JMIR老化

与老年人共同开发移动健康应用程序的扩展合作设计过程中的教训和反思:多阶段、混合方法研究

2022 - 10 - 28 - t09:15:02内

背景:针对老年患者的移动健康(mHealth)应用很多，但研究发现，广义上来说，mHealth仍然不能满足老年用户的特定需求。其他人则强调，需要以一种令人满意和有意义的方式将用户嵌入移动健康的设计过程中。协同设计已广泛应用于移动健康应用程序的开发，并使利益相关者参与到设计和开发过程的每个阶段。老年人在共同设计过程中的参与程度是不同的。到目前为止，协同设计方法倾向于在早期阶段(例如，预设计和生成)嵌入涉众，而不是贯穿始终。本研究的目的是反思参与为老年人开发mHealth应用程序的扩展联合设计过程的过程和吸取的教训，老年用户在每个阶段都有贡献。本研究旨在设计一个移动健康工具，以协助老年人协调他们与卫生保健专业人员和护理人员的护理。我们概念化、开发和测试mHealth应用程序的工作包括4个阶段:第一阶段，咨询利益相关者;第二阶段，与老年人进行应用开发和合作设计;第三阶段，使用较小样本的老年志愿者测试人员进行现场测试; and phase 4, reflecting, internally, on lessons learned from this process. In each phase, we drew on qualitative methods, including in-depth interviews and focus groups, all of which were analyzed in NVivo 11, using team-based thematic analysis. Results: In phase 1, we identified key features that older adults and primary care providers wanted in an app, and each user group identified different priority features (older adults principally sought support to use the mHealth app, whereas primary care providers prioritized recoding illnesses, immunizations, and appointments). Phases 2 and 3 revealed significant mismatches between what the older adult users wanted and what our developers were able and willing to deliver. We were unable to craft the app that our consultations recommended, which the older adult field testers asked for. In phase 4, we reflected on our abilities to embed the voices and perspectives of older adults throughout the project when working with a developer not familiar with or committed to the core principles of co-design. We draw on this challenging experience to highlight several recommendations for those embarking on a co-design process that includes developers and IT vendors, researchers, and older adult users. Conclusions: Although our final mHealth app did not reflect all the needs and wishes of our older adult testers, our consultation process identified key features and contextual information essential for those developing apps to support older adults in managing their health and health care.

技术干预在解决老年人的社会孤立、联系和孤独中的有效性:系统的全面审查

2022 - 10 - 24 - t09:30:02内

到2050年，全球老年人(60岁以上)人口预计将增加两倍，达到20亿。预计受孤独和社会孤立(或社会联系)影响的老年人比例将上升。快速的可部署性和社会变化增加了技术设备的可用性，为老年人创造了新的机会。本研究旨在通过评估评论质量、共同观察结果和衍生主题，识别、综合并批判性评估改善老年人社会连接的技术干预的有效性。根据PRISMA(系统回顾和荟萃分析首选报告项目)的指南，在2020年2月至2022年3月期间搜索4个数据库(psyinfo、PubMed、Embase和MEDLINE)。我们确定了社区和住宅环境中年龄≥50岁的成年人的综述，根据基于人口、干预措施、背景、结果和研究模式综述型文章(系统的、元分析的、综合的和范围的)的纳入标准，报告了与技术对社会脱节影响相关的结果，并包括了数字干预。推荐、评估、发展和评价分级(GRADE)用于衡量结果推荐的强度，包括偏倚风险。这些综述涵盖了326项初级研究，79538名参与者。根据新出现的主题提取、综合和组织研究结果。结果:总体而言，972份出版物满足初始搜索标准，24份出版物满足我们的纳入标准。 Revised Assessment of Multiple Systematic Reviews was used to assess the quality of the analysis. Eligible reviews (3/24, 12%) were excluded because of their low Revised Assessment of Multiple Systematic Reviews scores (<22). The included reviews were dedicated to information and communications technology (ICT; 11/24, 46%), videoconferencing (4/24, 17%), computer or internet training (3/24, 12%), telecare (2/24, 8%), social networking sites (2/24, 8%), and robotics (2/27, 8%). Although technology was found to improve social connectedness, its effectiveness depended on study design and is improved by shorter durations, longer training times, and the facilitation of existing relationships. ICT and videoconferencing showed the best results, followed by computer training. Social networking sites achieved mixed results. Robotics and augmented reality showed promising results but lacked sufficient data for informed conclusions. The overall quality of the studies based on GRADE was medium low to very low. Conclusions: Technology interventions can improve social connectedness in older adults. The specific effectiveness rates favor ICT and videoconferencing, but with limited evidence, as indicated by low GRADE ratings. Future intervention and study design guidelines should carefully assess the methodological quality of studies and the overall certainty of specific outcome measures. The lack of randomized controlled trials in underlying primary studies (<28%) and suboptimal methodologies limited our findings. Robotics and augmented or virtual reality warrant further research. Low GRADE scores highlight the need for high-quality research in these areas. Trial Registration: PROSPERO CRD42022363475; https://tinyurl.com/mdd6zds

