JMIR Aging最新文献

{"title":"Associations of Solid Fuel Use and Circadian Rhythm Syndrome With Physical Function and Muscle Strength in Middle-Aged and Older Adults: Nationwide Cohort Study in China.","authors":"Haochen Wang, Pengsen Mou, Donghao Liu, Ze Zhao, Wenzheng Chen, Yuxin Yao, Haoyan Shi, Jiaxin Guan, Jing Dong, Yingliang Wei","doi":"10.2196/78352","DOIUrl":"10.2196/78352","url":null,"abstract":"<p><strong>Background: </strong>The relationships among circadian rhythm syndrome, physical function, and muscle strength remain unclear.</p><p><strong>Objective: </strong>This study aimed to demonstrate the separate and combined deleterious effects of solid fuel use and circadian rhythm syndrome on physical function and muscle strength.</p><p><strong>Methods: </strong>We used data from the China Health and Retirement Longitudinal Study cohort. The study population consisted of participants who underwent comprehensive assessments of metabolism, circadian rhythm, indoor air pollution, physical function, and muscle strength at the initial evaluation. Muscle strength was assessed using repeated grip strength measurements, and physical function was assessed using a composite score of muscle strength, physical performance, and balance. Circadian rhythm syndrome was derived from the 5 diagnostic components of metabolic syndrome combined with sleep duration and depression. Logistic regression and linear mixed models were used to assess the relationships among solid fuel use, circadian rhythm syndrome, physical function, and muscle strength. Furthermore, we analyzed the mediating role of circadian rhythm syndrome and its combined effect with solid fuel use on physical function and muscle strength.</p><p><strong>Results: </strong>A total of 7934 participants were included in the study, most of whom used solid fuels. Solid fuel use was positively associated with circadian rhythm syndrome (odds ratio [OR] 1.078, 95% CI 1.031-1.125; P<.05). Circadian rhythm syndrome was found to be a significant risk factor for impairment of physical function (β=-0.475; P<.05) and muscle strength (β=-0.304; P<.05). Participants who used solid fuels and had circadian rhythm syndrome needed to pay more attention to changes in physical function (β=-0.698; P<.05) and muscle strength (β=-0.332; P<.05). A significant interaction was observed between solid fuel use and circadian rhythm syndrome on physical function (P_interaction=.03) and muscle strength (P_interaction=.02). Circadian rhythm syndrome partially mediated the association between solid fuel use and physical function, accounting for 2.51% of the total effect.</p><p><strong>Conclusions: </strong>Circadian rhythm syndrome exacerbates the adverse effects of solid fuel use on physical function and muscle strength. Fuel cleanliness and regular work and rest habits are crucial for the health of middle-aged and older adults.</p>","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"9 ","pages":"e78352"},"PeriodicalIF":4.6,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13365896/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148354069","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":"Use of Wearable Technology for Measuring and Characterizing Sedentary Behavior in People With Mild Cognitive Impairment and Dementia: Systematic Review.","authors":"Jenny L Wales, Chloe Hinchliffe, Ryan Stanley Falck, Silvia Del Din, Alison J Yarnall, Ríona Mc Ardle","doi":"10.2196/85361","DOIUrl":"10.2196/85361","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Sedentary behavior (SB) is a critical, modifiable risk factor for adverse health outcomes. Evidence suggests that SB is higher among individuals with cognitive impairment relative to their cognitively healthy peers. However, the nature and extent of SB across cognitive impairments remains unclear, largely due to the reliance on self-report data and the lack of synthesized evidence from more accurate methodology, such as wearable devices. Wearable device-based methodologies offer a reliable means of capturing SB in real-world settings, circumventing the recall bias inherent to self-report methods. Continuous remote monitoring of SB, via wearable devices, may provide nuanced insights important for understanding SB's contribution to cognitive impairment and health consequences.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This review aims to synthesize evidence on the volume, patterns, and variability of SB across cognitive impairment and critically appraise the wearable device-based methodology used to capture SB in this population.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched 5 databases (Embase, MEDLINE, PsycInfo, Scopus, and Web of Science) up to January 2025 for peer-reviewed English-language studies using wearable devices to measure SB in community-dwelling or aged residential care residents aged 50 years or older with cognitive impairment (PROSPERO: CRD42024616523). Study quality was assessed using an adapted version of the National Institute of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Data were extracted on SB outcomes (eg, volume, pattern, and variability) and methodological characteristics (eg, device type, placement, SB classification/processing, and its corresponding validation).