JMIR Aging最新文献

{"title":"A Digital Serious Game (Anticip'action) to Support Advance Care Planning Discussions in the General Population: Usability Study.","authors":"Dafne Campioni, Frederic Ehrler, Antoine Berger, Christine Clavien","doi":"10.2196/73378","DOIUrl":"10.2196/73378","url":null,"abstract":"<p><strong>Background: </strong>In the context of an aging population and increasingly medicalized end-of-life practices, it is crucial to promote early discussions to help patients express their view on what is essential in their life as well as articulate their preferences regarding future medical treatments and end-of-life issues. An interprofessional research team at Geneva University and the Geneva University Hospitals has developed Anticip'action, a card game designed to help initiate and conduct advance care planning and end-of-life discussions. It is available for free in paper format in diverse languages and in a digital version in French.</p><p><strong>Objective: </strong>This study aims to assess the ergonomic quality of the digital version of the game with primary users.</p><p><strong>Methods: </strong>Overall, 10 users (women: n=5, 50%; men: n=5, 50%; mean age 41, SD 13.4 years; range 25-65 years; education: upper level; comfortable with smartphones) completed an online usability test. The test began with a rapid desirability test to capture initial impressions of the game's main screen without knowing what it is about. This was followed by a think-aloud procedure, including 26 tasks to perform all steps of the game. Posttest questionnaires were administered to collect participants' subjective perceptions of the usability (System Usability Scale), attractiveness (AttrakDiff), and relevance as well as overall endorsement of the game (Mobile Application Rating Scale). Open-ended questions were used to further explore usability issues. Usability problems were categorized and evaluated using standard evaluation grids. Content readability was assessed with Scolarius.</p><p><strong>Results: </strong>The rapid desirability test revealed an overall good or average impression. In 83.2% (208/250) of the cases, participants successfully completed the think-aloud tasks without assistance. Some of the tasks (4/25, 16%) revealed multiple usability issues requiring assistance. Analysis of the 23 failures and difficulties encountered revealed that 3 (13%) issues were due to suboptimal wording of the task instructions and that there were 9 (39%) major usability problems. All could be addressed through minor modifications. The Scolarius test indicated that the card titles were understandable at an elementary school level, while the explanations on the back of the cards required a high school reading level. Participants rated Anticip'action as good or excellent in usability (79 out of 100 on the System Usability Scale), attractiveness (1.57 on the -3 to +3 AttrakDiff scale), and relevance (4.1 out of 5 on section F of the Mobile Application Rating Scale). Participants provided overall positive qualitative feedback.</p><p><strong>Conclusions: </strong>The usability testing of the digital French version of Anticip'action produced positive results, with some areas for improvement identified. It can be recommended as a valuable resource for patients, famil","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"8 ","pages":"e73378"},"PeriodicalIF":4.8,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12411793/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972590","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":"Effectiveness of Iso-Inertial Resistance Training on Muscle Power in Middle-Older Adults: Randomized Controlled Trial.","authors":"Aïda Cadellans Arroniz, Daniel Romero Rodríguez, Víctor Zárate, Flora Dantony, Marc Madruga Parera, Silvia Ortega Cebrian, David Blanco","doi":"10.2196/66414","DOIUrl":"https://doi.org/10.2196/66414","url":null,"abstract":"<p><strong>Background: </strong>Resistance training is commonly used to prevent the decline in muscle power associated with aging.</p><p><strong>Objective: </strong>This study aims to evaluate the effectiveness of iso-inertial (IN) training on power, physical performance, and variables associated with the risk of falls, compared to gravitational (GR) training, in physically active middle-older adults.</p><p><strong>Methods: </strong>A parallel-group, randomized controlled trial was conducted at Espai Esport Wellness Center (Granollers, Spain). In total, 44 physically active adults (age >57) were randomized 1:1 to either the IN (n=21) or GR (n=23) training groups (using R software; R Core Team). Participants completed a 6-week training program (2 sessions/week) consisting of 3 exercises (forward lunge, side lunge, and forward lunge with row). The primary outcome includes power in the eccentric phase of each exercise, evaluated using both IN and GR devices. Secondary outcomes include concentric power, physical performance, and variables associated with the risk of falls. Only outcome evaluators were blinded. We used multivariate linear regression models for the analysis.