新冠肺炎对老年人虚拟护理感知的影响:定性研究

2022 - 10 - 20 - t09:45:03内

背景:为应对2019冠状病毒病大流行，世界各地的老年人越来越多地接受虚拟医疗保健，卫生保健组织和专业机构表示，虚拟医疗“将持续存在”。由于老年人是医疗保健系统的最高用户，虚拟护理的实施可能对他们产生重大影响，可能需要额外的支持。本研究旨在了解大流行期间老年人对虚拟护理的看法和体验。作为一项关于大流行期间老年人技术使用的大型研究的一部分，我们在2020年夏季和2021年冬季/早春两个时间点对20名不同的加拿大老年人(平均年龄76.9岁，标准差6.5岁)进行了半结构化采访。参与者被问及他们的技术技能，虚拟预约的经验，以及对这种类型的护理交付的看法。采访被数字记录和转录。结合基于团队和框架的分析来解释数据。参与者描述了他们在大流行期间获得面对面护理和虚拟护理的经历，包括获得护理的问题和预约之间的长时间间隔。总体而言，参与者对他们在大流行期间获得的虚拟护理普遍感到满意。参与者描述了虚拟护理的好处(如增加了便利性、效率和安全性)、虚拟护理的局限性(如需要身体检查和触摸、缺乏非语言交流、使用技术的困难和获取系统障碍)，以及他们对虚拟护理未来的看法。 Half of our participants preferred a return to in-person care after the COVID-19 pandemic, while the other half preferred a combination of in-person and virtual services. Many participants who preferred to access in-person services were not opposed to virtual care options, as needed; however, they wanted virtual care as an option alongside in-person care. Participants emphasized a need for training and support to be meaningfully implemented to support both older adults and providers in using virtual care. Conclusions: Overall, our research identified both perceived benefits and perceived limitations of virtual care, and older adult participants emphasized their wish for a hybrid model of virtual care, in which virtual care is viewed as an addendum, not a replacement for in-person care. We recognize the limitations of our sample (small, not representative of all older Canadians, and more likely to use technology); this body of literature would greatly benefit from more research with older adults who do not/cannot use technology to receive care. Findings from this study can be mobilized as part of broader efforts to support older patients and providers engaged in virtual and in-person care, particularly post–COVID-19.

老年轮椅用户推荐轮椅维护应用程序的年龄友好设计改进:混合方法开发研究

2022 - 10 - 18岁t09:30:02内

背景:轮椅零件故障在过去十年中翻了一番。预防性的轮椅维修可以减少轮椅故障和防止使用者的后果。我们正在开发一款名为WheelTrak的智能手机应用程序，当需要维护时，它会提醒用户，以鼓励维护实践和遵守。本混合方法研究旨在开发一个轮椅维修应用程序，采用广泛的利益相关方建议，并调查老年人与该应用程序的交互体验，以及他们对维修的感知障碍和促进因素。与利益相关者(包括移动设备用户)进行访谈，以生成需求陈述和应用程序规格。该应用程序的设计分为两个阶段。第一阶段是根据主要用户对应用界面的规格和评价进行应用开发。第二阶段包括修改应用屏幕和手动功能测试。可用性测试和半结构化访谈对老年轮椅和滑板车使用者进行。系统可用性量表用来衡量应用的可用性。 Results: Interviews with power and manual wheelchair users (37/57, 65%), wheelchair service providers (15/57, 26%), manufacturers (2/57, 4%), seating and mobility researchers (1/57, 2%), and insurance plan providers (2/57, 4%) informed the needs and specifications of the app technology. The 2-stage development process delivered a fully functional app that met the design specifications. In total, 12 older adults (mean age 74.2, SD 9.1 years; n=10, 83% women; and n=2, 17% men) participated in the usability testing study. Of the 12 participants, 9 (75%) agreed to use WheelTrak for preventative maintenance. WheelTrak scored an average System Usability Scale score of 60.25 (SD 16). Four overarching themes were identified: WheelTrak app improvements, barriers to maintenance, consequences related to mobility device failure, and smart technology use and acceptance. Older adults preferred the simplicity, readability, personalization, and availability of educational resources in the app. Barriers to maintenance pertained to health issues and lack of maintenance knowledge among older adults. Facilitators of maintenance included notification for maintenance, app connectivity with the service provider, reporting of device failure, and the presence of a caregiver for maintenance. Conclusions: This study highlighted age-friendly design improvements to the app, making it easy to be used and adopted by older wheelchair users. The WheelTrak app has close to average system usability. Additional usability testing will be conducted following app revision in the future.

