Search

Importance: The importance of developing age-friendly environments is globally recognized. However, few clinical trials have comprehensively evaluated physical and social components of environments and examined the effects of offering support. Objective: To clarify the effectiveness of occupational therapy–based comprehensive environmental support for community-dwelling older adults. Design: A single-blind parallel-groups randomized controlled trial with blinded participants. Setting: Eight community-based settings under the long-term-care insurance system in regional towns and cities throughout Japan. Participants: Sixty older adults age ≥65 yr who were new users of adult day care or adult day health care and allocated by stratified block randomization on the basis of age. Intervention: Comprehensive environmental support was provided to participants for 3 mo according to results on the Comprehensive Environmental Questionnaire for older adults (CEQ) to make improvements in environmental factors participants wanted to change to create a more satisfying life. Outcomes and Measures: The primary outcome measure was the Japanese Medical Outcomes Study 36-Item Short-Form Health Survey (SF–36) score at 3 mo postrandomization. Additionally, scores on the Short-Form Six-Dimension utility index were calculated. Results: The experimental group showed significant improvements in the SF–36's Role/Social Component Summary (p =.005) and Role–Physical (p =.02), Role–Emotional (p =.01), and Mental Health (p =.05) domains, with moderate effect sizes. The number needed to treat was 3.46, showing statistical significance. Conclusions and Relevance: Occupational therapy–based comprehensive environmental support based on CEQ scores was effective, resulting in moderate improvements in health-related quality of life among community-dwelling older adults. Plain-Language Summary: Older adults experience a decline in physical and mental functions along with changes in social relationships. These problems make it challenging for older adults to perform valuable occupations, thus reducing their quality of life. This study demonstrated that occupational therapy based on the Comprehensive Environmental Questionnaire for older adults can improve health-related quality of life among community-dwelling older adults. Our findings pave the way for the development of an effective compensatory intervention model in occupational therapy practice. Occupational therapy based on the Comprehensive Environmental Questionnaire for older adults can improve health-related quality of life among community-dwelling older adults. [ABSTRACT FROM AUTHOR]

Introduction: Psychiatric day-care services play a central role in community-based care in Japan. Recovery and related psychosocial factors are critical in promoting community participation of people with mental illness. This study aimed to reveal the relationships among activity information, personal recovery, and related psychosocial factors in day-care users. Method: Forty day-care participants answered self-report questionnaires. The following assessments were applied: Recovery Assessment Scale, Occupational Questionnaire, Perceived Devaluation Discrimination Scale, and 26-item version of World Health Organization Quality of Life (QOL). The correlations among the factors were analyzed. Results: Data for 35 people were analyzed. Total recovery score was strongly correlated with total WHOQOL-26 score (r = 0.76, p < 0.001). Total QOL score was positively related with the value of activities (r = 0.46, p < 0.05). Social QOL and total stigma score had a significant negative relationship (r = −0.44, p < 0.05). Conclusion: Participation in activities was suggested to improve QOL. Although there was a strong relationship between recovery and QOL, it was unclear to what extent participation in activities was related to recovery. We should consider approaches regarding other factors to fully accomplish community integration and personal recovery. [ABSTRACT FROM AUTHOR]

Laws in Latin American countries are based on scientific evidence that calls for mental health services to move to the community. These care modalities have implementation problems. The objective of this article is to describe the implementation of the services proposed in Law 1616 of 2013 of Colombia (Mental Health Law): emergencies, hospitalization, community-based rehabilitation, pre-hospital care, day hospital for children and adults, Drug Addiction Care Center, groups support and mutual aid, telemedicine, and home and outpatient care. We used a mixed study, with a cross-sectional descriptive quantitative component, where an instrument was used to determine the level of implementation of these services, consisting of a scale that established the availability and use of these services, in addition to the climate of implementation of the services and community mental health strategies, in addition to a qualitative determination of barriers and facilitators of implementation. We found a low availability of all services in departments such as Amazonas, Vaupés, Putumayo, and Meta and an implementation of services in Bogotá and Caldas. The least implemented services are the community ones, and those with the greatest presence at the territorial level are emergencies and hospitalization. We conclude that low- and middle-income countries have few community models and invest a large part of their technical and economic effort in emergencies and hospitalization. There are difficulties in the implementation of most of the services proposed by Colombian legislation related to mental health. [ABSTRACT FROM AUTHOR]

