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George Demiris

University of Pennsylvania, School of Nursing, Faculty Member

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George Demiris is a PIK (Penn Integrates Knowledge) University Professor at the University of Pennsylvania with joint appointments in Biobehavioral Health Sciences in the School of Nursing and in Biostatistics, Epidemiology and Informatics in the Perelman School of Medicine. His research interests focus on the design, implementation and evaluation of informatics systems to engage and empower older adults and their families, and tools to facilitate a redesign of home health and hospice care. He is one of the founders of the Hospice Caregiving Research Network. Prior to joining the University of Pennsylvania, he was a faculty member at the University of Washington where he directed the Clinical Informatics andPatient Centered Technologies Program and the Aging and Informatics Training Program. He is a Fellow of the American College of Medical Informatics and the Gerontological Society of America.

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Mikhail Cherkashin

Sorana D. Bolboacă

University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca

Massimo Martinelli

Consiglio Nazionale delle Ricerche (CNR)

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Papers by George Demiris

Can Artificial Intelligence Aid Diagnosis by Teleguided Point-of-Care Ultrasound? A Pilot Study for Evaluating a Novel Computer Algorithm for COVID-19 Diagnosis Using Lung Ultrasound

AI

With the 2019 coronavirus disease (COVID-19) pandemic, there is an increasing demand for remote m... more With the 2019 coronavirus disease (COVID-19) pandemic, there is an increasing demand for remote monitoring technologies to reduce patient and provider exposure. One field that has an increasing potential is teleguided ultrasound, where telemedicine and point-of-care ultrasound (POCUS) merge to create this new scope. Teleguided POCUS can minimize staff exposure while preserving patient safety and oversight during bedside procedures. In this paper, we propose the use of teleguided POCUS supported by AI technologies for the remote monitoring of COVID-19 patients by non-experienced personnel including self-monitoring by the patients themselves. Our hypothesis is that AI technologies can facilitate the remote monitoring of COVID-19 patients through the utilization of POCUS devices, even when operated by individuals without formal medical training. In pursuit of this goal, we performed a pilot analysis to evaluate the performance of users with different clinical backgrounds using a comput...

How do I compare to the other people?": Older Adults' Perspectives on Personal Smart Home Data for Self-Management

Proceedings of the ACM on Human-Computer Interaction

Research on smart home monitoring for older adults has predominantly focused on systems whose dat... more Research on smart home monitoring for older adults has predominantly focused on systems whose data and alerts are directed towards family members, caregivers, or healthcare providers. Older adults have expressed interest in engaging with these systems by seeing and using their data, but they are often limited to a passive role as subjects of monitoring. This paper presents qualitative results of a longitudinal smart home project with older adults living independently in the community. Based on interviews conducted throughout the 2.5-year study with 12 participants, we report on their lived experiences of having the monitoring system in their homes and on how they reflected on the data collected by the system. The results show how participants were able to extract meaningful information from the monitoring data without finding the system invasive or intrusive. Specifically, older adults exhibited interest in data that they found indicative of living an active lifestyle, such as time ...

Preliminary Efficacy of Let’s Talk Tech: Technology Use Planning for Dementia Care Dyads

Innovation in Aging

Background and Objective Care partners of people living with dementia require support to knowledg... more Background and Objective Care partners of people living with dementia require support to knowledgeably navigate decision making about how and when to use monitoring technologies for care purposes. We conducted a pilot study of a novel self-administered intervention, “Let’s Talk Tech,” for people living with mild dementia and their care partners. This paper presents preliminary efficacy findings of this intervention designed to educate and facilitate dyadic communication about a range of technologies used in dementia care and to document the preferences of the person living with dementia. It is the first-of-its-kind decision-making and planning tool with a specific focus on technology use. Research Design and Methods We used a 1-group pretest–post-test design and paired t tests to assess change over 2 time periods in measures of technology comprehension, care partner knowledge of the participant living with mild Alzheimer’s disease’s (AD) preferences, care partner preparedness to mak...