</p><p><strong>Results: </strong>In total, 27 participants completed the program (IN: n=15 IN; GR: n=12). IN training resulted in better eccentric power gains compared to GR training when assessed using the IN system, although the difference was only statistically significant for the side lunge. For forward lunge, between-group difference was 4.50 W (95% CI -2.94 to 11.94 W, P=.23); for side lunge, between-group difference was 9.24 W (95% CI 2.99-15.49 W; P<.01); and for forward lunge with row, between-group difference was 15.25 W (95% CI -0.63 to 31.13 W; P=.06). We observed no significant differences for the eccentric power using the GR system evaluation, concentric power, physical performance, and variables associated with the risk of falls. Both groups showed significant improvements from baseline across all outcomes.</p><p><strong>Conclusions: </strong>Although IN training appeared to result in greater power gains during the eccentric phase when assessed with the IN system, statistically significant differences were observed only for the side lunge exercise. Both training systems seemed equally effective in improving eccentric power as evaluated with the GR system, concentric power, physical performance, and reducing variables associated with the risk of falls.</p>","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"8 ","pages":"e66414"},"PeriodicalIF":4.8,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12370268/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972568","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":"Predicting Postoperative Delirium in Older Patients Before Elective Surgery: Multicenter Retrospective Cohort Study.","authors":"Shun-Chin Jim Wu, Nitin Sharma, Anne Bauch, Hao-Chun Yang, Jasmine L Hect, Christine Thomas, Sören Wagner, Bernd R Förstner, Christine A F von Arnim, Tobias Kaufmann, Gerhard W Eschweiler, Thomas Wolfers","doi":"10.2196/67958","DOIUrl":"10.2196/67958","url":null,"abstract":"<p><strong>Background: </strong>Elective surgeries for older adults are increasing. Machine learning could enhance risk assessment, influencing surgical planning and postoperative care. Preoperative cognitive assessment may facilitate early detection and management of postoperative delirium (POD).</p><p><strong>Objective: </strong>This study aims to assess machine learning models' predictive ability for POD, focusing on the added predictive value of the neuropsychological assessments before elective surgery.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed data from the multicenter PAWEL (Patient safety, Efficiency and Life quality in elective surgery) and PAWEL-R (risk) studies, encompassing older patients (≥70 y) undergoing elective surgeries from July 2017 to April 2019. A total of 1624 patients (52.3% male, N=850; age: mean 77.9, SD 4.9 years) were included, with a POD diagnosis made before discharge. Sociodemographic, clinical, surgical, and neuropsychological features were collected pre- and intraoperatively by care providers. Machine learning models' performance was evaluated using the area under the receiver operating characteristic curve (AUC), with permutation testing for significance, and Shapley Additive Explanations to identify effective neuropsychological assessments.</p><p><strong>Results: </strong>Predicting POD before surgery with a random forest model achieved an AUC of 0.760. Incorporating all pre- and intraoperative features into the model yielded a slightly higher AUC of 0.783, with no statistically significant difference observed (P=.24). While cognitive factors alone were not strong predictors (AUC=0.617), specific tests within neuropsychological assessments, such as the Montreal Cognitive Assessment and Trail Making Tests, showed high feature attribution and played a crucial role in further enhancing prediction before surgery.</p><p><strong>Conclusions: </strong>Preoperative risk prediction for POD can increase risk awareness in presurgical assessment and improve perioperative management in older patients at a high risk for delirium.</p>","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"8 ","pages":"e67958"},"PeriodicalIF":4.8,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12364014/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144883930","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":"Assessing the Time for Living and Caring (TLC) Study: Mixed-Methods Feasibility Study of a Web-Based Caregiver Intervention to Improve Respite.","authors":"Amber D Thompson, Alexandra L Terrill, Michael Caserta, Bob Wong, Eli Iacob, Catharine Sparks, Louisa Stark, Rebecca L Utz","doi":"10.2196/71792","DOIUrl":"10.2196/71792","url":null,"abstract":"<p><strong>Background: </strong>Interventions that are self-administered and delivered online are increasingly being seen as a flexible way to support family caregivers. Intervention research should prioritize the measurement of feasibility throughout all of the stages of intervention development and evaluation to provide the essential feedback loop needed for the iterative development and refinement process.</p><p><strong>Objective: </strong>We describe the methodology and data used to assess the feasibility, usability, and acceptability of the Time for Living and Caring (TLC) intervention, a technology-delivered intervention (app) for dementia caregivers to improve respite time use.