JMIR Aging最新文献

{"title":"Daily Monitoring of Behavioral and Psychological Symptoms of Dementia in Residential Care: Mixed Methods Pilot Study.","authors":"Johannes Malm, Therése Bielsten, Charlotta Nilsen, Elzana Odzakovic, Ingemar Kåreholt","doi":"10.2196/98024","DOIUrl":"10.2196/98024","url":null,"abstract":"<p><strong>Background: </strong>Many clinically relevant aspects of health are expressed through behavior, affect, and interaction, and therefore rely on observation rather than instrumental measurement; yet such information is often documented infrequently in routine care. Dementia, and particularly behavioral and psychological symptoms of dementia (BPSD), is a relevant case because symptoms fluctuate across time and context. Little is known about how structured daily symptom assessment can be integrated into routine dementia care practice.</p><p><strong>Objective: </strong>This pilot study aimed to investigate whether structured daily observation of BPSD, supported by digital documentation, can be incorporated into everyday residential dementia care.</p><p><strong>Methods: </strong>A convergent mixed methods design was applied across 4 nursing home units in southern Sweden. Feasibility was operationalized through 4 focus areas (implementation, practicality, acceptability, and integration), with adherence to the registration routine as the primary feasibility outcome. Quantitative data comprised structured registrations collected daily by care staff over 90 days for 8 residents with BPSD, analyzed descriptively, and interpreted using selected NASSS (nonadoption, abandonment, scale-up, spread, and sustainability) framework domains to contextualize variation in symptom patterns, adherence, and registration practices. Semistructured dyadic interviews were analyzed using deductive content analysis guided by the same domains, with integration occurring at the analytical and interpretive stages.</p><p><strong>Results: </strong>A total of 21,993 item-level registrations were completed: 19,123 NPI-NH (Neuropsychiatric Inventory - Nursing Home version) symptom ratings, recorded across 1623 shift registrations (1 per resident per shift), and 2870 individually selected variables. Overall adherence to the registration routine averaged 75% across shifts but varied considerably between residents (range 33%-90%) and between staff members. Mean time per shift registration decreased from 77.1 seconds in the initial 30-day period to 46.2 seconds in the final 30-day period (P=.008). Symptom prevalence varied widely across NPI domains (7.5% to 38.1% of observation days), and daily symptom counts varied both between and within residents. The routine was experienced as technically straightforward and easy to incorporate into daily work. At the same time, challenges emerged, including time constraints, inconsistent participation, varying levels of interpretive confidence, and difficulties distinguishing among overlapping symptoms. Organizational routines and team stability were central to sustaining staff engagement.</p><p><strong>Conclusions: </strong>The high number of completed registrations indicates that daily observations can be integrated into daily dementia care. The participants perceived it as meaningful and useful. Feasibility was primarily influenced by or","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"9 ","pages":"e98024"},"PeriodicalIF":4.6,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13395431/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148580587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Community-in-the-Loop Approach to Smart Home Monitoring for Aging in Place: Mixed Methods Evaluation of a Co-Designed Prototype.","authors":"Roschelle L Fritz, Connie Kim Yen Nguyen-Truong, Jennifer Phipps, Ellen E Hinderlie, Yolanda Lb Rodriguez, Thai Hien Nguyen, Gabrielle Barling, Anna Mishuk, Heather Schoonover, Christi Zuber, Marilyn Rantz","doi":"10.2196/88290","DOIUrl":"10.2196/88290","url":null,"abstract":"<p><strong>Background: </strong>The population of adults aged 65 and older is rapidly increasing, while the availability of caregivers is declining. Smart homes that provide unobtrusive, continuous monitoring and alerting on clinically relevant changes in daily activity patterns offer a potentially innovative solution for aging in place.</p><p><strong>Objective: </strong>This study aims to evaluate the barriers and facilitators to the adoption of a low-cost smart home embedded within a community-based approach to health monitoring for older adults with multiple chronic conditions and who are experiencing poverty.</p><p><strong>Methods: </strong>Using a prospective, mixed methods design and iterative community co-design, 46 older adults from 7 different language groups were continuously monitored for 6 months with ambient sensors installed in their homes. Two older adults were monitored for 4 and 5 months, respectively, resulting in a total sample of 48. The system generated alerts based on movement pattern changes and escalated notifications to participants, support persons, community health workers, and nurses. Sensor data were analyzed descriptively to quantify alert patterns and response rates, while written text-based data from in-the-moment surveys, community health workers' and registered nurses' notes, and semistructured interviews underwent qualitative descriptive analysis and reflexive thematic coding.