50 Years of Achievements and Persistent Challenges for Biomedical and Health Informatics and John Mantas’ Educational and Nursing Informatics Contributions

Studies in Health Technology and Informatics

Biomedical and Health Informatics (BMHI) have been essential catalysts for achievements in medica... more Biomedical and Health Informatics (BMHI) have been essential catalysts for achievements in medical research and healthcare applications over the past 50 years. These include increasingly sophisticated information systems and data bases for documentation and processing, standardization of biomedical data, nomenclatures, and vocabularies to assist with large scale literature indexing and text analysis for information retrieval, and methods for computationally modeling and analyzing research and clinical data. Statistical and AI techniques for decision support, instrumentation integration, and workflow aids with improved data/information management tools are critical for scientific discoveries in the - omics revolutions with their related drug and vaccine breakthroughs and their translation to clinical and preventive healthcare. Early work on biomedical image and pattern recognition, knowledge-based expert systems, innovative database, software and simulation techniques, natural langua...

An Online Community Intervention for Older Persons with Pre-Frailty and Frailty: Pilot Studies

Innovation in Aging, 2021

Online community interventions can support self-management in older populations but have rarely t... more Online community interventions can support self-management in older populations but have rarely targeted symptomology of pre-frailty and frailty. To support older adults’ pre-frailty/frailty symptom management, we iteratively refined an approach entitled Virtual Online Community for Aging Life Experience (VOCALE) in three consecutive pilot studies (2018-2020). These studies employed asynchronous online discussions in which participants were asked to respond to weekly prompts. A study facilitator moderated the discussion, encouraging participants to respond to both the prompts and comments of other participants. In the first pilot (n=8), participants engaged in a collective exploration of different symptoms of pre-frailty and frailty. The second (n=10) and third (n=10) pilots employed a hybrid approach including collaborative exploration and learning of different problem-solving therapy skills over eight weeks. The mean age of participants of the three pilots combined was 80.6 (SD = ...

Social Isolation and Loneliness: The Pros and Cons of Technological Interventions

Innovation in Aging, 2020

A variety of technologies have been proposed, tested, and used to reduce social isolation and lon... more A variety of technologies have been proposed, tested, and used to reduce social isolation and loneliness [SIL]. Furthermore, information technology may offer a way to detect or predict patterns of SIL. In this paper, the range of technology tools for assessment (e.g., passive monitoring, tracking data patterns, electronic health records) and intervention (e.g., social robots, social media, virtual reality) are reviewed for evidence of impact, and consideration is given for related ethical issues. The role of technology in relation to the report’s recommendations is discussed, including assessment and testing of new technological interventions for their potential benefits and harms, consideration of contextual issues such as broadband access, and the role of technology in education and training. Finally, gap areas of research are explored, such as the impact of the use of technology among current younger adults as they age. Part of a symposium sponsored by Loneliness and Social Isola...

Technology-Based Applications for the Assessment and Management of Alzheimer’s Disease and Related Disorders

Innovation in Aging, 2020

Over the last decade, technological advances have made it possible for people to access health in... more Over the last decade, technological advances have made it possible for people to access health information right at their fingertips. Indeed, technology-based applications (apps) have been developed to tackle a wide range of health-related issues, including Alzheimer’s disease and related disorders (ADRD). As such, there is a critical need to develop and test effective dementia apps that can ultimately be converted in to scalable programs. In this interdisciplinary symposium, we will discuss the development and testing of novel apps for the assessment and management of ADRD. The first session will discuss the development of an online money management credit card task to assess cognitively vulnerable older adults who are at risk for making poor financial decisions. The second session will describe the development and psychometric testing properties of a mobile app to detect the earliest features of preclinical Alzheimer’s disease. The third session will highlight findings from a stud...

278 Understanding Perspectives on Artificial Intelligence Technologies for Sleep Self-Management

Sleep, 2021

Until recently, understanding one’s sleep activity relied on technology only available in sleep l... more Until recently, understanding one’s sleep activity relied on technology only available in sleep labs with data analyzed by experts. Transitioning this technology from the lab to natural environments results in noisy data. Fortunately, advances in signal processing through Artificial Intelligence (AI) have made these technologies accessible to consumers. This study seeks to provide recommendations that address user preferences and concerns related to sleep self-management devices and software that leverage AI, as they have the potential to increase both the quantity and quality of sleep data available to researchers. We assigned adult participants (N=25) with Pittsburgh Sleep Quality Index scores ≥ 5 (indicating low sleep quality) to one of four focus group sessions based on their self-reported prior use of sleep technologies. After a short demonstration, the moderator solicited participant feedback on devices and software in each of the following four categories: • headbands (Beddr,...