</p><p><strong>Methods: </strong>The feasibility analysis is theoretically guided by a multidimensional definition of feasibility and uses a mixed-methods research design. Stakeholder feedback collected via focus groups during intervention development (n=15), self-reported surveys from participants enrolled in the pilot trial of the intervention (n=163), surveys of a nationwide sample of respite providers (n=57), and end-user statistics, captured passively by Google Analytics from those using the app, were used in the feasibility analysis of the TLC intervention.</p><p><strong>Results: </strong>The TLC study used an appropriate design and data collection procedures, along with acceptable recruitment capability. Out of 5 intervention features, 4 received favorable ratings (range of 82%-99%) by intervention participants and respite providers, which, when combined with open-ended recommendations for improvements, indicate a high degree of usability. Acceptability was measured through appraisal of the intervention experience (135/159, 85% positive), potential future use (127/163, 78%), willingness to recommend (148/163, 91%), and perceived benefit (135/163, 83%).</p><p><strong>Conclusions: </strong>Taken together, the data suggest that the TLC app is a promising intervention that could be implemented as an on-demand resource for respite-using caregivers, irrespective of where they are located or when they choose to access it. Additionally, this paper provides a blueprint for systematically evaluating multiple dimensions of feasibility, using various forms of mixed-methods data collected during intervention development and pilot testing of an intervention, which should help streamline the eventual implementation of effective interventions in real-world settings.</p>","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"8 ","pages":"e71792"},"PeriodicalIF":4.8,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12360673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875612","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, Attitudes, and Behaviors Related to Dementia Prevention and Caregiving Among Korean Americans (the KIMCHI Project): Pre- and Posttest Evaluation Study.","authors":"Van Ta Park, Bora Nam, Daren Huang, Stacy W Yun, Nicole Phan, Eun Jeong Lee, Hye-Won Shin","doi":"10.2196/72147","DOIUrl":"10.2196/72147","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Many Korean American older adults have limited English proficiency, have low socioeconomic status, and are immigrants. The availability and accessibility of linguistic and culturally appropriate dementia-related health care and caregiving resources for this population are limited. This is concerning given that Korean American older adults are a rapidly growing population, and Alzheimer disease and related dementias (ADRD) represent a significant public health issue.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;We aimed to assess changes in pre- and posttest knowledge, attitudes, and behaviors regarding ADRD prevention and caregiving among participants in the Koreans Invested in Making Caregivers' Health Important (KIMCHI) before and after their participation in KIMCHI workshop presentations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A community engagement dissemination project, KIMCHI, was developed by academic and community partners to culturally and linguistically tailor selected evidence-based research from the Patient-Centered Outcomes Research Institute for Korean American older adults, caregivers, and other stakeholders. Dissemination activities were conducted in-person (as workshops) and on digital platforms. Through partnerships with 1 academic institution and 2 community organizations that serve Korean Americans, 211 participants participated in the KIMCHI in-person workshop presentations, and 134 participants participated asynchronously online (via fact sheets on the project website, YouTube videos, and other social media, such as Facebook and X [formerly known as Twitter]). Pre- and postparticipation tests on knowledge, attitudes, and behaviors for ADRD and caregiving were conducted with workshop participants. We administered satisfaction surveys to all participants (workshop and online) and conducted two-tailed paired-sample 2-tailed t tests to assess mean changes in the pre- and postparticipation tests.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among the workshop participants (N=211), most (114/204, 55.9%) were older adults (mean age 69, SD 12.1 y; range 24-90 y), female (n=148, 70.1%), and foreign-born (n=203, 96.2%). Many reported having limited English proficiency (167/211, 79.1%). Significant changes were observed in posttest ADRD knowledge (mean 11.51, SD 2.64), attitudes (mean 7.13, SD 2.83), and behaviors (mean 8.88, SD 2.72) compared to pretest scores (knowledge: mean 10.34, SD 2.67; t&lt;sub&gt;210&lt;/sub&gt;=1.17; P&lt;.001; attitudes: mean 6.33, SD 2.44; t&lt;sub&gt;210&lt;/sub&gt;=0.8; P&lt;.001; and behaviors: mean 8.11, SD 2.68; t&lt;sub&gt;210&lt;/sub&gt;=0.76; P&lt;.001). Workshop participants reported high satisfaction (196/209, 93.8%) with KIMCHI, with the workshop presentations being perceived as culturally relevant and