 4 electronic databases (MEDLINE, PsycINFO, CINAHL, and Web of Science) systematically on July 6, 2023, and updated the search on April 17, 2024, using specific terms and keywords.</p><p><strong>Results: </strong>This review included 45 studies from 18 countries with 4705 participants from 2014 to 2024 encompassing different combinations of physical training (PT), cognitive training (CT), nutrition intervention, psychosocial intervention, social activities, and electrical stimulation. There is a growing numbers of studies combining PT and CT for MCI treatment, with additional modalities often added to address various aspects of the condition. Compared to single-modal interventions and usual care, multimodal approaches demonstrated significantly better improvements in cognition domains such as attention, global cognition, executive function, memory, processing speed, and verbal fluency. Technology has been instrumental in delivering these interventions and enhancing the effects of PT and CT. Multimodal interventions also show promise in terms of acceptability and user experience, which can improve treatment adherence.</p><p><strong>Conclusions: </strong>Research is limited regarding the cost-effectiveness and optimal dosage of these interventions, making it difficult to assess the additional benefits of incorporating more modalities. Future research should examine the long-term effects of incorporating multiple modalities, using standardized MCI criteria and outcome measures.</p>","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"8 ","pages":"e70291"},"PeriodicalIF":5.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12107202/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989464","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":"Identifying Optimal Wearable Devices for Monitoring Mobility in Hospitalized Older Adults: Feasibility, Acceptability, and Validity Study.","authors":"Paulo Nascimento, Renata Kirkwood, Lauren E Griffith, Mylinh Duong, Cody Cooper, Yujiao Hao, Rong Zheng, Samir Raza, Marla Beauchamp","doi":"10.2196/64372","DOIUrl":"10.2196/64372","url":null,"abstract":"<p><strong>Background: </strong>Hospitalized, frail older adults have an increased risk of developing hospital-acquired disability associated with hospital practices of restricted physical activity and immobilization. The use of activity tracking wearable devices may allow identification and prevention of mobility decline, reducing hospital-acquired disability.</p><p><strong>Objective: </strong>This study aimed to identify the optimal wearable device and wear location for monitoring mobility in older hospitalized patients. Specific objectives included (1) comparison of the feasibility and acceptability of ActiGraph wGT3X-BT (ActiGraph LLC), MOX1 (Maastricht Instruments), MetaMotionC (mBientLab), and Fitbit Versa (Google) for continuous mobility monitoring and (2) determination of the concurrent validity of the selected device for detecting body posture and step count.</p><p><strong>Methods: </strong>Participants were recruited for this observational study in the acute medical care unit of an academic hospital in Hamilton, Ontario, Canada. Eligible patients were aged 60 years and older, able to undertake the mobility protocol, and had an anticipated length of stay greater than 4 days. The study was divided into 2 experiments. Experiment 1 evaluated the feasibility of 4 wearable devices and validated the derived data for body posture and step count. Experiment 2 involved a mobility assessment session and a 24-hour monitoring and feasibility period with the selected device from experiment 1.</p><p><strong>Results: </strong>The ActiGraph wGT3X-BT emerged as the most feasible device, demonstrating superior usability, data acquisition, and management. The thigh-worn ActiGraph accurately detected sedentary behavior, while the ankle-worn device provided detailed information on step counts and body postures. Bland-Altman plots and intraclass correlation coefficients indicated that the ankle-worn ActiGraph showed excellent reliability for step counting, with minimal bias and narrow limits of agreement. Patients expressed a high willingness to wear a continuous mobility tracking device at the hospital and at home.</p><p><strong>Conclusions: </strong>Thigh- and ankle-worn ActiGraph are optimal for assessing and monitoring mobility in older hospitalized patients. Challenges such as discomfort and device removal observed during the 24-hour monitoring period highlight areas for future studies. Overall, our findings support the integration of wearable technology in hospital settings to enhance mobility monitoring and early intervention strategies. Further research is warranted to evaluate the long-term use of wearable data for predicting health outcomes post hospitalization and informing clinical decision-making to promote early mobility.</p>","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"8 ","pages":"e64372"},"PeriodicalIF":5.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030799","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}