Personal Health Informatics

Encyclopedia of Behavioral Medicine, 2020

Objectives: To provide an editorial introduction to the 2012 IMIA Yearbook of Medical Informatics... more Objectives: To provide an editorial introduction to the 2012 IMIA Yearbook of Medical Informatics with an overview of its contents and contributors. Methods: A brief overview of the main theme, and an outline of the purposes, contents, format, and acknowledgment of contributions for the 2012 IMIA Yearbook. Results: This 2012 issue of the IMIA Yearbook highlights important developments in personal health informatics, impacting the activities in research, education and practice in this interdisciplinary field. There has been steady progress towards introducing individualization or personalization into informatics systems by taking advantage of the increasing amounts of personal information that is relevant to medical decisions and application in clinical practice. At the same time, there are serious issues about the limits of existing systems being able to effectively personalize information within both practical and ethical constraints so critical to the practice of medicine. Recent literature bearing on these questions includes the selected papers published during the past 12 months, and articles reported by IMIA Working Groups on these topics. Conclusion: Surveys of the main research sub-fields in biomedical informatics in the Yearbook provide an overview of progress and current challenges across the spectrum of the discipline, focusing on the challenges and opportunities involved in personal health informatics.

Promoting Problem Solving About Health Management: A Mixed-Methods Pilot Evaluation of a Digital Health Intervention for Older Adults With Pre-Frailty and Frailty

Gerontology and Geriatric Medicine, 2021

Background: There is a need for interventions to promote health management of older adults with p... more Background: There is a need for interventions to promote health management of older adults with pre-frailty and frailty. Technology poses promising solutions, but questions exist about effective delivery. Objectives: We present the results of a mixed-methods pilot evaluation of Virtual Online Communities for Older Adults (VOCALE), an 8-week intervention conducted in the northwestern United States, in which participants shared health-related experiences and applied problem solving skills in a Facebook group. Methods: We performed a mixed-methods process evaluation, integrating quantitative and qualitative data, to characterize the intervention and its effects. We focus on four areas: health-related measures (health literacy and self-efficacy), participation, problem solving skills enacted, and subjective feedback. Results: Eight older adults with pre-frailty and frailty (age = 82.7 ± 6.6 years) completed the study. There was an upward trend in health literacy and health self-efficacy...

Caregiver-Centered Communication: A New Tool for Assessment of the Quality of Communication With Family Caregivers

Innovation in Aging, 2020

Improved communication with caregivers can lead to reduced caregiver anxiety and burden, improved... more Improved communication with caregivers can lead to reduced caregiver anxiety and burden, improved quality of life, and better coping during a stressful time. Even though caregiver communication with the health care team is essential in gerontology, we are lacking standardized instruments to assess quality of communication. We describe the initial development and testing of the Caregiver Centered Communication Questionnaire (CCCQ). The questionnaire has 30 items with 5 subscales: exchange of information, fostering health relationships with team/provider, recognizing and responding to emotions, managing care and decision making. We conducted a cross-sectional survey of 115 family caregivers of older adults in home care and hospice. Cronbach’s α for the scale was 0.97. Internal consistencies of subscales were high, ranging from 0.82 to 0.93. Preliminary testing indicates the potential of CCCQ in assessing engagement and quality of communication; further testing is required.

Ideas for how informaticians can get involved with COVID-19 research

BioData Mining, 2020

The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on population healt... more The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on population health and wellbeing. Biomedical informatics is central to COVID-19 research efforts and for the delivery of healthcare for COVID-19 patients. Critical to this effort is the participation of informaticians who typically work on other basic science or clinical problems. The goal of this editorial is to highlight some examples of COVID-19 research areas that could benefit from informatics expertise. Each research idea summarizes the COVID-19 application area, followed by an informatics methodology, approach, or technology that could make a contribution. It is our hope that this piece will motivate and make it easy for some informaticians to adopt COVID-19 research projects.