老年人骨折后急性疼痛管理的移动应用程序原型:以用户为中心的设计方法

2022 - 10 - 17 - t09:30:23内

背景:骨折后急性疼痛在老年人中往往得不到适当的处理。移动保健(mHealth)技术可以为自我管理疼痛提供机会;然而，用于骨折后急性疼痛管理的应用程序不足，也没有针对老年人设计的应用程序。本研究旨在设计、开发和评估一个mHealth应用程序原型，采用以人为本的设计方法，支持老年人骨折后急性疼痛的自我管理。本研究采用了多学科和以用户为中心的设计方法。总体而言，项目团队中的7名利益相关者(即1名专门从事内科医学的临床研究员、2名用户体验设计师、1名计算机科学研究员、1名临床研究助理研究员和2名药剂师)以及355名外部利益相关者参与了我们以用户为中心的开发过程，包括调查、需求引出、参与式设计研讨会、移动应用程序设计与开发、移动应用程序内容开发、和可用性测试。我们分三个阶段完成了这项研究。我们分析了之前对305名加拿大骨质疏松症患者网络成员和34名医疗保健专业人员的调查数据，以确定设计低保真原型的需求。接下来，我们举办了4个参与式设计研讨会，有6个参与者，就内容、演示和与我们提议的低保真原型的交互进行反馈。 After analyzing the collected data using thematic analysis, we designed a medium-fidelity prototype. Finally, to evaluate our medium-fidelity prototype, we conducted usability tests with 10 participants. The results informed the design of our high-fidelity prototype. Throughout all the phases of this development study, we incorporated inputs from health professionals to ensure the accuracy and validity of the medical content in our prototypes. Results: We identified 3 categories of functionalities necessary to include in the design of our initial low-fidelity prototype: the need for support resources, diary entries, and access to educational materials. We then conducted a thematic analysis of the data collected in the design workshops, which revealed 4 themes: feedback on the user interface design and usability, requests for additional functionalities, feedback on medical guides and educational materials, and suggestions for additional medical content. On the basis of these results, we designed a medium-fidelity prototype. All the participants in the usability evaluation tests found the medium-fidelity prototype useful and easy to use. On the basis of the feedback and difficulties experienced by participants, we adjusted our design in preparation for the high-fidelity prototype. Conclusions: We designed, developed, and evaluated an mHealth app to support older adults in the self-management of pain after a fracture. The participants found our proposed prototype useful for managing acute pain and easy to interact with and navigate. Assessment of the clinical outcomes and long-term effects of our proposed mHealth app will be evaluated in the future.

进化混合部分遗传算法分类模型的低成本弱点筛选:调查研究

2022年10月- 07 - t09:15:02内

度量脆弱的常用方法是用脆弱指数(FI)表示的缺陷的累积。fi可以很容易地适应许多数据库，因为使用的参数没有规定，而是反映提取的特征(变量)的子集。不幸的是，许多数据库的结构不允许直接提取一个合适的子集，需要额外的努力来确定和验证每个记录的特征值，从而显著增加成本。我们的目标是描述一种被称为部分遗传算法的人工智能(AI)优化技术如何被用于优化用于计算FI的特征子集，并偏爱具有最小获取成本的特征。方法:这是一个从澳大利亚昆士兰的10个机构编译的住宿护理数据库的二次分析。该数据库包括常规收集的管理数据和592名75岁及以上居民的非结构化病历。初步研究从36个合适的特征中计算出电子脆弱指数(eFI)。然后，我们对遗传算法进行结构修正，从2组特征中找到计算出的eFI(0.21阈值)的最佳预测因子。部分遗传算法用于优化4种基础分类模型:逻辑回归、决策树、随机森林和支持向量机。结果:在基础模型中，逻辑回归发现在几乎所有场景和特征集大小下都能产生最佳模型。 The best models were built using all the low-cost features and as few as 10 high-cost features, and they performed well enough (sensitivity 89%, specificity 87%) to be considered candidates for a low-cost frailty screening test. Conclusions: In this study, a systematic approach for selecting an optimal set of features with a low cost of acquisition and performance comparable to the eFI for detecting frailty was demonstrated on an aged care database. Partial genetic algorithms have proven useful in offering a trade-off between cost and accuracy to systematically identify frailty.