</p><p><strong>Results: </strong>The system generated 37 million sensor readings condensed into 1.2 million high-level events and 4719 novel alerts. Qualitative data comprised 34,086 words of text. Participants responded to 1.57% (74) of the initial email alerts and 7.79% (368) of the follow-up SMS text message alerts sent when no email response was received. Community health workers and registered nurses responded to 78.36% (n=3698) of the escalated alerts, resulting in 1060 contacts with participants in response to alerts. Clinical contacts resulted in 72 interventions. Three major qualitative themes emerged: (1) Alone, (2) Trust, and (3) Human Connection. Subthemes included Safety, Personalization, and Digital Distress defined as stress associated with interacting with digital health-monitoring systems. Participants rated the system highly (mean likelihood-to-recommend rating 8.68/10, SD 1.68); however, they expressed a strong preference for phone calls over automated alerts. Cultural expectations influenced adoption, particularly in multigenerational households.</p><p><strong>Conclusions: </strong>Communities can effectively engage in technology-delivered health care. Future research is needed to improve technical aspects of smart home monitoring systems, including accurate alerting using machine learning, data visualizations for older adults and health care workers, and culturally sensitive features. Additional work should address how and when to communicate automated messaging, engage older adults with their own data, and integrate se","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"9 ","pages":"e88290"},"PeriodicalIF":4.6,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13395425/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148580601","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":"Digital Mahjong-Based Cognitive Engagement Intervention for Older Adults: Randomized Controlled Trial.","authors":"Heng-Hsin Tung, Chen-Yuan Kuo, Pei-Lin Lee, Chih-Wen Chang, Kun-Hsien Chou, Katelyn E Chen, Ching-Po Lin, Chih-Kuang Liang, Liang-Kung Chen","doi":"10.2196/85339","DOIUrl":"10.2196/85339","url":null,"abstract":"<p><strong>Background: </strong>Gamified digital training may support long-term engagement in aging populations, yet randomized evidence linking behavioral effects to convergent neuroimaging outcomes remains limited.</p><p><strong>Objective: </strong>This study tested whether a home-based digital mahjong-based cognitive engagement intervention enhanced cognition in community-dwelling older adults and explored brain changes using multimodal magnetic resonance imaging (MRI).</p><p><strong>Methods: </strong>We conducted a single-blind, parallel-group randomized controlled trial in Taipei, Taiwan (July 2020-November 2021). Community-dwelling adults aged 55 years and older were randomized (1:1) to a 6-month digital mahjong-based intervention (two 30-minute sessions per week via an iPad app) with an incentivized walking component (Mi Band step tracking with in-game tokens) or no intervention. Primary MRI outcomes were gray matter volume, regional homogeneity (ReHo), fractional amplitude of low-frequency fluctuations (fALFF), and global brain connectivity. Secondary outcomes included cognition (Montreal Cognitive Assessment), physical activity (International Physical Activity Questionnaire), mental health (Brief Resilience Scale and Mandarin version of the Demoralization Scale), quality of life (EQ-5D with a visual analog scale), physical fitness and body composition, and blood biomarkers. Per-protocol analyses were performed. Voxel-wise imaging analyses used analysis of covariance in SPM12 with family-wise error (FWE) correction at the cluster level (P<.05). Sensitivity analyses controlling for MRI delay duration were conducted to assess robustness of findings.</p><p><strong>Results: </strong>In total, 60 participants were enrolled (n=30, 50% per group); 96.7% (29/30) in the intervention group and 90% (27/30) in the control group completed primary assessments. Compared with controls, the intervention group showed a greater improvement in Montreal Cognitive Assessment delayed recall (between-group difference=-0.79 points, 95% CI -1.538 to -0.042; P=.04). Neuroimaging revealed increased ReHo in the right insula (FWE-corrected P<.05) and decreased gray matter volume in the left frontal pole and orbitofrontal cortex, with reduced fALFF in the left frontal pole. Changes in delayed recall were positively associated with right insular ReHo and also showed significant associations with the right anterior cingulate gyrus (ReHo), left inferior frontal gyrus, and right paracingulate gyrus (fALFF; FWE-corrected P<.05 in all cases). In exploratory dose analyses, right insular ReHo correlated with total practice sessions (r=0.48; P=.009). Among physiological outcomes, the intervention group had a larger reduction in diastolic blood pressure (-3.50 mm Hg, 95% CI -6.911 to -0.091; P=.04), whereas the thyroid-stimulating hormone decreased but remained within the normal range. Sensitivity analyses confirmed that primary findings remained stable after controlling for MRI","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"9 ","pages":"e85339"},"PeriodicalIF":4.6,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13448193/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148580593","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":"Characterizing Digital Mindfulness Intervention Utilization and Weekly Assessments in Caregivers of Persons Living With Dementia: Secondary Analysis of a Randomized Controlled Trial.","authors":"Michael P Williams, Darby M Simon, Morgan Seward, Raquel G Tatar, Jennifer Huberty, Ana-Maria Vranceanu, Evan Plys","doi":"10.2196/83618","DOIUrl":"10.2196/83618","url":null,"abstract":"<p><strong>Background: </strong>Caregivers of persons living with dementia are at increased risk of reporting high stress. Mindfulness-based interventions (MBIs) teach caregivers mindfulness skills and are effective at reducing stress. Digital MBIs are a feasible way to improve access to MBIs for caregivers of persons living with dementia. Yet, caregiver improvement with digital MBI utilization is less defined in the literature.</p><p><strong>Objective: </strong>The goal of this secondary data analysis was to characterize weekly mindfulness and stress ratings among caregivers of persons living with dementia and to examine how digital MBI utilization impacted these ratings throughout 12 weeks of a feasibility trial.</p><p><strong>Methods: </strong>Participants were eligible for this secondary analysis if they were randomized to the digital MBI condition (Healthy Minds Program for Caregivers [HMP-C], n=46) and completed weekly ratings over the 12-week trial. At baseline and at the end of each week of the trial, participants rated their mindfulness and stress in the past week from 0 to 10. Weekly HMP-C utilization was defined as the time spent using HMP-C in the week prior to the weekly ratings. Descriptive statistics and visualizations were used to characterize mindfulness and stress ratings. Generalized linear mixed models were used to estimate the effect of mindfulness on stress and the effect of HMP-C utilization on stress and mindfulness throughout the trial (α=.05).</p><p><strong>Results: </strong>Baseline mindfulness and stress ratings were 4 (IQR 3-6, range 0-8) and 7 (IQR 6.5-8, range 4-10), respectively. Stress had the greatest decrease between baseline and week 3 (-2 points on average), whereas mindfulness had the greatest increase between baseline and week 4 (+2.5 points on average). There was a significant fixed effect of baseline mindfulness on baseline stress (β=.5, P<.001), with a significant interaction between mindfulness and study week (β=.05, P=.001), suggesting that this relationship was attenuated over time. There was variability in baseline stress (τ00=2.04) and the relationship between mindfulness and stress (τ₁₁=0.08), with a high correlation (ρ01=0.86), suggesting that those with high baseline stress benefited most from increases in mindfulness. For every 10 minutes of HMP-C utilization between baseline and week 1, mindfulness and stress ratings were 0.14 points higher (P<.001) and 0.14 points lower (P<.001), respectively. Despite a significant interaction between HMP-C utilization and study week in both models, the effect size was small (mindfulness: β=.02, P<.001; stress: β=.01, P=.013), suggesting that this relationship was sustained over time.</p><p><strong>Conclusions: </strong>Mindfulness and stress changed mostly during the first 3 to 4 weeks of the trial. During this time of mindfulness skill acquisition, mindfulness and stress were most significantly negatively associated, especially among those with high baseline ","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"9 ","pages":"e83618"},"PeriodicalIF":4.6,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13386664/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148537241","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":"Perceived Algorithmic Care Intensity and Older Adults' Autonomy in Community Smart Care: Mixed Methods Study.","authors":"Xianghui Huang","doi":"10.2196/94559","DOIUrl":"10.2196/94559","url":null,"abstract":"<p><strong>Background: </strong>As smart older adult care shifts from basic information support to more continuous algorithm-driven care, concerns have grown about whether such systems support older adults' independence or weaken their sense of autonomy. Although previous research has focused mainly on technology acceptance, less is known about how algorithmic care shapes perceived autonomy and through which psychological pathways this occurs.</p><p><strong>Objective: </strong>This study examined whether perceived algorithmic care intensity reduces older adults' perceived autonomy in community smart care settings, whether decisional substitution and perceived surveillance mediate this relationship, and whether digital literacy moderates these effects.