Development and Usability Assessment of a Food Record App for Dietary Assessments among Older Adults with Type 2 Diabetes (Preprint)

BACKGROUND More than one in four people in the United States aged 65 years and older have diabete... more BACKGROUND More than one in four people in the United States aged 65 years and older have diabetes. For diabetes care, medical nutrition therapy (MNT) is recommended as a clinically effective intervention. Prior researchers have developed and validated dietary assessment methods using images of food items for improving the accuracy of self-reporting over traditional methods. Nevertheless, little is known about the usability of image-assisted dietary assessment methods for older adults with diabetes. OBJECTIVE The aims of this study were: a) to create a food record app for dietary assessments (FRADA) that would support image-assisted dietary assessments, and b) to evaluate the usability of FRADA for older adults with diabetes. METHODS For the development of FRADA, we identified design principles that address the needs of older adults and implemented three fundamental tasks required for image-assisted dietary assessments: capturing, viewing, and transmitting images of food based on th...

Loneliness as a mediator of the impact of social isolation on cognitive functioning of Chinese older adults

Age and Ageing, 2020

Background and Objective older adults have increased risk of social isolation, loneliness and cog... more Background and Objective older adults have increased risk of social isolation, loneliness and cognitive functioning impairment, but the relationships among these factors are not conclusive. We investigated the potential mediation mechanism of loneliness on the association between social isolation and cognitive functioning among Chinese older adults within their cultural context. Design secondary analysis of the baseline wave (2011–12) of the harmonised China Health and Retirement Longitudinal Study. Setting and Subjects community-dwelling older adults in China (N = 7,410 participants aged 60–101 years). Methods we applied a multiple indicator multiple cause approach to determine whether the construct of social isolation is well defined by four indicators (social activity engagement, weekly adult children contact, caregiving for grandchildren and living alone) and used structural equation modelling to examine the direct and indirect effects among variables of interest. Results the re...

How Are Social Isolation and Loneliness Related to Cognitive Functioning Among Chinese Older Adults?

Innovation in Aging, 2019

Older adults have increased risk of social isolation, loneliness, and cognitive functioning decli... more Older adults have increased risk of social isolation, loneliness, and cognitive functioning decline, but the relationships among these factors are not conclusive. We used the 2011 and 2012 waves of the harmonized China Health and Retirement Longitudinal Study to: 1) measure the association between social isolation and cognitive functioning among Chinese older adults within their cultural context, and 2) investigate the potential mediation mechanism of loneliness on this association. Specifically, we applied a multiple indicator multiple cause approach to determine whether the construct of social isolation is well defined by four indicators (social activity engagement, weekly adult children contact, caregiving for grandchildren, and living alone). We used structural equation modeling to examine the direct and indirect effects among variables of interest. The results demonstrated that three indicators of social isolation were significantly associated with cognitive functioning (β =-0....

Usability of an Online Discussion Platform: Development of a Coding Scheme

Innovation in Aging, 2019

Online discussion platforms have the potential to support or even improve older adults’ well-bein... more Online discussion platforms have the potential to support or even improve older adults’ well-being. Nonetheless, potential health benefits are often shaped by the usability of such platforms. Improving usability is imperative to maximize these potential benefits. As a part of a qualitative analysis of a study of an online community for older adults with frailty symptoms, we developed and refined a coding scheme targeting usability. The scheme was derived by reviewing contemporary literature on user experience, usability, and health information technology in older adults. Our review revealed challenges to apply commonly used terms to summarize our qualitative data. For example, the concept of perceived usability has different meanings and definitions in existing frameworks as they pertain to user engagement and technology adoption (specifically, the Technology Acceptance Model) than usability in an online discussion context for older adults. Because none of the meanings of usability ...