老年心力衰竭患者和护理人员姑息治疗移动干预的可用性和可接受性:观察性研究

2022 - 10 - 06 - t09:00:03内

背景:心力衰竭是老年人死亡的主要原因。数字卫生可以增加晚期心力衰竭患者及其护理人员对姑息治疗的获取和认识。然而，很少有姑息治疗数字干预针对心力衰竭或患者的照护者、家人和朋友，在这里被称为社会护卫。为了满足这一需求，开发了社会护送缓和医疗移动干预，为晚期心力衰竭的老年人和他们的社会护送提供自我管理工具和缓和医疗资源。该研究的目的是测试护送- pal在患有晚期心力衰竭的老年人及其社交护送者中的可接受性和可用性。Convoy-Pal包括基于平板电脑和智能手表的工具，促进自我管理和获取姑息治疗资源。老年人和社会护理员通过Zoom完成了接受性和可用性的面试，包括开放式问题和移动应用程序评级量表:用户版本(uMARS)。描述性分析总结了开放式反馈和自我报告的可接受性和可用性的结果。共有26名参与者(16名老年人和10名社会护理员)参加了访谈。总体而言，用户反馈良好(uMARS平均值3.96/5 [SD 0.81])。 Both older adults and social convoy caregivers scored information provided by Convoy-Pal the highest (mean 4.22 [SD 0.75] and mean 4.21 [SD 0.64], respectively). Aesthetics, functionality, and engagement were also perceived as acceptable (mean >3.5). Open-ended feedback resulted in 5 themes including improvements to goal setting, monitoring tools, daily check-in call feature, portal and mobile app, and convoy assessment. Conclusions: Convoy-Pal was perceived as acceptable with good usability among older adults with heart failure and their social convoy caregivers. With good acceptability, Convoy-Pal may ultimately lead to increased access to palliative care resources and facilitate self-management among older adults with heart failure and their social convoy caregivers.

远程和全自动故事回忆任务评估老年人早期认知障碍的有效性:纵向病例对照观察研究

2022 - 09 - 30 - t09:15:02内

故事回忆是一种简单而敏感的认知测试，通常用于测量早期阿尔茨海默病(AD)患者的情景记忆功能的变化。最近数字技术和自然语言处理方法的进步使该测试成为自动化管理和评分的候选。需要多个并行测试刺激来进行更高频率的疾病监测。本研究旨在开发和验证一种适用于纵向评估的远程全自动故事回忆任务，受试者为患有或不患有轻度认知障碍(MCI)或轻度AD的老年人。“淀粉样蛋白在早期阿尔茨海默病中的预测”(AMYPRED)研究在英国(AMYPRED- uk: NCT04828122)和美国(AMYPRED- us: NCT04928976)招募参与者。参与者被要求在7到8天内通过智能设备远程完成可选的每日自我管理评估。评估包括从自动故事回忆任务(ASRT)中立即和延迟回忆3个故事，这是一个多重平行刺激(18个短篇故事和18个长故事)的测试，平衡了关键的语言和话语指标。口头回答被记录下来，并从参与者的个人设备安全传输，并自动转录和评分，使用源文本和复述之间的文本相似度指标，以得出一个广义的匹配得分。使用逻辑模型和线性混合模型分别检验依从性和任务表现的组间差异。相关分析检验了asrt的平行形式信度和认知测试(逻辑记忆测试和临床前阿尔茨海默氏症认知复合与语义处理)的收敛效度。 Acceptability and usability data were obtained using a remotely administered questionnaire. Results: Of the 200 participants recruited in the AMYPRED studies, 151 (75.5%)—78 cognitively unimpaired (CU) and 73 MCI or mild AD—engaged in optional remote assessments. Adherence to daily assessment was moderate and did not decline over time but was higher in CU participants (ASRTs were completed each day by 73/106, 68.9% participants with MCI or mild AD and 78/94, 83% CU participants). Participants reported favorable task usability: infrequent technical problems, easy use of the app, and a broad interest in the tasks. Task performance improved modestly across the week and was better for immediate recall. The generalized match scores were lower in participants with MCI or mild AD (Cohen d=1.54). Parallel-forms reliability of ASRT stories was moderate to strong for immediate recall (mean rho 0.73, range 0.56-0.88) and delayed recall (mean rho=0.73, range=0.54-0.86). The ASRTs showed moderate convergent validity with established cognitive tests. Conclusions: The unsupervised, self-administered ASRT task is sensitive to cognitive impairments in MCI and mild AD. The task showed good usability, high parallel-forms reliability, and high convergent validity with established cognitive tests. Remote, low-cost, low-burden, and automatically scored speech assessments could support diagnostic screening, health care, and treatment monitoring.