Introduction: With advances in monitoring, anesthesia, and minimally invasive techniques, same-day surgeries are expected to rise significantly in the coming years. In this group, patients undergo diagnostic and therapeutic procedures and are sent home on the same day. This poses a great responsibility on the doctors involved and the hospital services, in ensuring the absence of delays, unanticipated admissions, and unexpected adverse events. Patient selection criteria are being used effectively by various centers across the world to prevent elective case cancellation and unplanned hospital admission and identify high-risk cases for major complications including morbidity and mortality. In recent year patient selection criteria, based on the latest guidelines, are being used to identify the risk factors and channel patients for ambulatory, day-care, and inpatient categories. Aims and Objectives: This article purposes a proper patient selection process for the improvement of quality and safety in patients undergoing day-care and office-based procedures. The patient selection criteria, if understood by all the team players, is instrumental in providing clinical guidance and appropriate patient triaging for caring for an ever-increasing, large volume of same-day surgical population. As the volume and complexity of the patient population grow, it is important to revise the patient selection criteria from time to time. Conclusion: Patient selection criteria have to be developed and modified by bodies and institutions to suit local circumstances to channel patients for ambulatory, day-care, and inpatient categories. Processes, administrative, clinical, and technical standards must be in-built into place and the pathway need to be well understood by all the team players in an institution. [ABSTRACT FROM AUTHOR]

The demand for lower limb arthroplasty is projected to increase significantly over the next three decades, which poses a major challenge to healthcare services. Novel solutions in arthroplasty services are required to meet the growing volume of patients that require essential orthopaedic surgery. These solutions must be safe, efficient, and reproducible at scale. They must also be robust to the disruption felt with increasing frequency from the need to accommodate the growth of unscheduled inpatient care services. Day case total hip arthroplasty (THA) has become established in North America and is being used with increasing frequency in the UK and Europe. This approach been shown to be safe and effective in a wide variety of settings and is associated with good outcomes and high levels of patient satisfaction. Day case arthroplasty may improve the efficiency and productivity of planned essential surgery by reducing the burden on inpatient services, and consequently the demand for day case THA is likely to increase. It is therefore essential that the principles of day case THA are included in the continued professional development of clinicians in orthopaedic surgery, anaesthetics and perioperative care, and allied health professionals involved in the delivery of arthroplasty services. The first part of this article offers a narrative review of day case THA and considers the relative merits of this approach to lower limb arthroplasty services. The second part describes the experiences of successful units and provides a summary of the principles that are essential to deliver safe and effective care. [ABSTRACT FROM AUTHOR]

Background:The long-term care insurance system for the elderly is being implemented as a social support for the elderly in need of care. As of 2022, as the use of adult day care centre among home benefits is on the rise, it is necessary to devise measures to reduce the caregiving burden and family conflicts targeting the caregivers of the elderly who use adult day care centre. Objectives: The purpose of this study is to examine the dual mediating effect of caregiving mastery and self-esteem on the relationship between caregiving burden and family conflict. Methods:In this study, 304 caregivers of the elderly who received a long-term care grad and were using anadult day care centre were targeted. The data were analysed using SPSS PC+ Win. 24.0 and SPSS PROCESS macro 4.1. Applied statistical techniques were descriptive statistics, reliability analysis, correlation analysis, and double mediating effect analysis. Results:First, the age and length of support for caregivers increased the caregiving burden, but the health and economic status of caregivers lowered the caregiving burden and family conflict, and improved caregiving mastery and self-esteem. Second, the caregiving burden of the family caregiver was 2.51 points (out of 5 points) and family conflict was low at 1.85 points (out of 5 points). The parameter, caregiving mastery, was at 3.40 points (out of 5 points) and self-esteem was at 3.40 points (out of 4 points), which is a fairly high level. Third, the higher the caregiving burden, the higher the family conflict was, but the effect of the caregiving burden on family conflict through caregiving mastery and self-esteem was lowered. Conclusions: In order to reduce the impact of the burden of care on family conflict, it is necessary to improve the ability to solve problems in a positive way, such as mastery of caring and selfesteem. This suggests that adult day care centre need to provide caring education for family caregivers to increase their caring skills and provide counselling to improve their self-esteem. [ABSTRACT FROM AUTHOR]