Design and Preliminary Testing of the Caregiver-Centered Communication Questionnaire (CCCQ)

Journal of Palliative Care, 2019

The study objective was to develop and test a new survey instrument that measures caregiver-cente... more The study objective was to develop and test a new survey instrument that measures caregiver-centered communication. We developed a questionnaire inspired by the National Cancer Institute framework on patient-centered communication, focusing on family caregiver communication for this tool. The questionnaire includes 5 subscales: exchange of information, relationship with team, emotions, managing care, and decision-making. The initial questionnaire was reviewed by domain experts for face validity and edited further to include 30 items. We administered the modified questionnaire to 115 family caregivers of patients with serious illness in various settings. Cronbach α for the entire scale was 0.97 and ranged from 0.82 to 0.93 for the 5 subscales. Participants found that the survey addressed important concepts and that items were in most cases easy to understand. This instrument provides a structured way to assess caregiver-centered communication, addressing a pressing need for tools tha...

High-value care for older adults with complex care needs: Leveraging nurses as innovators

Nursing Outlook, 2019

Background: Our health care system is facing unprecedented and complex challenges in caring for o... more Background: Our health care system is facing unprecedented and complex challenges in caring for older adults and their families. A paradigm shift is needed that recognizes new roles and competencies for nurses to play a leadership role in the design and implementation of high value care models. Purpose: The purpose of this paper is to introduce a series of recommendations for leveraging nurses to generate innovative tools and solutions for the delivery of value-based care for older adults living with complex health and social needs and their families. Methods: These recommendations were generated by a Think-Tank of national experts based on review of current evidence and focus groups with older adults. Discussion: The generated recommendations focus on positioning nurses to assume leadership roles in implementing evidence-based care models, preparing nurses to serve as health innovators and catalysts of system transformation, and fostering system-level infrastructure that leverages the contributions of nurses for current and emerging roles. Conclusion: Nurses as innovators can address the challenges in providing high quality care for older adults with complex needs and their families. System-level infrastructure, including resources for training and implementation of well-established programs, is necessary to leverage the contributions of nurses and facilitate innovative approaches to care.

Delivering problem‐solving therapy to family caregivers of people with cancer: A feasibility study in outpatient palliative care

Psycho-Oncology, 2018

ObjectiveIn response to the well‐documented need for evidence‐based cancer caregiver support, we ... more ObjectiveIn response to the well‐documented need for evidence‐based cancer caregiver support, we examined the feasibility of problem‐solving therapy for family caregivers of cancer patients receiving outpatient palliative care and investigated the impact of problem‐solving therapy on family caregivers' anxiety, depression, and quality of life.MethodsWe conducted a feasibility study of a structured problem‐solving therapy intervention delivered to family caregivers of cancer patients receiving outpatient palliative care from an academic health center in the Midwestern United States. Participants (N = 83) were randomly assigned to receive usual care or usual care plus a problem‐solving therapy intervention, which was delivered over three sessions via web‐based videoconferencing or telephone. Descriptive statistics were used to determine feasibility relative to recruitment, retention, and fidelity to core intervention components. Outcome data were analyzed using ordinary least squa...

Understanding optimisation processes of electronic health records (EHRs) in select leading hospitals: a qualitative study

BMJ Health & Care Informatics, 2018

BackgroundLittle is known about optimisation of electronic health records (EHRs) systems in the h... more BackgroundLittle is known about optimisation of electronic health records (EHRs) systems in the hospital setting while adoption of EHR systems continues in the United States.ObjectiveTo understand optimisation processes of EHR systems undertaken in leading healthcare organisations in the United States.MethodsInformed by a grounded theory approach, a qualitative study was undertaken that involved 11 in-depth interviews and a focus group with the EHR experts from the high performing healthcare organisations across the United States.ResultsThe study describes EHR optimisation processes characterised by prioritising exponentially increasing requests with predominant focus on improving efficiency of EHR, building optimisation teams or advisory groups and standardisation. The study discusses 16 types of optimisation that interdependently produced 16 results along with identifying 11 barriers and 20 facilitators to optimisation.ConclusionsThe study describes overall experiences of optimisi...