</p><p><strong>Methods: </strong>A 3-stage design was adopted. First, a qualitative prestudy with 15 older adults was conducted to refine the focal constructs and measures. Second, a vignette-based experiment with 233 valid participants tested the effects of algorithmic care intensity on decisional substitution, perceived surveillance, and perceived autonomy. Third, a community-based survey with 298 valid participants examined the moderated mediation model in real-world smart older adult care settings.</p><p><strong>Results: </strong>In study 1, compared with the low-intensity condition, the high-intensity condition significantly increased decisional substitution and perceived surveillance, while reducing perceived autonomy. Indirect effects through decisional substitution (effect=-0.072, 95% CI -0.144 to -0.016) and perceived surveillance (effect=-0.084, 95% CI -0.161 to -0.019) were both significant. In study 2, perceived algorithmic care intensity positively predicted decisional substitution (β=.400, P<.001) and perceived surveillance (β=.440, P<.001), and negatively predicted perceived autonomy (β=-.356, P<.001). The indirect effects through decisional substitution (effect=-0.112, 95% CI -0.172 to -0.065) and perceived surveillance (effect=-0.149, 95% CI -0.215 to -0.093) were significant. Digital literacy significantly weakened the effect of algorithmic care intensity on decisional substitution (β=-.174, P=.002), but not on perceived surveillance (β=-.071, P=.18).</p><p><strong>Conclusions: </strong>Algorithmic care may undermine older adults' perceived autonomy both directly and indirectly through decisional substitution and perceived surveillance. Digital literacy appears to be a selective rather than universal buffer. These findings extend smart older adult care research beyond technology acceptance and clarify the tension between empowerment and control in algorithmic care.</p>","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"9 ","pages":"e94559"},"PeriodicalIF":4.6,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13378906/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148473282","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":"Smart Home Technology Integration in Home Modification Programs Serving Older Adults: Focus Group Study With Program Grantees.","authors":"Haomin Hu, Moriah Clarke, Meredith Hughes, Palash Sharma, Jack Fried, Portia Singh, Pamela Toto","doi":"10.2196/89729","DOIUrl":"10.2196/89729","url":null,"abstract":"<p><strong>Background: </strong>As people age over the coming decades, demand for in-home support and other interventions, such as home modifications, to help older adults age in place successfully, is also expected to rise. Smart home technologies have the potential to enhance aging in place by complementing traditional home modifications; however, adoption within federally funded home modification programs remains limited.</p><p><strong>Objective: </strong>This study explored grantees' perspectives on the Older Adults Home Modification Program (OAHMP) to understand current practices, perceived benefits, barriers, and strategies for integrating smart home technologies into home modification services.</p><p><strong>Methods: </strong>An exploratory qualitative study was conducted with staff, occupational therapists, and home builders from 3 OAHMP grantee organizations. A 1.5-hour virtual focus group was held and thematically analyzed using a deductive approach grounded in the discussion agenda.</p><p><strong>Results: </strong>A total of 11 participants reported early adoption of select smart devices-most commonly smart speakers, doorbell cameras, motion-activated lights, and smart plugs-to enhance home safety, communication, and independence. Barriers to broader implementation emerged at three levels: (1) older adults' digital literacy, privacy concerns, and device maintenance burden; (2) contextual constraints, such as unreliable internet in rural areas; and (3) organizational limitations, including training needs, staffing capacity, and funding challenges. Participants emphasized the importance of progressive adoption, hands-on training, and low-maintenance technology. In addition, partnerships with university educational programs were well established among selected grantees to provide technology training resources for older adults. To inform a reasonable technology selection for home modifications, criteria were proposed across 5 domains: installation, usability, accessibility, sustainability, and security and privacy.</p><p><strong>Conclusions: </strong>Integrating smart home technologies into home modification programs provides a scalable, cost-effective opportunity to improve aging in place outcomes. Policy support, workforce training, valid selection criteria, and sustainable funding models are needed to promote equitable adoption across OAHMP and similar federally supported programs.