applicable (196/209, 93.8%). Most workshop participants expressed interest in learning more about ADRD-related health topics (186/209, 89%). Similarly, the online participants (N=134) expressed high satisfaction (115/134, 85.8%) and agreed t","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"8 ","pages":"e72147"},"PeriodicalIF":4.8,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12397760/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859725","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":"Ethics and Equity Challenges in Telerehabilitation for Older Adults: Rapid Review.","authors":"Mirella Veras, Louis-Pierre Auger, Jennifer Sigouin, Nahid Gheidari, Michelle LA Nelson, William C Miller, Anne Hudon, Dahlia Kairy","doi":"10.2196/69660","DOIUrl":"10.2196/69660","url":null,"abstract":"<p><strong>Background: </strong>The integration of technology in rehabilitation is transforming health care delivery for older adults, especially through telerehabilitation, which addresses barriers to in-person care.</p><p><strong>Objective: </strong>This rapid review explores the ethical and equity concerns associated with telerehabilitation for older adults, focusing on challenges such as internet access, technology adoption, and digital literacy.</p><p><strong>Methods: </strong>Conducted according to Cochrane Rapid Review guidelines, this review used the Metaverse Equitable Rehabilitation Therapy framework, focusing on equity and ethics. Studies included telerehabilitation services for adults aged 55 years and older, published between 2010 and 2023. Screening was conducted independently by 2 researchers using Rayyan (Qatar Computing Research Institute, Hamad Bin Khalifa University), with full-text review by additional team members. Searches were performed in Medline and CINAHL.</p><p><strong>Results: </strong>From 323 papers retrieved, 49 studies met the inclusion criteria. The included studies were published between 2013 and 2023. Disparities in socioeconomic status, geographic location, and racial and ethnic backgrounds were found to impact telerehabilitation use. Additionally, ethical concerns around privacy, security, and autonomy were often inadequately addressed.</p><p><strong>Conclusions: </strong>This review emphasizes the need for culturally appropriate, accessible, and inclusive telerehabilitation services that integrate ethical and equity considerations into their design and delivery.</p>","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"8 ","pages":"e69660"},"PeriodicalIF":4.8,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12349735/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144849274","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":"The Impact of Social Stress and Healthy Lifestyle on the Mortality of Chinese Older Adults: Prospective Cohort Study.","authors":"Jin Yang, Jilong Huang, Qingmei Huang, Jian Gao, Dan Liu, Zhihao Li, Yuebin Lv, Xiaoming Shi, Chen Mao","doi":"10.2196/75942","DOIUrl":"10.2196/75942","url":null,"abstract":"<p><strong>Background: </strong>With social progress, social stress (SS) has become a key factor affecting health. Unhealthy lifestyles may exacerbate these effects. However, the relationship between SS, lifestyle, and older adults' mortality rate still needs to be studied.</p><p><strong>Objective: </strong>This study aimed to explore the relationship between SS and all-cause mortality in Chinese older adults, as well as the influence of healthy lifestyle factors.</p><p><strong>Methods: </strong>Three groups of SS were defined through latent class analysis: low, medium, and high. We created a healthy lifestyle index based on smoking, alcohol consumption, physical activity, and diet. Multivariable Cox proportional hazards models, interaction analyses, and mediation analyses were conducted.</p><p><strong>Results: </strong>The Chinese Longitudinal Healthy Longevity Survey (CLHLS) datasets included participants from 806 cities and counties across 23 provinces in China from 1998 to 2018. In this study, participants were recruited from 4 waves of the CLHLS (2005, 2008, 2011, and 2014). Finally, 19,236 participants were included in this study, of which 6891 (35.8%) had low SS, 11,662 (60.6%) had medium SS, and 683 (3.6%) had high SS. In the fully adjusted model, the hazard ratio (HR) for medium SS was 1.16 (95% CI 1.11-1.20; P<.001), and for high SS, it was 1.28 (95% CI 1.18-1.40; P<.001) compared to the low SS group. For individuals aged ≥80 years, the medium SS group had a 28% (HR 1.28, 95% CI 1.22-1.34; P<.001) increased mortality risk, and the high SS group had a 38% (HR 1.38, 95%CI 1.26-1.52; P<.001) increased risk compared to the low SS group. Approximately 7% of the association between SS and mortality was mediated through the healthy lifestyle. Under different SS, the lower the healthy lifestyle score, the higher the risk of mortality.</p><p><strong>Conclusions: </strong>SS was an independent predictor of all-cause mortality in Chinese older adults. The healthy lifestyle mediated this effect to some extent. Unhealthy lifestyle behaviors were associated with a higher risk of mortality at all SS levels.