Introduction: The Cognitive Orientation to daily Occupational Performance (CO-OP) ApproachTM is a leading approach in occupational therapy. Implementing the CO-OP ApproachTM in a group format in day rehabilitation has not yet been explored. Method: In day rehabilitation, a barrier to implementing the CO-OP ApproachTM is the group model. To address these challenges, this feasibility study involved the development, implementation, and evaluation of a CO-OP group for adults. Four patients participated in six group sessions. Pre- and post-measures included the Canadian Occupational Performance Measure (COPM) and the Assessment of Motor and Process Skills (AMPS). Subjective data were collected to reflect the participant's experiences during the group. Results: 80% of participants recruited completed the group. All participants demonstrated improvement in goals addressed within the group and goals not addressed within the group on the COPM. AMPS findings were inconclusive. Subjective findings indicated participants appreciated the group learning environment, valued the CO-OP process, were motivated to participate, and would have liked more groups. Conclusion: To our knowledge, this is the first adult CO-OP group in a clinical setting. Results support the feasibility of a CO-OP group in day rehabilitation and the need for further examination of the effectiveness of this intervention. [ABSTRACT FROM AUTHOR]

Oral exercise is a training method for swallowing dysfunction in older adults. The study investigated the effect of oral exercise on tongue pressure in older adults in Taiwanese community day care centers over a 3-month period. Participants over age 50 who were able to communicate and participating for the duration of the 12-week period were recruited from five community day care centers. A 15-min weekly group oral exercise activity was conducted. The tongue pressures were measured and multivariable linear regression models were used to assess the effect of oral exercise intervention on the participants' tongue pressures. A total of 66 older adult participants, among whom the mean age was 78.06 ± 10.74 years. Tongue pressure continued improving during the intervention period, and the mean tongue pressure at the end of the study was 20.63 ± 10.45 kPa, which was significantly higher than the baseline measurement (16.92 ± 10.62 kPa, p < 0.001). Participants exhibited significant improvement in tongue pressure regardless of their age groups. Moreover, participants with one to seven pairs of functional tooth units (FTUs) exhibited significantly more improvement in tongue pressure (16.00 kPa, 95% CI = 2.58–29.43) than those without FTUs (p = 0.021). Oral exercise over a 3-month period significantly improved tongue pressure among the study participants regardless of their gender or age group. Oral exercise should be integrated into comprehensive health promotion programs to assist in the improvement and maintenance of oral function among older adults. [ABSTRACT FROM AUTHOR]

Specialist palliative day care can support palliative caregiving for those living in the community with advanced disease. However, how people access specialist palliative day care and why is unclear. This study therefore aims to explore the referral experiences of patients, carers and staff in the context of a specialist palliative day care unit. Qualitative study using constant comparative analysis to explore referral experiences to a UK specialist palliative day unit through one-to-one interviews with patients (n=15), family carers (n=6) and staff (n=10) including nurses, medics and managers and focus groups with (n=3 and n=7) specialist palliative care nurses. The three datasets (staff, patients and carers) provide a triangulation of perspectives captured within the core category of 'managing referral' and presented as six sub-themes. Staff described referral as an intuitive interaction involving 'looking for openings' and 'getting people through the door'. Patients familiar with the service were persistent in 'shouting for help' but most regarded referral with dread, only 'giving it a go' following crisis. For family carers referral presented 'time out/respite' but also the 'end-of-the-line'. Unclear understandings of services as well as uncertain professional, patient and carers notions of candidacy influence referral to specialist palliative day care. [ABSTRACT FROM AUTHOR]

Objectives: This study analyzed trends in foodborne and waterborne diseases in South Korea between 2015 and 2019. Methods: The data consisted of information on outbreaks of waterborne and foodborne infectious diseases reported through the Korea Centers for Disease Control and Prevention (KCDC) system. We analyzed the trends and epidemiological aspects of outbreaks by month, place of occurrence, and causative pathogens in this observational study. Results: The number of outbreaks has steadily increased over the last 5 years, but the number of cases per outbreak has followed a decreasing trend. Incidence at daycare centers and preschools has been steadily increasing over consecutive years. Conclusion: The steady number of patients and decreasing number of cases per outbreak, even as the number of outbreaks has been increasing, suggest that the KCDC's professional management system is operating effectively. It is necessary to continue improving the objectivity and efficiency of the management system and to carefully examine the increasing number of outbreaks in smaller-scale group catering facilities, such as daycare centers and preschools. Outbreaks can be prevented by closely examining those caused by unidentified pathogens and group outbreaks caused by other diseases, identifying problems, and supplementing the management system. [ABSTRACT FROM AUTHOR]