</p>","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"9 ","pages":"e89729"},"PeriodicalIF":4.6,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13375085/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148473323","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":"Correction: Speech Recognition-Based Dietary Assessment Tool for Older Adults: Validation and Usability Study.","authors":"Yoonjee Sung, Soyoung Jung, Hae Jin Kang, So Young Moon, Jee Hyang Jeong, Seong Hye Choi, Eun-Hye Lee, Yoo Kyoung Park","doi":"10.2196/104170","DOIUrl":"10.2196/104170","url":null,"abstract":"","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"9 ","pages":"e104170"},"PeriodicalIF":4.6,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13374683/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148473309","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":"Adoption and Use of a Smart Home Connected Care System by Older Adults: Mixed Methods Study.","authors":"Laura Pemberton, Michelle Carter, Nikolay Mehandjiev","doi":"10.2196/76012","DOIUrl":"10.2196/76012","url":null,"abstract":"<p><strong>Background: </strong>Smart home technologies are often promoted as a means to support independent living and alleviate pressure on health and care systems. However, adoption among older adults remains low, and little is known about how passive, ambient technologies are experienced over time.</p><p><strong>Objective: </strong>This study aimed to examine the adoption of a Connected Care System among older adults and their caregivers in a real-world deployment, testing the applicability of the Unified Theory of Acceptance and Use of Technology model and identifying design considerations for future systems.</p><p><strong>Methods: </strong>A mixed methods study was conducted with 91 older adults who used the Connected Care System for approximately 6 months. Quantitative survey data were analyzed using structural equation modeling to assess predictors of behavior intention. Thematic analysis of open-ended survey responses was used to explore participants' experiences and perceptions of the system.</p><p><strong>Results: </strong>Perceived ease of use (β=0.075; P=.02) and facilitating conditions (β=0.232; P<.001) were significant predictors of behavior intention, while perceived usefulness and social influence were not. Thematic analysis revealed that older adults often conceptualized usefulness in emotional and relational terms, such as peace of mind and caregiver reassurance. Adoption was frequently described as a shared process involving family members. Key barriers included low confidence in setup and reliability concerns, while valued features included passive monitoring, increased independence, and reduced caregiver burden.</p><p><strong>Conclusions: </strong>The findings suggest that conventional adoption models require adaptation to account for passive, caregiver-mediated smart home systems. Emotional and relational benefits, rather than task efficiency, drive perceived usefulness. Design recommendations are offered to support user-friendly, personalized, and relationally aware smart home technologies that align with the realities of aging in place.</p>","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"9 ","pages":"e76012"},"PeriodicalIF":4.6,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13420526/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148457078","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 Influence of Robot Facial Expression and Inclusion Behavior on Rapport and Trust in Older Adults: Mixed-Factorial Experimental Study.","authors":"Hsiu-Ping Yueh, Kuang-Chi Lin, Weijane Lin","doi":"10.2196/91235","DOIUrl":"10.2196/91235","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The World Health Organization framework for healthy aging emphasizes that the capacity to establish and sustain relationships is a vital component of functional ability. Social robots offer valuable support for this relational aspect, although their effectiveness is contingent upon the quality of the interactions. While it is established that facial expressions and inclusive behaviors can influence rapport building, the combined effects of these elements on older adults remain unexamined.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to investigate the main and interaction effects of robot facial expression (happy vs unhappy) and interaction style (inclusive vs exclusive) on the development of rapport between social robots and older adults residing in the community.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A 2 × 2 mixed-factorial experimental design was used in this study, involving 53 community-dwelling older adults (mean age 70.57, SD 4.27 years; n=45, 84.9% female). Participants engaged in a gamified interaction known as Radish Squat featuring 2 humanoid robots that exhibited various combinations of facial expressions and interaction styles. The inclusive robot designated participants within the game 75% of the time, whereas the exclusive robot did so approximately 25% of the time. Dependent measures included robot acceptance, rapport, rapport expectation, and trust. Behavioral designation frequencies were recorded throughout the gameplay. A mixed-design repeated-measure ANOVA was conducted to examine both main and interaction effects.