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;From 2824 screened records, 17 studies (2016-2025) were included. Most studies (n=11, 65%) were of \"good\" quality (scoring ≥5 on bias assessment). Synthesis revealed inconsistent evidence for differences in SB volume across cognitive impairment. However, individuals with dementia consistently exhibited a unique SB pattern, engaging in significantly fewer but longer sedentary bouts than other forms of cognitive impairment and cognitively intact controls. All (n=17, 100%) studies used volume metrics to describe SB, followed by pattern metrics (n=7, 41%); only 1 study reported on SB variability. Methodological appraisal found significant heterogeneity: 13 different device models across 6 body placements were used. Most studies quantified SB using count-based thresholds (counts per minute), which were largely unvalidated in cognitively impaired or older adult populations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This review found that participants with dementia consistently exhibited a unique pattern of SB compared to other forms of cognitive impairment and healthy controls, while","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"9 ","pages":"e85361"},"PeriodicalIF":4.6,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13351645/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148333365","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":"Patient Satisfaction With Telehealth Visits in Rural Compared With Urban Communities: Single-Center Study.","authors":"Corrin Hepburn, Karolina Krawczyk, Cara Joyce, Jonah Rubin","doi":"10.2196/85018","DOIUrl":"10.2196/85018","url":null,"abstract":"<p><strong>Background: </strong>Studies performed in urban communities with access to technology suggest high patient satisfaction with telehealth. While virtual visits can increase the reach of clinical practice in rural communities, technological barriers may reduce patient satisfaction.</p><p><strong>Objective: </strong>This study aimed to compare satisfaction with telehealth visits between patients living in rural and urban communities.</p><p><strong>Methods: </strong>A telephone survey was developed and administered to hepatology patients seen at outpatient clinics from March 2020 through March 2021. Patient characteristics and survey responses were compared by urban and rural location as defined by the census tract based on zip code using univariable and multivariable logistic regression.</p><p><strong>Results: </strong>Of 400 patients, 164 (41%) completed the survey. Compared with urban patients, rural patients had twice the transportation time to clinic (mean 59, SD 35 vs mean 30, SD 15 min) and were more likely to cancel due to transportation issues (21/48, 46% vs 15/116, 13%). Rural patients reported less proficiency with technology and more technical difficulties, including an inability to log on to the portal or access the camera or microphone (35/48, 75% vs 29/116, 25%) and less comfort with their devices (26/48, 54% vs 10/116, 9%). Overall, urban patients were more likely to prefer telehealth (adjusted odds ratio 5.20, 95% CI 2.15-13.7) and were more satisfied with telehealth vs in-person visits than rural patients (72/116, 62.1% vs 10/48, 20.8%).</p><p><strong>Conclusions: </strong>Rural patients reported more technical challenges with telehealth and more transportation issues than urban patients but favored in-person hepatology visits. Urban patients were more satisfied with telehealth visits compared with in-person visits. Research is needed to improve telehealth delivery and satisfaction for rural patients.</p>","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"9 ","pages":"e85018"},"PeriodicalIF":4.6,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13293599/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148319548","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":"Impact of Sleep Quality on Gait Variability: Pilot Cohort Study.","authors":"Francesca R Marino, Minzae Kim, Phillip H Hwang, Yorghos Tripodis, Michael Alosco, Jesse Mez, Ann McKee, Rhoda Au, Robert Joseph Thomas, Ludy Shih","doi":"10.2196/81630","DOIUrl":"10.2196/81630","url":null,"abstract":"<p><strong>Background: </strong>Higher step width variability while walking is associated with poor physical function and falls. Sleep is an established modifiable risk factor for both gait and physical function impairments, but it remains to be examined whether sleep is also related to step width variability.</p><p><strong>Objective: </strong>This study aimed to evaluate the cross-sectional associations between objectively measured sleep quality, using cardiopulmonary coupling spectrograms, and step width variability during a preferred walking condition among middle-aged and older adults.