Copyright of Revista Ciência & Saúde Coletiva is the property of Associacao Brasileira de Pos-Graduacao em Saude Coletiva and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Social interaction is an essential factor in ensuring the quality of older adult living. This study aimed to investigate socio-spatial features associated with social interaction in older adult care facilities. A socio-technological approach integrating space syntax and agent-based analysis was applied as an evaluation framework to measure the spatial and social attributes. Visibility from the nurses' and patients' locations, behavioural accessibility to social spaces, and strong to weak circulation patterns were examined. There was low patient visibility from the nurse stations in cluster-type units, and the visual connection was higher in the patient room corridors than the lounge areas in racetrack-type units. Increased inflows of patients to common areas appeared with a direct and uninterrupted connection between patient room corridors and central circulation area. This study contributes to potential applications of the spatial features to enhance social interaction possibilities with an awareness of the effects on visual and social properties. [ABSTRACT FROM AUTHOR]

The demented elderly have physical, emotional and behavioral patterns that differ from those of the normal elderly, and those patterns differentiate their needs in terms of the indoor built environment (IBE). Therefore, it is essential to investigate the effects of the IBE on the quality of life (QoL) of the demented elderly. To ensure the study's reliability and validity, multiple research methods were applied, including qualitative methods (i.e., an interview) and quantitative ones (i.e., a questionnaire survey). In total, 96 demented elderly residents and 18 caregivers from eight care and attention (C&A) homes were involved in the current study. Based on the data collection, an IBE-QoL model was developed using a reliability test, correlation analysis and regression analysis. The model confirmed the following: 1) building services factors – lighting, temperature, lifts and water supply – predict demented elderly residents' physical health, psychological health, independence, activities of daily living and social relationships; and 2) supporting facilities factors – signage, finishes and furniture – also exert a positive impact on the residents' physical health, activities of daily living, social relationships and cognitive functioning. Practical recommendations are made, including that C&A homes provide access to a sky garden on each floor, label water taps with hot/cold signs, provide signage with iconic information at different strategic locations, employ color contrasting finishes in different rooms, use historical furniture, and so on. This study's results provide valuable insight into improving C&A homes' IBE in order to enhance the QoL of the demented elderly. • Six QoL domains and twelve indoor built environment (IBE) factors are identified. • The existing IBE in care and attention homes are generally unsatisfactory. • An IBE-QoL model for the demented elderly is built using multiple research methods. • Four building services factors positively predict their QoL of the demented elderly. • Three supporting facilities positively affect their QoL and cognitive functioning. [ABSTRACT FROM AUTHOR]

INTRODUCTION: This study examined the experiences of adults with disabilities (AWDs) transitioning to community based residential settings. This field of study has not been sufficiently researched despite being a key aspect of adulthood. METHOD: A literature review of articles relating to residential transitions for AWDs was undertaken. FINDINGS: The literature review findings could be grouped around three main categories: AWDs' perception and self-determination, caregivers' perceptions of the process and, lastly, the insights from service providers and social policies. The review and feedback identified issues experienced during the residential transition, such as feelings of readiness to transit which relate closely to the person's self-determination. As the study delved deeper into the residential transition process in Aotearoa New Zealand, AWDs are noted to be vulnerable persons always requiring support in order to develop and maintain their independence. IMPLICATIONS: Substantive state recognition, such as a social compact, is the key groundwork for this marginalised group to develop self-efficacy, have successful transition experiences and sustain good lives. Eventually, this must be in the form of Crown-binding legislation, where vulnerable adults are served through restorative and protective policies. [ABSTRACT FROM AUTHOR]

For many service-oriented firms, knowledge is a key commodity, and the process by which knowledge is codified is critical for firm survival. The administrator or top manager acts as the repository and disseminator of organizational knowledge. The purpose of this project is to examine the association between the administrator's educational attainment and innovation in residential care facilities. The study hypothesized that administrator academic education and certification or licensure would be positively associated with facility innovation. Data for this project comes from the 2010 National Survey of Residential Care Facilities. There were 2277 facilities included in the sample (weighted 30 811). Innovation, the dependent variable, was operationalized using 5 dichotomized measures: clinical information systems, pharmaceutical information systems, electronic health records, providing adult day care, and providing respite care. The data were analyzed using logistic regression. Overall, the results reveal that college education or certification/licensure increased the likelihood of technology use. In addition, those with a high school diploma and certification/licensure were more likely to use technology than were individuals who had, at a minimum, some college. The services models were not significant. It may be that the resources necessary to implement information systems vary substantially from the resources necessary to provide services. [ABSTRACT FROM AUTHOR]