Can Artificial Intelligence Aid Diagnosis by Teleguided Point-of-Care Ultrasound? A Pilot Study for Evaluating a Novel Computer Algorithm for COVID-19 Diagnosis Using Lung Ultrasound

AI

With the 2019 coronavirus disease (COVID-19) pandemic, there is an increasing demand for remote m... more With the 2019 coronavirus disease (COVID-19) pandemic, there is an increasing demand for remote monitoring technologies to reduce patient and provider exposure. One field that has an increasing potential is teleguided ultrasound, where telemedicine and point-of-care ultrasound (POCUS) merge to create this new scope. Teleguided POCUS can minimize staff exposure while preserving patient safety and oversight during bedside procedures. In this paper, we propose the use of teleguided POCUS supported by AI technologies for the remote monitoring of COVID-19 patients by non-experienced personnel including self-monitoring by the patients themselves. Our hypothesis is that AI technologies can facilitate the remote monitoring of COVID-19 patients through the utilization of POCUS devices, even when operated by individuals without formal medical training. In pursuit of this goal, we performed a pilot analysis to evaluate the performance of users with different clinical backgrounds using a comput...

How do I compare to the other people?": Older Adults' Perspectives on Personal Smart Home Data for Self-Management

Proceedings of the ACM on Human-Computer Interaction

Research on smart home monitoring for older adults has predominantly focused on systems whose dat... more Research on smart home monitoring for older adults has predominantly focused on systems whose data and alerts are directed towards family members, caregivers, or healthcare providers. Older adults have expressed interest in engaging with these systems by seeing and using their data, but they are often limited to a passive role as subjects of monitoring. This paper presents qualitative results of a longitudinal smart home project with older adults living independently in the community. Based on interviews conducted throughout the 2.5-year study with 12 participants, we report on their lived experiences of having the monitoring system in their homes and on how they reflected on the data collected by the system. The results show how participants were able to extract meaningful information from the monitoring data without finding the system invasive or intrusive. Specifically, older adults exhibited interest in data that they found indicative of living an active lifestyle, such as time ...

Preliminary Efficacy of Let’s Talk Tech: Technology Use Planning for Dementia Care Dyads

Innovation in Aging

Background and Objective Care partners of people living with dementia require support to knowledg... more Background and Objective Care partners of people living with dementia require support to knowledgeably navigate decision making about how and when to use monitoring technologies for care purposes. We conducted a pilot study of a novel self-administered intervention, “Let’s Talk Tech,” for people living with mild dementia and their care partners. This paper presents preliminary efficacy findings of this intervention designed to educate and facilitate dyadic communication about a range of technologies used in dementia care and to document the preferences of the person living with dementia. It is the first-of-its-kind decision-making and planning tool with a specific focus on technology use. Research Design and Methods We used a 1-group pretest–post-test design and paired t tests to assess change over 2 time periods in measures of technology comprehension, care partner knowledge of the participant living with mild Alzheimer’s disease’s (AD) preferences, care partner preparedness to mak...

50 Years of Achievements and Persistent Challenges for Biomedical and Health Informatics and John Mantas’ Educational and Nursing Informatics Contributions

Studies in Health Technology and Informatics

Biomedical and Health Informatics (BMHI) have been essential catalysts for achievements in medica... more Biomedical and Health Informatics (BMHI) have been essential catalysts for achievements in medical research and healthcare applications over the past 50 years. These include increasingly sophisticated information systems and data bases for documentation and processing, standardization of biomedical data, nomenclatures, and vocabularies to assist with large scale literature indexing and text analysis for information retrieval, and methods for computationally modeling and analyzing research and clinical data. Statistical and AI techniques for decision support, instrumentation integration, and workflow aids with improved data/information management tools are critical for scientific discoveries in the - omics revolutions with their related drug and vaccine breakthroughs and their translation to clinical and preventive healthcare. Early work on biomedical image and pattern recognition, knowledge-based expert systems, innovative database, software and simulation techniques, natural langua...

An Online Community Intervention for Older Persons with Pre-Frailty and Frailty: Pilot Studies

Innovation in Aging, 2021

Online community interventions can support self-management in older populations but have rarely t... more Online community interventions can support self-management in older populations but have rarely targeted symptomology of pre-frailty and frailty. To support older adults’ pre-frailty/frailty symptom management, we iteratively refined an approach entitled Virtual Online Community for Aging Life Experience (VOCALE) in three consecutive pilot studies (2018-2020). These studies employed asynchronous online discussions in which participants were asked to respond to weekly prompts. A study facilitator moderated the discussion, encouraging participants to respond to both the prompts and comments of other participants. In the first pilot (n=8), participants engaged in a collective exploration of different symptoms of pre-frailty and frailty. The second (n=10) and third (n=10) pilots employed a hybrid approach including collaborative exploration and learning of different problem-solving therapy skills over eight weeks. The mean age of participants of the three pilots combined was 80.6 (SD = ...