</p><p><strong>Methods: </strong>This study included 72 adults (mean age 71, SD 8.3 y; n=37, 51% female; n=65, 90% non-Hispanic White) who had ≥2 nights of objectively measured sleep (cardiopulmonary coupling via SleepImage ring) and completed a 10-m walk at preferred speed while wearing inertial sensors (APDM Mobility Lab). Sleep measures included sleep duration, efficiency, fragmentation, stability, apnea-hypopnea index, percentage of time oxygen saturation level <90%, oxygen desaturation index, and respiratory disturbance index. Additional derived sleep variables were explored using least absolute shrinkage and selection operator models. Step width variability was defined by the asymmetry of lateral step variability and categorized as medial (≤-7.5 cm), minimal (within ±7.5 cm; reference), or lateral displacement (≥7.5 cm). Multinomial logistic regression models adjusted for age, sex, race, education, BMI, and usual gait speed evaluated cross-sectional associations between sleep and step width variability categories.</p><p><strong>Results: </strong>We found that a 1% higher sleep fragmentation was associated with a 6% higher probability of step width variability ≥7.5 cm (95% CI 1.01-1.11), while a 1% higher sleep stability was associated with a 5% lower probability of variability ≥7.5 cm (95% CI 0.91-0.99), compared to minimal variability. From the least absolute shrinkage and selection operator models, we found that a 1% higher sleep quality index, a 1% higher rapid eye movement sleep, a 1-second shorter apnea duration, and a 1-beat per minute slower mean heart rate were also associated with a lower probability of lateral compared to minimal displacement.</p><p><strong>Conclusions: </strong>Poor sleep quality was associated with higher step width variability among middle-aged and older adults. This suggests that sleep may be a modifiable risk factor for maintaining postural stability while walking among middle-aged and older adults. Future studies are needed to examine whether intervening in these sleep measures also lowers the risk of falls.</p>","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"9 ","pages":"e81630"},"PeriodicalIF":4.6,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13271590/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148266275","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":"Exploring Expectations, Ethical Dimensions, and Values for Voice-Enabled AI Assistants That Support Older Adults and Informal Family Caregivers: Participatory Speculative Design Study.","authors":"Shweta Singh, Aqueasha Martin-Hammond","doi":"10.2196/79740","DOIUrl":"10.2196/79740","url":null,"abstract":"<p><strong>Background: </strong>Continuous advancements in voice artificial intelligence technologies aim to assist older adults and caregivers, potentially improving quality of life and reducing caregiving burdens. Although research has explored the potential of voice-enabled artificial intelligence (VAI) assistants, such as Alexa (Amazon.com, Inc) and Google Home, to support older adults' health in informal care settings, there remains a significant gap in understanding the ethical dimensions and values that may influence their future adoption by caregivers and care recipients.</p><p><strong>Objective: </strong>This research aims to explore older adult and informal family caregivers' perspectives of VAI assistants for supporting informal care, including the ethical dimensions and values that influence their decisions about future adoption for these purposes.</p><p><strong>Methods: </strong>This research uses participatory speculative design to explore older adults' and informal family caregivers' perspectives of how VAI might support informal care in the future, and the ethical concerns they have about adopting VAI technologies. We conducted 8 workshop sessions with older adults and caregivers (n=9) over four months. Each phase focused on one of three goals: (1) to understand existing experiences, (2) to envision future VAI technologies, and (3) to reflect on ethical values that shape acceptance. In workshops, we aimed to gain insights into their experiences and challenges in managing informal care tasks and how future implementation of VAI might support the caregiving process to address their needs and concerns while emphasizing the ethical dimensions they value.</p><p><strong>Results: </strong>The findings suggest older adults and informal family caregivers see potential opportunities for VAIs to support informal aging care by automating daily health tasks to improve efficiency, enhancing mental health and well-being, and offering companionship. However, participants felt that VAI alone might not be sufficient to address the complex needs of informal care. Additionally, they raised several ethical concerns related to transparency, privacy, inclusiveness, trust, affordability, and autonomy, which they felt needed to be addressed to encourage adoption of VAI technologies for informal care in the future.</p><p><strong>Conclusions: </strong>Based on the findings, we offer insights and design implications for VAI systems that balance efficiency with ethical values to support diverse caregiving needs and potentially encourage future adoption in the informal care space.