Living and working in isolated northern communities pose challenges in using evidence to inform dementia care. Purpose: To better understand the contextual dimensions of two home care centres in two Canadian northern, rural communities that influence the use of evidence from the perspectives of home care providers (HCPs). Sample: All clinical leaders, managers, and home care providers (n=48 FTE) in the two home care centres were sent an information letter outlining the study's purpose, expectations, and benefits and invited to participate in focus groups conducted in two home care centres. Fourteen staff participated in the two focus groups. Method: A qualitative interpretive descriptive approach was used. Semi-structured questions were used to guide the audiotape recorded focus groups. Transcripts were coded using Lubrosky's thematic analysis. Findings: Findings are described in broad contextual themes (e.g., challenges in using the RAI-HC, availability of resources, relationships in a rural community, leadership, and evaluation) that included both positive and negative contextual dimensions that influenced the use of evidence. Conclusions: Most importantly, reallocated resources are needed in northern home care settings. Challenges in exchanging evidence related to difficult relationships with physicians, clients, and their family caregivers were identified. Leadership and collaboration dimensions were fundamental to establishing a vibrant workplace in which HCPs provided and exchanged evidence-based dementia care. [ABSTRACT FROM AUTHOR]

This article focuses on a study which developed a modified screening tool to predict the occurrence of falls in primary care setting referencing the research "A Modified Fall Risk Assessment Tool That Is Specific to Physical Function Predicts Falls in Community-Dwelling Elderly People," published in the October-December 2014 issue of the "Journal of Geriatric Physical Therapy." Topics discussed include the methods used in the study and the relevance of its findings to high-risk fallers.

With anticipated greater demand for formal care services globally, this article examines the sociodemographic and health characteristics of frail older people in receipt of community support. Data were collected from audits of case files of older people receiving care management at two time points during which two government policy initiatives were implemented to promote greater standardization in health and social care provision for older people in England. Findings at Time 2 revealed that there were higher levels of physical and mental impairment and more health care assessments undertaken. There was a slight decrease in home care receipt but a marginal increase of more intensive home care provision. Service users living with a carer were less likely to receive home care but more likely to receive respite care or day care than those living alone. The policy goal of widening access to specialist health and social care services for older people with mental health problems was achieved. Guidance that focused eligibility criteria on the identification of older people with complex needs required the availability of appropriate support and services. Irrespective of policy initiatives, the sociodemographic characteristics of older people and the availability of informal support are principal determinants of service provision. [ABSTRACT FROM AUTHOR]

Background: Day centres are central for community participation among people with mental health problems. Understanding day centre attendees' occupational engagement is therefore important. Method: A total of 88 people from six day centres in four municipalities in southern Sweden completed a time-use diary, recording their occupational engagement during the most recent day at the day centre. The transcribed data were analysed using thematic content analysis. Findings: The main theme was being part of the spirit of togetherness and getting empowered, from which the participants' reflections could be understood. Conclusion: The day centres provided opportunities to be occupationally engaged and to create routines, and challenged the attendees to be more active in their daily life. Day centres have the potential to provide empowering occupations and rehabilitation for people with mental health problems and to help them towards a more participatory life. [ABSTRACT FROM AUTHOR]

The article discusses volunteers' role in care and activity settings for adults with dementia. It includes approach in recruiting and orienting volunteers. It states that volunteers can be developed to meet client, family, staff, and organizational needs. Strategies for managing volunteers and tips for being a good volunteer are also included.

The article discusses a November 30, 2011 legal settlement in the U.S. District Court for the Northern District of California case Darling v. Douglas which deals with Medicaid funding for an adult day health care program. A historical overview of the adult day care program in California is presented, along with the impact of several preliminary injunctions on the outcome of the case.

Individuals with dementia have cognitive deficits that inhibit processing information and adapting to environmental changes. The environment in which the individual is evaluated may impact assessment results. An interdisciplinary approach was used to assess individuals with dementia in three settings on independent living skills. Significant differences were found between home and clinical settings on motor skills, with motor skills higher in the home. No significant differences were found on social skills, cognitive-communicative skills, or instrumental activities. Although contemporary practice emphasizes the importance of the environment in individuals with dementia, results indicate that these individuals score similarly across three different environments. [ABSTRACT FROM AUTHOR]