</p>","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"8 ","pages":"e75942"},"PeriodicalIF":4.8,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342692/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144838072","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":"Staff Enablement of the Tovertafel for Enrichment in Residential Aged Care: Field Study.","authors":"Ryan M Kelly, Asmita Manchha, Jenny Waycott, Rajna Ogrin, Judy A Lowthian","doi":"10.2196/67919","DOIUrl":"10.2196/67919","url":null,"abstract":"<p><strong>Background: </strong>Enrichment activities are essential for enhancing the psychosocial well-being of older adults living in residential aged care homes. There has been increasing interest in using digital technology for enrichment, but the implementation of technology requires careful support and enablement from staff to ensure that residents experience the intended benefits.</p><p><strong>Objective: </strong>This study aimed to understand how care staff facilitate aged care residents' use of the Tovertafel (\"magic table\" in Dutch), a technology that projects images onto a tabletop to enable groups of people to play games. The study further aimed to understand the benefits arising from the Tovertafel when facilitated by staff.</p><p><strong>Methods: </strong>We conducted a field study in 1 residential aged care home in Queensland, Australia. The methods included semistructured interviews with the staff and residents about their experiences with the Tovertafel, observations of 4 sessions in which the residents and staff played Tovertafel games, and a diary completed by the staff after Tovertafel sessions. Data were analyzed through reflexive thematic analysis.</p><p><strong>Results: </strong>We developed 3 themes through our analysis. Theme 1 highlights the need for the staff to overcome physical and personal barriers before Tovertafel sessions could take place. These included a lack of a dedicated space for playing Tovertafel games and the residents' reluctance to attend Tovertafel sessions. Theme 2 highlights how the staff used creative strategies to make Tovertafel sessions successful. These included helping the residents learn how to interact with the games; adapting the activity to suit the capabilities of the residents; sustaining engagement by choosing appropriate games; and using prompts, questions, and storytelling to make the games more engaging. Theme 3 describes the benefits and outcomes that arose from staff-supported enablement of the Tovertafel, including participation in an enjoyable physical activity, socialization, and reminiscence.</p><p><strong>Conclusions: </strong>This study suggests that the Tovertafel provides opportunities for aged care staff to engage in creative play and personalization catering to residents with different capabilities. However, the benefits arising from the Tovertafel are unlikely to be achieved without substantial facilitation from the staff, who play a key role in enabling the participation of the residents. Sustaining the engagement of the residents is important during Tovertafel activities and can lead to beneficial outcomes.</p>","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"8 ","pages":"e67919"},"PeriodicalIF":4.8,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12381539/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144822790","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":"Analyzing Disparity in Geographical Accessibility to Home Medical Care Using a Claims Database and Geographical Information System: Simulation Study.","authors":"Yasuhiro Morii, Yasuhiro Nakanishi, Yuichi Nishioka, Yukio Tsugihashi, Tatsuya Noda, Tomoya Myojin, Tomoaki Imamura, Manabu Akahane","doi":"10.2196/70040","DOIUrl":"10.2196/70040","url":null,"abstract":"<p><strong>Background: </strong>The demand for home medical care services has increased in aging societies. Therefore, allocating health care resources optimally to meet the needs of each community is essential. Geographical accessibility is an important factor affecting access to home medical care services; however, little research has been conducted on regional disparities in geographical accessibility.</p><p><strong>Objective: </strong>This study aims to analyze the regional disparities in geographical accessibility to home medical care services using the Kokuho database (KDB), a comprehensive medical claims database for a prefecture in Japan.</p><p><strong>Methods: </strong>This study included 39 municipalities in Nara Prefecture, Japan. Using a geographical information system, accessibility to home medical care services, that is, travel distance and time from hospitals and clinics to hypothetical patients, was analyzed in two scenarios: (1) an ideal scenario, where we assumed that all hospitals or clinics in Nara Prefecture provided those services and (2) an actual scenario, where hospitals or clinics in Nara Prefecture that actually provided home medical care services, identified from KDB data analysis, were used in the analysis. Hypothetical patients were randomly distributed on the geographical information system in accordance with the usage rates of home medical care services and with the distributions of the population aged ≥75 years. The usage rate by municipalities was aggregated from the analysis of KDB data of Nara Prefecture in FY2019.