</p>","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"9 ","pages":"e79740"},"PeriodicalIF":4.6,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13273013/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148266150","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":"Web-Based Gamified Auditory-Cognitive Dual-Task Training for Older Adults With Age-Related Hearing Loss: Pilot Randomized Controlled Trial.","authors":"Ivy Yan Zhao, Angela Yee Man Leung, Chen Li, Laurence Lloyd Parial, Hongming Ma, Jed Montayre, Justin S Golub, Robert Sweetow, Janet Ho-Yee Ng, Engle Angela Chan","doi":"10.2196/84083","DOIUrl":"10.2196/84083","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Everyday listening ability is essential for individual health and well-being. Age-related hearing loss (ARHL) is associated with reduced communication engagement, social isolation, loneliness, cognitive decline, and increased dementia risk. Interventions that simultaneously target auditory processing and cognitive function, particularly within engaging and ecologically valid contexts, may offer greater benefits than unimodal approaches. However, culturally adapted, web-based, gamified auditory-cognitive dual-task training (ACDT) tailored for older adults with ARHL remains underexplored. At the time of this writing, few auditory or auditory-cognitive training programs are available in Chinese languages, creating linguistic and cultural barriers for older adults.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to (1) assess the feasibility and acceptability of home-based ACDT among older Chinese adults with ARHL and (2) examine its preliminary effects on global cognition, hearing, social engagement, and loneliness. It was hypothesized that the intervention group would demonstrate greater improvements in global cognition, hearing, and social engagement than the control group.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Sixty community-dwelling older adults with mild-to-moderate ARHL were randomized 1:1 to either the ACDT group or a waitlist control group in a single-blinded pilot randomized controlled trial. Demographic data and outcome measures were collected at baseline, week 6, and week 12. Postintervention interviews were conducted to assess the feasibility and acceptability of ACDT.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 60 participants were randomized (mean age 67.65, SD 4.78 years; 45/60, 75% male). ACDT demonstrated high feasibility and acceptability. The ACDT group showed significant improvements in focused attention (mean change=-0.15; P=.02; d=-0.46) and divided attention (mean change=-0.21; P=.002; d=-0.63). Significant cognitive improvements on the Hong Kong-Montreal Cognitive Assessment were identified in naming (r=0.37; P=.05) and visual cognition (r=0.44; P=.02) in the intervention group, while no significant improvements were found in the control group. Both groups reported significant decreases in emotional hearing handicap, with slightly greater improvement in the intervention group (r=0.39; P=.03) than in the control group (r=0.37; P=.04). Linear mixed model analysis revealed a small to moderate group effect (Cohen d=0.38) for 5-minute delayed recall on the Auditory Verbal Learning Test, with the fixed effects explaining 69% of the variance (marginal R²=0.69). A significant time×group interaction was observed for left-ear thresholds (P=.01). Qualitative analysis identified three key themes: (1) intervention coherence and participants' affective attitude toward ACDT; (2) perceived benefits in cognition, information acquisition, and self-awareness from ACDT; and (3) perceiving ACDT as less burdensome with","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"9 ","pages":"e84083"},"PeriodicalIF":4.6,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13271602/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148266300","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 Roadmap for Implementing Virtual Geriatric Mental Health Services for Rural Veterans: Qualitative Longitudinal Evaluation.","authors":"Christine E Gould, Marika Blair Humber, Chalise Carlson, Ranak B Trivedi, Marisa-Francesca Lindsey, Althea Lloyd, Lynsay Paiko, Amanda D Peeples","doi":"10.2196/95286","DOIUrl":"10.2196/95286","url":null,"abstract":"<p><strong>Background: </strong>Access to geriatric mental health (GMH) care is limited in rural areas. To meet this need, the Veterans Health Administration provides specialty tele-GMH care for aging rural veterans via regional telehealth hubs.</p><p><strong>Objective: </strong>This study aims to create a roadmap describing key phases and determinants underlying the implementation and sustainment of tele-GMH services as part of a qualitative longitudinal evaluation of tele-GMH teams.</p><p><strong>Methods: </strong>Semistructured interviews were conducted with clinicians from all 8 tele-GMH teams (n=25) at 3 time points across a 3-year period (October 2021-September 2024). Interview (n=46) data were summarized into key domains using a templated rapid qualitative approach, guided by the Consolidated Framework for Implementation Research (CFIR) 2.0. Further thematic analysis and team discussion elucidated the findings.</p><p><strong>Results: </strong>We identified key activities and determinants of success in three phases: (1) preimplementation (engaging leaders, securing funding/hiring, and defining services); (2) implementation scale-up and expansion (advertising, addressing challenges, seeking feedback, refining, and growth); and (3) sustainment (maintenance). Activities within each phase were cyclical and iterative (ie, nonlinear). Barriers to implementation included unfamiliarity with local aging resources; facilitators included tailoring strategies and engaging referring clinicians.