Background: Electronic health records (EHRs) are a central feature of care delivery in acute care hospitals; however, the financial and quality outcomes associated with system performance remain unclear. Objective: In this study, we aimed to evaluate the association between the top 3 EHR vendors and measures of hospital financial and quality performance. Methods: This study evaluated 2667 hospitals with Cerner, Epic, or Meditech as their primary EHR and considered their performance with regard to net income, Hospital Value–Based Purchasing Total Performance Score (TPS), and the unweighted subdomains of efficiency and cost reduction; clinical care; patient- and caregiver-centered experience; and patient safety. We hypothesized that there would be a difference among the 3 vendors for each measure. Results: None of the EHR systems were associated with a statistically significant financial relationship in our study. Epic was positively associated with TPS outcomes (R2 =23.6%; β=.0159, SE 0.0079; P =.04) and higher patient perceptions of quality (R2 =29.3%; β=.0292, SE 0.0099; P =.003) but was negatively associated with patient safety quality scores (R2 =24.3%; β=−.0221, SE 0.0102; P =.03). Cerner and Epic were positively associated with improved efficiency (R2 =31.9%; Cerner: β=.0330, SE 0.0135, P =.01; Epic: β=.0465, SE 0.0133, P <.001). Finally, all 3 vendors were associated with positive performance in the clinical care domain (Epic: β=.0388, SE 0.0122, P =.002; Cerner: β=.0283, SE 0.0124, P =.02; Meditech: β=.0273, SE 0.0123, P =.03) but with low explanatory power (R2 =4.2%). Conclusions: The results of this study provide evidence of a difference in clinical outcome performance among the top 3 EHR vendors and may serve as supportive evidence for health care leaders to target future capital investments to improve health care delivery. J Med Internet Res 2021;23(4):e23961 doi:10.2196/23961 [ABSTRACT FROM AUTHOR]

Background: Electronic health records (EHRs) are a central feature of care delivery in acute care hospitals; however, the financial and quality outcomes associated with system performance remain unclear.Objective: In this study, we aimed to evaluate the association between the top 3 EHR vendors and measures of hospital financial and quality performance.Methods: This study evaluated 2667 hospitals with Cerner, Epic, or Meditech as their primary EHR and considered their performance with regard to net income, Hospital Value-Based Purchasing Total Performance Score (TPS), and the unweighted subdomains of efficiency and cost reduction; clinical care; patient- and caregiver-centered experience; and patient safety. We hypothesized that there would be a difference among the 3 vendors for each measure.Results: None of the EHR systems were associated with a statistically significant financial relationship in our study. Epic was positively associated with TPS outcomes (R2=23.6%; β=.0159, SE 0.0079; P=.04) and higher patient perceptions of quality (R2=29.3%; β=.0292, SE 0.0099; P=.003) but was negatively associated with patient safety quality scores (R2=24.3%; β=-.0221, SE 0.0102; P=.03). Cerner and Epic were positively associated with improved efficiency (R2=31.9%; Cerner: β=.0330, SE 0.0135, P=.01; Epic: β=.0465, SE 0.0133, P<.001). Finally, all 3 vendors were associated with positive performance in the clinical care domain (Epic: β=.0388, SE 0.0122, P=.002; Cerner: β=.0283, SE 0.0124, P=.02; Meditech: β=.0273, SE 0.0123, P=.03) but with low explanatory power (R2=4.2%).Conclusions: The results of this study provide evidence of a difference in clinical outcome performance among the top 3 EHR vendors and may serve as supportive evidence for health care leaders to target future capital investments to improve health care delivery. [ABSTRACT FROM AUTHOR]

Background: Older adults want to preserve their health and autonomy and stay in their own home environment for as long as possible. This is also of interest to policy makers who try to cope with growing staff shortages and increasing health care expenses. Ambient assisted living (AAL) technologies can support the desire for independence and aging in place. However, the implementation of these technologies is much slower than expected. This has been attributed to the lack of focus on user acceptance and user needs.Objective: The aim of this study is to develop a theoretically grounded understanding of the acceptance of AAL technologies among older adults and to compare the relative importance of different acceptance factors.Methods: A conceptual model of AAL acceptance was developed using the theory of planned behavior as a theoretical starting point. A web-based survey of 1296 older adults was conducted in the Netherlands to validate the theoretical model. Structural equation modeling was used to analyze the hypothesized relationships.Results: Our conceptual model showed a good fit with the observed data (root mean square error of approximation 0.04; standardized root mean square residual 0.06; comparative fit index 0.93; Tucker-Lewis index 0.92) and explained 69% of the variance in intention to use. All but 2 of the hypothesized paths were significant at the P<.001 level. Overall, older adults were relatively open to the idea of using AAL technologies in the future (mean 3.34, SD 0.73).Conclusions: This study contributes to a more user-centered and theoretically grounded discourse in AAL research. Understanding the underlying behavioral, normative, and control beliefs that contribute to the decision to use or reject AAL technologies helps developers to make informed design decisions based on users' needs and concerns. These insights on acceptance factors can be valuable for the broader field of eHealth development and implementation. [ABSTRACT FROM AUTHOR]