基于社交媒体的美国华裔痴呆护理人员干预研究:方案开发

2022 - 09 - 29 - t10:00:04内

背景:痴呆患者的少数族裔和移民照顾者经历了高比率的心理社会压力和不良健康结果。很少有针对这些弱势群体的文化定制的移动卫生(mHealth)项目。本研究报告了一项被称为“照料者健康增强”(WECARE)的文化定制移动健康项目的开发，以提高照料技能，减少痛苦，并改善老年痴呆患者的华裔美国家庭照料者的心理健康。方法:应用基于社区的以用户为中心的设计原则进行程序开发。首先，WECARE项目的结构和课程是基于现有的以证据为基础的护理干预措施制定的，并听取了4位专家的意见。其次，通过与8个利益相关者的密切合作，我们在文化上将循证项目改编为多媒体项目组成部分。最后，5个目标用户对初始WECARE方案进行了测试;他们的经验和反馈被用来进一步完善项目。结果:WECARE是一个为期7周的移动健康项目，通过微信提供，微信是一个在华裔美国人中非常流行的社交媒体应用程序。通过订阅WECARE官方账号，用户可以连续7周每周收到6篇推送到微信账号的互动多媒体文章。 The 7 major themes include (1) facts of dementia and caregiving; (2) the enhancement of caregiving skills; (3) effective communication with health care providers, care partners, and family members; (4) problem-solving skills for caregiving stress management; (5) stress reduction and depression prevention; (6) the practice of self-care and health behaviors; and (7) social support and available resources. Users also have the option of joining group chats for peer support. The WECARE program also includes a back-end database that manages intervention delivery and tracks user engagement. Conclusions: The WECARE program represents one of the first culturally tailored social media–based interventions for Chinese American caregivers of persons with dementia. It demonstrates the use of community-based user-centered design principles in developing an mHealth intervention program in underserved communities. We call for more cultural adaptation and development of mHealth interventions for immigrant and racial/ethnic minority caregivers of persons with dementia.

基于规则的自然语言处理的医疗记录识别护理人员可用性:回顾性队列研究

2022 - 09 - 22 - t10:00:04内

背景:确定护理人员的可用性，特别是对痴呆症患者或残疾患者，对于告知卫生系统、医院和提供者适当的护理计划至关重要。这些信息并不容易获得，而且缺乏实用的方法来自动识别护理人员的可用性和类型。目的:我们的主要目的是使用医疗记录来评估住院痴呆患者的护理人员的可用性和类型。我们的第二个目标是确定患者是住在家里还是住在机构。方法:在这项回顾性队列研究中，我们使用来自单一机构的2016-2019年电话遭遇医疗记录，开发基于规则的自然语言处理(NLP)算法，以确定患者的护理人员可用性和居住地。使用笔记级数据，我们将NLP算法的结果与人类进行的图表抽象进行了比较，这两种结果分别为训练(749/976,77%)和测试集(227/976,23%)，共223名65岁及以上的老年人被诊断为痴呆症。我们的结果包括确定患者(1)住在家里还是在机构，(2)有一个正式的照顾者，(3)有一个非正式的照顾者。结果:测试集结果表明，我们的NLP算法在识别患者是否有非正式照顾者方面具有较高的准确性和可靠性(F₁=0.94，准确性=0.95，敏感性=0.97，特异性=0.93)，但在识别患者是否住在机构方面相对较差(F₁=0.64，准确性=0.90，敏感性=0.51，特异性=0.98)。对于所有类别的NLP错误分类，最常见的解释是(1)设施名称不完整或拼写错误;(2)过去的、不确定的或未确定的状态; (3) uncommon abbreviations; and (4) irregular use of templates. Conclusions: This innovative work was the first to use medical notes to pragmatically determine caregiver availability. Our NLP algorithm identified whether hospitalized patients with dementia have a formal or informal caregiver and, to a lesser extent, whether they lived at home or in an institutional setting. There is merit in using NLP to identify caregivers. This study serves as a proof of concept. Future work can use other approaches and further identify caregivers and the extent of their availability.