</p><p><strong>Conclusions: </strong>Similar processes emerged across regions in the development and sustainment of tele-GMH services, allowing for the creation of a unified roadmap. Limitations including sampling bias are discussed. Further work could apply and evaluate the utility of the roadmap to guide creation of tele-GMH services in new regions to enhance access to specialty care for aging rural veterans.</p>","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"9 ","pages":"e95286"},"PeriodicalIF":4.6,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13271587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148266100","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 Frailty Trajectories Using Interpretable Machine Learning Among Older Adults Following Hip Surgery: Prospective Longitudinal Study.","authors":"Jingying Huang, Qinqin Fan, Huiqin Shi, Jiaojiao Chen, Hongbo Gao, Kailai Gu, Jin Yang","doi":"10.2196/90705","DOIUrl":"10.2196/90705","url":null,"abstract":"<p><strong>Background: </strong>Postoperative frailty is highly prevalent among older adults undergoing hip surgery and is closely linked to poor clinical outcomes. Despite growing interest in understanding its progression, the temporal patterns of frailty remain underexplored. Moreover, there is a lack of validated models that can predict frailty trajectories and stratify patients by risk in the early postoperative period.</p><p><strong>Objective: </strong>This study aimed to identify distinct frailty trajectories within 6 months following hip surgery in older adults and to explore their associated predictors. An interpretable machine-learning model was developed and internally validated for individualized risk prediction and was implemented as a clinically accessible web-based calculator.</p><p><strong>Methods: </strong>This prospective longitudinal observational study was conducted among older adults undergoing hip surgery at a tertiary hospital in China. Frailty assessments were performed preoperatively and at 1, 3, and 6 months postoperatively. A total of 209 participants who completed the 6-month follow-up were included in the analysis. Frailty was assessed using the Frailty Index, and group-based trajectory modeling was applied to identify distinct frailty progression patterns. Predictive variables were selected using the least absolute shrinkage and selection operator regression. An interpretable Extreme Gradient Boosting (XGBoost) model was developed using a 60:40 training-test data split. Model performance was evaluated in terms of discrimination, calibration, and clinical utility. Interpretability was assessed using SHAP (Shapley Additive Explanations) at both the global and individual levels.</p><p><strong>Results: </strong>Three distinct frailty trajectories were identified: low-fluctuation frailty (55/209, 26%), high-improvement frailty (81/209, 39%), and high-deterioration frailty (73/209, 35%). Twelve predictors grounded in the Health Ecology Model were selected, spanning individual characteristics, interpersonal networks, and the living environment. The XGBoost model demonstrated excellent discrimination, with a microaverage area under the receiver operating characteristic curve of 0.98 (95% CI 0.96-0.99) in the training set and 0.93 (95% CI 0.90-0.96) in the test set. Calibration was acceptable, with a weighted Brier score of 0.0852. Decision curve analysis showed favorable clinical utility across a range of threshold probabilities. A web-based risk calculator was developed to facilitate personalized frailty trajectory prediction.</p><p><strong>Conclusions: </strong>The XGBoost model demonstrated strong predictive performance and interpretability, enabling the early identification of older patients at risk for adverse frailty trajectories following hip surgery. This tool may support targeted interventions and improve perioperative care in geriatric populations.</p>","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"9 ","pages":"e90705"},"PeriodicalIF":4.6,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13271583/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148266216","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":"Experiences of Older Adults and Caregivers With Home Telemonitoring for Heart Failure in Canada: Qualitative Study.","authors":"Guy Paré, Marie-Pierre Moreault, Philippe Voyer, Alexandre Castonguay, Marie-Soleil Hardy, Mickael Ringeval","doi":"10.2196/79797","DOIUrl":"10.2196/79797","url":null,"abstract":"<p><strong>Background: </strong>Home telemonitoring programs are increasingly used to support older adults living with chronic conditions such as heart failure (HF). While these interventions show promise for improving health outcomes and reducing care burden, their effectiveness depends largely on how patients and caregivers integrate digital technologies into everyday life and care relationships. However, relatively few studies have examined these experiences using conceptual frameworks that capture both functional and relational dimensions of care.</p><p><strong>Objective: </strong>This study aimed to explore the experiences of older adults and their informal caregivers participating in a home telemonitoring program for HF. Drawing on the Person-Based Approach and the Person-Centered Practice frameworks, we examined how participants engaged with both the technofunctional and relational aspects of the intervention.