Background: There is a need to develop interventions to reduce the risk of dementia in the community by addressing lifestyle factors and chronic diseases over the adult life course.Objective: This study aims to evaluate a multidomain dementia risk reduction intervention, Body Brain Life in General Practice (BBL-GP), targeting at-risk adults in primary care.Methods: A pragmatic, parallel, three-arm randomized trial involving 125 adults aged 18 years or older (86/125, 68.8% female) with a BMI of ≥25 kg/m2 or a chronic health condition recruited from general practices was conducted. The arms included (1) BBL-GP, a web-based intervention augmented with an in-person diet and physical activity consultation; (2) a single clinician-led group, Lifestyle Modification Program (LMP); and (3) a web-based control. The primary outcome was the Australian National University Alzheimer Disease Risk Index Short Form (ANU-ADRI-SF).Results: Baseline assessments were conducted on 128 participants. A total of 125 participants were randomized to 3 groups (BBL-GP=42, LMP=41, and control=42). At immediate, week 18, week 36, and week 62 follow-ups, the completion rates were 43% (18/42), 57% (24/42), 48% (20/42), and 48% (20/42), respectively, for the BBL-GP group; 71% (29/41), 68% (28/41), 68% (28/41), and 51% (21/41), respectively, for the LMP group; and 62% (26/42), 69% (29/42), 60% (25/42), and 60% (25/42), respectively, for the control group. The primary outcome of the ANU-ADRI-SF score was lower for the BBL-GP group than the control group at all follow-ups. These comparisons were all significant at the 5% level for estimates adjusted for baseline differences (immediate: difference in means -3.86, 95% CI -6.81 to -0.90, P=.01; week 18: difference in means -4.05, 95% CI -6.81 to -1.28, P<.001; week 36: difference in means -4.99, 95% CI -8.04 to -1.94, P<.001; and week 62: difference in means -4.62, 95% CI -7.62 to -1.62, P<.001).Conclusions: A web-based multidomain dementia risk reduction program augmented with allied health consultations administered within the general practice context can reduce dementia risk exposure for at least 15 months. This study was limited by a small sample size, and replication on a larger sample with longer follow-up will strengthen the results.Trial Registration: Australian clinical trials registration number (ACTRN): 12616000868482; https://anzctr.org.au/ACTRN12616000868482.aspx. [ABSTRACT FROM AUTHOR]

Background: Most people wish to die at home, but most people in Switzerland die in hospitals or nursing homes. Family caregivers often offer support so patients with palliative care needs can stay at home for as long as possible. However, crises and unplanned hospital admissions often occur in this setting because of family caregiver strain and symptom severity in patients. The so-called smart devices such as wearables or smartphones offer the opportunity to continuously monitor certain parameters and recording symptom deteriorations. By providing professionals with this information in a timely manner, crises in the home could be avoided. Objective: The aim of this interdisciplinary study is to explore the symptom burden of people with palliative care needs who are cared for at home and to understand the development of crises in the home care setting. On the basis of the findings from this study, we will develop an early warning system to stabilize the home care situation and to prevent critical events from happening, thereby reducing avoidable hospitalizations. Methods: A mixed method study is being conducted consisting of 4 main consecutive phases: (1) developing the monitoring system; (2) pretesting the system and adapting it to user needs; (3) conducting the study in the palliative home care setting with approximately 40 patients; and (4) distinguishing symptom patterns from the collected data specific to crisis emergence, followed by the development of an early warning system to prevent such crises. In study phase 3, each patient will receive an upper arm sensor and a symptom diary to assess symptom burden related to patients and family caregivers. A within-case analysis will be conducted for each patient's situation followed by a cross-case comparison to identify certain symptom patterns that may predict symptom deterioration (study phase 4). Results: The collaboration with the local mobile palliative care team for participant recruitment and data collection has been established. Recruitment is forthcoming. Conclusions: We expect the findings of this study to provide holistic insight into symptom burden and the well-being of patients with palliative care needs and of their family caregivers. This information will be used to develop an early warning system to avoid the occurrence of potential crises, thereby improving palliative care provision at home. International Registered Report Identifier (IRRID):  PRR1-10.2196/13933 We help JMIR researchers to raise funds to pursue their research and development aimed at tackling important health and technology challenges. If you would like to show your support for this author, please donate using the button below. The funds raised will directly benefit the corresponding author of this article (minus 8% admin fees). Your donations will help this author to continue publishing open access papers in JMIR journals. Donations of over $100 may also be acknowledged in future publications. Suggested contribution levels: $20/$50/$100 [ABSTRACT FROM AUTHOR]