Social Isolation and Loneliness: The Pros and Cons of Technological Interventions

Innovation in Aging, 2020

A variety of technologies have been proposed, tested, and used to reduce social isolation and lon... more A variety of technologies have been proposed, tested, and used to reduce social isolation and loneliness [SIL]. Furthermore, information technology may offer a way to detect or predict patterns of SIL. In this paper, the range of technology tools for assessment (e.g., passive monitoring, tracking data patterns, electronic health records) and intervention (e.g., social robots, social media, virtual reality) are reviewed for evidence of impact, and consideration is given for related ethical issues. The role of technology in relation to the report’s recommendations is discussed, including assessment and testing of new technological interventions for their potential benefits and harms, consideration of contextual issues such as broadband access, and the role of technology in education and training. Finally, gap areas of research are explored, such as the impact of the use of technology among current younger adults as they age. Part of a symposium sponsored by Loneliness and Social Isola...

Technology-Based Applications for the Assessment and Management of Alzheimer’s Disease and Related Disorders

Innovation in Aging, 2020

Over the last decade, technological advances have made it possible for people to access health in... more Over the last decade, technological advances have made it possible for people to access health information right at their fingertips. Indeed, technology-based applications (apps) have been developed to tackle a wide range of health-related issues, including Alzheimer’s disease and related disorders (ADRD). As such, there is a critical need to develop and test effective dementia apps that can ultimately be converted in to scalable programs. In this interdisciplinary symposium, we will discuss the development and testing of novel apps for the assessment and management of ADRD. The first session will discuss the development of an online money management credit card task to assess cognitively vulnerable older adults who are at risk for making poor financial decisions. The second session will describe the development and psychometric testing properties of a mobile app to detect the earliest features of preclinical Alzheimer’s disease. The third session will highlight findings from a stud...

278 Understanding Perspectives on Artificial Intelligence Technologies for Sleep Self-Management

Sleep, 2021

Until recently, understanding one’s sleep activity relied on technology only available in sleep l... more Until recently, understanding one’s sleep activity relied on technology only available in sleep labs with data analyzed by experts. Transitioning this technology from the lab to natural environments results in noisy data. Fortunately, advances in signal processing through Artificial Intelligence (AI) have made these technologies accessible to consumers. This study seeks to provide recommendations that address user preferences and concerns related to sleep self-management devices and software that leverage AI, as they have the potential to increase both the quantity and quality of sleep data available to researchers. We assigned adult participants (N=25) with Pittsburgh Sleep Quality Index scores ≥ 5 (indicating low sleep quality) to one of four focus group sessions based on their self-reported prior use of sleep technologies. After a short demonstration, the moderator solicited participant feedback on devices and software in each of the following four categories: • headbands (Beddr,...

Personal Health Informatics

Encyclopedia of Behavioral Medicine, 2020

Objectives: To provide an editorial introduction to the 2012 IMIA Yearbook of Medical Informatics... more Objectives: To provide an editorial introduction to the 2012 IMIA Yearbook of Medical Informatics with an overview of its contents and contributors. Methods: A brief overview of the main theme, and an outline of the purposes, contents, format, and acknowledgment of contributions for the 2012 IMIA Yearbook. Results: This 2012 issue of the IMIA Yearbook highlights important developments in personal health informatics, impacting the activities in research, education and practice in this interdisciplinary field. There has been steady progress towards introducing individualization or personalization into informatics systems by taking advantage of the increasing amounts of personal information that is relevant to medical decisions and application in clinical practice. At the same time, there are serious issues about the limits of existing systems being able to effectively personalize information within both practical and ethical constraints so critical to the practice of medicine. Recent literature bearing on these questions includes the selected papers published during the past 12 months, and articles reported by IMIA Working Groups on these topics. Conclusion: Surveys of the main research sub-fields in biomedical informatics in the Yearbook provide an overview of progress and current challenges across the spectrum of the discipline, focusing on the challenges and opportunities involved in personal health informatics.