</p><p><strong>Results: </strong>The median travel distance was longer than 16 km, the reference limit value specified in the Japanese fee table, and the median travel time exceeded 30 min in certain rural municipalities in the southern part of Nara Prefecture, in the actual scenario, whereas the travel distance and time were improved in the ideal scenario. The differences in travel time between the ideal and actual scenarios were the largest in the depopulated municipalities in the southern part, such as Totsukawa (32.6 vs 5.8 min), Kawakami (30.1 vs 11.8 min), Kurotaki (21.3 vs 5.2 min), and Kamikitayama (20.7 vs 3.5 min). The usage rates were also lower in rural municipalities in the southern part.</p><p><strong>Conclusions: </strong>The results revealed that geographical accessibility was lower in depopulated municipalities in the southern part, and the disparity could be partly solved in the ideal scenario, especially in that area, highlighting the necessity of increasing supply in the southern areas. KDB is a comprehensive database that includes medical claims information for home medical care patients and details of the provision of medical institutions, enabling geographical analysis that reflects actual health care usage.</p>","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"8 ","pages":"e70040"},"PeriodicalIF":4.8,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12327904/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144795723","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":"Development and Validation of a Brain Aging Biomarker in Middle-Aged and Older Adults: Deep Learning Approach.","authors":"Zihan Li, Jun Li, Jiahui Li, Mengying Wang, Andi Xu, Yushu Huang, Qi Yu, Lingzhi Zhang, Yingjun Li, Zilin Li, Xifeng Wu, Jiajun Bu, Wenyuan Li","doi":"10.2196/73004","DOIUrl":"10.2196/73004","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Precise assessment of brain aging is crucial for early detection of neurodegenerative disorders and aiding clinical practice. Existing magnetic resonance imaging (MRI)-based methods excel in this task, but they still have room for improvement in capturing local morphological variations across brain regions and preserving the inherent neurobiological topological structures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To develop and validate a deep learning framework incorporating both connectivity and complexity for accurate brain aging estimation, facilitating early identification of neurodegenerative diseases.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We used 5889 T1-weighted MRI scans from the Alzheimer's Disease Neuroimaging Initiative dataset. We proposed a novel brain vision graph neural network (BVGN), incorporating neurobiologically informed feature extraction modules and global association mechanisms to provide a sensitive deep learning-based imaging biomarker. Model performance was evaluated using mean absolute error (MAE) against benchmark models, while generalization capability was further validated on an external UK Biobank dataset. We calculated the brain age gap across distinct cognitive states and conducted multiple logistic regressions to compare its discriminative capacity against conventional cognitive-related variables in distinguishing cognitively normal (CN) and mild cognitive impairment (MCI) states. Longitudinal track, Cox regression, and Kaplan-Meier plots were used to investigate the longitudinal performance of the brain age gap.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The BVGN model achieved an MAE of 2.39 years, surpassing current state-of-the-art approaches while obtaining an interpretable saliency map and graph theory supported by medical evidence. Furthermore, its performance was validated on the UK Biobank cohort (N=34,352) with an MAE of 2.49 years. The brain age gap derived from BVGN exhibited significant difference across cognitive states (CN vs MCI vs Alzheimer disease; P&lt;.001), and demonstrated the highest discriminative capacity between CN and MCI than general cognitive assessments, brain volume features, and apolipoprotein E4 carriage (area under the receiver operating characteristic curve [AUC] of 0.885 vs AUC ranging from 0.646 to 0.815). Brain age gap exhibited clinical feasibility combined with Functional Activities Questionnaire, with improved discriminative capacity in models achieving lower MAEs (AUC of 0.945 vs 0.923 and 0.911; AUC of 0.935 vs 0.900 and 0.881). An increasing brain age gap identified by BVGN may indicate underlying pathological changes in the CN to MCI progression, with each unit increase linked to a 55% (hazard ratio=1.55, 95% CI 1.13-2.13; P=.006) higher risk of cognitive decline in individuals who are CN and a 29% (hazard ratio=1.29, 95% CI 1.09-1.51; P=.002) increase in individuals with MCI.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;BVGN offers a precise framework for brain aging ass","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"8 ","pages":"e73004"},"PeriodicalIF":4.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12357125/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765619","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}