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Facial expression exhibited significant main effects on acceptance (F1,51=14.27; P&lt;.001; η2=0.22), rapport (F1,51=6.69; P=.01; η2=0.12), conversation partner expectations (F1,51=11.34; P=.001; η2=0.18), togetherness expectations (F1,51=10.28; P=.002; η2=0.17), and trust (F1,51=4.36; P=.04; η2=0.08). Interaction style significantly affected rapport (F1,51=6.22; P=.02; η2=0.11), as well as both rapport expectation subscales. Significant interaction effects were also observed for rapport (F1,51=8.44; P=.005; η2=0.14) and trust (F1,51=16.62; P=.002; η2=0.25) such that the positive effect of happy facial expressions was substantially larger under exclusive interaction conditions. Older adults designated the exclusive robot within the game more frequently than the inclusive robot (mean 6.42, SD 1.84 vs 5.32, SD 2.12; t52=2.18; P=.03), and qualitative data pointed to the use of fairness-based turn-taking strategies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Positive facial expressions and inclusive interaction behaviors significantly enhanced rapport and trust, with synergistic interaction effects primarily emerging under exclusive interaction conditions. The observed patterns, whereby older adults compensated for exclusive robot behavior, suggest that they perceive robots as social entities deserving of equitable treatment. Collectively, these findings offer eviden","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"9 ","pages":"e91235"},"PeriodicalIF":4.6,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13372258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148457088","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":"Real-Time Associations Between Subjective Cognitive Concerns and Daily Activity Participation in Persons Aging With Stroke: Smartphone-Based Ecological Momentary Assessment Study.","authors":"Jiali He, Quoc Bui, Mandy W M Fong, David C Mohr, Christopher L Metts, Alex W K Wong","doi":"10.2196/80222","DOIUrl":"10.2196/80222","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Stroke is a leading cause of global disability in the aging population, with cognitive impairments playing a significant role. Prior research has shown that subjective cognitive concerns (SCCs) can predict later dementia and serve as an essential indicator for poststroke functional rehabilitation. The use of smartphone-based ecological momentary assessment (EMA) in real-world environments may help us understand how SCCs relate to daily functioning in individuals aging with stroke, thereby guiding cognitive rehabilitation and prevention efforts.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Our study aimed to use EMA to examine the real-time associations between SCCs and daily activity participation in persons aging with stroke.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This longitudinal observational study used smartphone-based EMA for real-time assessment of individual cognitive concerns and participation in various daily activities. EMA survey items, including SCCs (concentration and learning) and participation in daily activities (location, company, current activity, and self-appraisals of performance, help needed, satisfaction, and engagement), were collected 5 times per day for 2 weeks. Multilevel models were used to analyze the data.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 202 individuals with mild-to-moderate chronic stroke participated in the study (n=90, 44.6% female; n=89, 44.1% Black; n=182, 90.1% ischemic stroke; mean age 59.7, SD 11.7 years). SCCs were concurrently lower when participants engaged in activities of daily living (ADL; B=-0.04, 95% CI -0.07 to -0.01; P=.02), instrumental ADL (B=-0.05, 95% CI -0.07 to -0.02; P&lt;.001), cognitively stimulating activities (B=-0.05, 95% CI -0.08 to -0.02; P&lt;.001), and social activities (B=-0.05, 95% CI -0.08 to -0.02; P=.002); when participants were located in a friend's home (B=-0.10, 95% CI -0.17 to -0.02; P=.001); and when they spent time with family members (B=-0.07, 95% CI -0.10 to -0.04; P&lt;.001), friends (B=-0.05, 95% CI -0.10 to -0.01; P=.01), and spouse or partners (B=-0.04, 95% CI -0.07 to -0.01; P=.02). Conversely, SCCs were higher when participants were in the hospital (B=0.39, 95% CI 0.25-0.53; P&lt;.001). Additionally, greater SCCs were concurrently associated with worse ratings of performance (B=-0.05, 95% CI -0.06 to -0.05; P&lt;.001), satisfaction (B=-0.05, 95% CI -0.06 to -0.05; P&lt;.001), and activity engagement (B=-0.05, 95% CI -0.06 to -0.04; P&lt;.001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;EMA provides an effective means of understanding the links between poststroke cognition and participation in daily activities. Our findings suggest that ADL, instrumental ADL, cognitively demanding activities, and socially engaging activities may lessen cognitive concerns among stroke survivors, implying that clinicians should schedule these activities to help reduce poststroke cognitive issues. Conversely, interventions that enhance cognition may increase participation in these challen","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"9 ","pages":"e80222"},"PeriodicalIF":4.6,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13367758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148449693","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}