Background: As a result of improvements in cancer screening, treatment, and supportive care, nearly two-thirds of individuals diagnosed with colorectal cancer (CRC) live for 5 years after diagnosis. An ever-increasing population of CRC survivors creates a need for effective survivorship care to help manage and mitigate the impact of CRC and its treatment. Personal health records (PHRs) and survivorship care plans provide a means of supporting the long-term care of cancer survivors. Objective: The purpose of this study is to characterize the usefulness of a CRC PHR and survivorship care plan and to describe the usability of these technologies in a population of CRC survivors. To our knowledge, this is the first study to assess a PHR and survivorship care plan specifically targeting CRC survivors. Methods: Twenty-two patients with CRC were recruited from surgery clinics of an academic medical center and Veterans Affairs hospital in Indianapolis and provided access to an online Colorectal Cancer Survivor's Personal Health Record (CRCS-PHR). Survey data were collected to characterize the usefulness of the CRCS-PHR and describe its usability in a population of CRC survivors. CRC survivors were surveyed 6 months after being provided online access. Means and proportions were used to describe the usefulness and ease of using the CRC website. Open-ended questions were qualitatively coded using the constant comparative method. Results: CRC survivors perceived features related to their health care (ie, summary of cancer treatment history, follow-up care schedule, description of side effects, and list of community resources) to be more useful than communication features (ie, creating online relationships with family members or caregivers, communicating with doctor, and secure messages). CRC survivors typically described utilizing traditional channels (eg, via telephone or in person) to communicate with their health care provider. Participants had overall positive perceptions with respect to ease of use and overall satisfaction. Major challenges experienced by participants included barriers to system log-in, lack of computer literacy or experience, and difficulty entering their patient information. Conclusions: For CRC, survivors may find the greater value in a PHR's medical content than the communication functions, which they have available elsewhere. These findings regarding the usefulness and usability of a PHR for the management of CRC survivorship provide valuable insights into how best to tailor these technologies to patients' needs. These findings can inform future design and development of PHRs for purposes of both cancer and chronic disease management. [ABSTRACT FROM AUTHOR]

Background: Dementia is a major cause of disability and dependency in older adults worldwide. It is often accompanied by general psychological distress, such as depression and anxiety symptoms, among caregivers of people with dementia (PwD). The physical and mental health of the caregiver is a prerequisite and a promise to help PwD continue to live as long and as well as possible. Web-based interventions can provide convenient and efficient support and an education tool to potentially reduce the negative outcomes associated with providing care.Objective: The aim of this study was to examine the effect of internet-based interventions on the mental health outcomes of family caregivers of PwD and to explore which components of the Web-based interventions play an important role.Methods: A comprehensive literature search was conducted in PubMed, Excerpta Medica dataBASE, PsycINFO, Cochrane Database, and the Cumulative Index to Nursing and Allied Health Literature using relevant terms such as Web-based and caregiver as keywords, covering all studies published before June 2018. A total of 2 reviewers independently reviewed all published abstracts, according to established inclusion and exclusion criteria. We extracted information about the participants, interventions, and results and reviewed article quality in terms of the randomized trial methods, using the approach recommended by the Cochrane Handbook for Systematic Reviews of Interventions.Results: A total of 815 caregivers participated in 6 studies, with 4 of the studies using depression as an outcome. The analysis found that depression scores dropped an average of 0.23 (95% CI -0.38 to -0.07; P<.01) after Web-based interventions. In 2 studies of caregivers who were experiencing anxiety symptoms, the average score for anxiety dropped by 0.32 points (95% CI -0.50 to -0.14; P<.01). However, in terms of coping, pain, and stress, the Web-based interventions showed a poor effect. On the whole, the addition of professional psychological support on the basis of education can improve caregivers' mental health.Conclusions: Internet-based interventions were generally effective at reducing anxiety and depression in dementia caregivers, although negative results were found in some studies. As for burden and stress, further research is required. [ABSTRACT FROM AUTHOR]

Familial interdependence is a concept that may not be familiar to many therapists. This study explored ways in which familial interdependence affects dynamics of caregiving in Latino families. Study results yield practical recommendations to improve quality of care when treating Latino older adults. [ABSTRACT FROM AUTHOR]