</p><p><strong>Methods: </strong>We conducted a qualitative study involving 34 patients, 28 informal caregivers, and 20 nurses across 3 primary care organizations in Quebec, Canada. The 6-month intervention included 4 connected devices used by patients (smartwatch, Bluetooth-enabled scale, voice-activated tablet, and a smart pill dispenser [xPill; Domedic]) and a mobile app for caregivers, complemented by remote nursing follow-up. Nurses reviewed patient data through a clinical dashboard at least once daily during weekday daytime shifts. Data were collected through semistructured interviews and field notes and analyzed using directed content analysis.</p><p><strong>Results: </strong>Participants' experiences revealed both enabling and constraining factors across 2 key dimensions. Technofunctional engagement was shaped by digital literacy, emotional responses to the technology, alignment with daily routines, and access to technical or caregiver support. Relational aspects of care were influenced by perceived professional presence, opportunities for communication and shared decision-making, and the degree of emotional reassurance provided by remote monitoring. While many participants reported increased confidence and a sense of being supported, others experienced frustration, fatigue, or disengagement when the system disrupted routines or when feedback from clinicians was perceived as limited.</p><p><strong>Conclusions: </strong>Engagement with home telemonitoring technologies among older adults depends not only on usability but also on the relational context in which these technologies are embedded. Combining technofunctional and relational perspectives provides a more comprehensive understanding of how telemonitoring interventions are experienced and highlights the importance of personalized support, reliable technology, and sustained clinical engagement to promote meaningful adoption.</p>","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"9 ","pages":"e79797"},"PeriodicalIF":4.6,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13320013/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148266088","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":"Feasibility and Acceptability of a Remote Sleep-Dependent Memory Assessment in Older Adults With Cognitive Concerns: Pilot Cross-Sectional Study.","authors":"Clara Cher Yi Tan, Aaron Lam, David Ireland, Dana Bradford, Nathan Cross, Melvern Ted Kurniawan, Simone Simonetti, Jurgen Fripp, Sharon L Naismith","doi":"10.2196/87926","DOIUrl":"10.2196/87926","url":null,"abstract":"<p><strong>Background: </strong>Sleep-dependent memory consolidation (SDMC), the process by which sleep supports the transfer of memories into long-term storage, declines with age but remains underexplored in older adults with subjective cognitive decline and mild cognitive impairment. Traditional SDMC assessments are typically conducted in lab settings, with limited evidence for feasibility to do these assessments at home for this clinical population.</p><p><strong>Objective: </strong>To address this, we co-designed the Sleep Memories app, which assesses overnight memory for a previously validated 32-item word-pairs task. This pilot study first explored the feasibility and acceptability of the app, including willingness to participate. Second, we explored various demographic, clinical, and subjective sleep factors associated with task completion and SDMC performance in a memory clinic sample.</p><p><strong>Methods: </strong>Within an 8-month period, we invited 141 older adults aged 50 years and above (mean 71.27, SD 7.51 y) from the Healthy Brain Ageing clinic, a specialist brain health and memory clinic in Sydney, to pilot the Sleep Memories app. Of these, 76 (mean 70.19, SD 7.75) agreed to participate. All participants underwent a full neuropsychological test battery, medical assessment, and mood assessment.</p><p><strong>Results: </strong>Sixty-eight participants completed at least 1 test of the word-pairs task. The word-pairs task completion rate for all trials was over 50%. There was 57% (39/68) completion of both evening and morning delayed recall tests. Lower willingness to participate was associated with lower global cognitive scores, poorer sleep behavior, and clinical factors. Higher task completion was associated with greater education and greater anxiety levels. User feedback indicated that the app was well-accepted and liked, although some participants reported minor technical difficulties.</p><p><strong>Conclusions: </strong>These findings support the feasibility of mobile app-based SDMC assessment in older adults at risk of cognitive decline and underscore the importance of considering individual characteristics (eg, subjective sleep factors, clinical characteristics, and education) when designing digital SDMC tools.</p>","PeriodicalId":36245,"journal":{"name":"JMIR Aging","volume":"9 ","pages":"e87926"},"PeriodicalIF":4.6,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13256488/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148228575","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}