Promoting Problem Solving About Health Management: A Mixed-Methods Pilot Evaluation of a Digital Health Intervention for Older Adults With Pre-Frailty and Frailty

Gerontology and Geriatric Medicine, 2021

Background: There is a need for interventions to promote health management of older adults with p... more Background: There is a need for interventions to promote health management of older adults with pre-frailty and frailty. Technology poses promising solutions, but questions exist about effective delivery. Objectives: We present the results of a mixed-methods pilot evaluation of Virtual Online Communities for Older Adults (VOCALE), an 8-week intervention conducted in the northwestern United States, in which participants shared health-related experiences and applied problem solving skills in a Facebook group. Methods: We performed a mixed-methods process evaluation, integrating quantitative and qualitative data, to characterize the intervention and its effects. We focus on four areas: health-related measures (health literacy and self-efficacy), participation, problem solving skills enacted, and subjective feedback. Results: Eight older adults with pre-frailty and frailty (age = 82.7 ± 6.6 years) completed the study. There was an upward trend in health literacy and health self-efficacy...

Caregiver-Centered Communication: A New Tool for Assessment of the Quality of Communication With Family Caregivers

Innovation in Aging, 2020

Improved communication with caregivers can lead to reduced caregiver anxiety and burden, improved... more Improved communication with caregivers can lead to reduced caregiver anxiety and burden, improved quality of life, and better coping during a stressful time. Even though caregiver communication with the health care team is essential in gerontology, we are lacking standardized instruments to assess quality of communication. We describe the initial development and testing of the Caregiver Centered Communication Questionnaire (CCCQ). The questionnaire has 30 items with 5 subscales: exchange of information, fostering health relationships with team/provider, recognizing and responding to emotions, managing care and decision making. We conducted a cross-sectional survey of 115 family caregivers of older adults in home care and hospice. Cronbach’s α for the scale was 0.97. Internal consistencies of subscales were high, ranging from 0.82 to 0.93. Preliminary testing indicates the potential of CCCQ in assessing engagement and quality of communication; further testing is required.

Ideas for how informaticians can get involved with COVID-19 research

BioData Mining, 2020

The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on population healt... more The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on population health and wellbeing. Biomedical informatics is central to COVID-19 research efforts and for the delivery of healthcare for COVID-19 patients. Critical to this effort is the participation of informaticians who typically work on other basic science or clinical problems. The goal of this editorial is to highlight some examples of COVID-19 research areas that could benefit from informatics expertise. Each research idea summarizes the COVID-19 application area, followed by an informatics methodology, approach, or technology that could make a contribution. It is our hope that this piece will motivate and make it easy for some informaticians to adopt COVID-19 research projects.

Development and Usability Assessment of a Food Record App for Dietary Assessments among Older Adults with Type 2 Diabetes (Preprint)

BACKGROUND More than one in four people in the United States aged 65 years and older have diabete... more BACKGROUND More than one in four people in the United States aged 65 years and older have diabetes. For diabetes care, medical nutrition therapy (MNT) is recommended as a clinically effective intervention. Prior researchers have developed and validated dietary assessment methods using images of food items for improving the accuracy of self-reporting over traditional methods. Nevertheless, little is known about the usability of image-assisted dietary assessment methods for older adults with diabetes. OBJECTIVE The aims of this study were: a) to create a food record app for dietary assessments (FRADA) that would support image-assisted dietary assessments, and b) to evaluate the usability of FRADA for older adults with diabetes. METHODS For the development of FRADA, we identified design principles that address the needs of older adults and implemented three fundamental tasks required for image-assisted dietary assessments: capturing, viewing, and transmitting images of food based on th...

Loneliness as a mediator of the impact of social isolation on cognitive functioning of Chinese older adults

Age and Ageing, 2020

Background and Objective older adults have increased risk of social isolation, loneliness and cog... more Background and Objective older adults have increased risk of social isolation, loneliness and cognitive functioning impairment, but the relationships among these factors are not conclusive. We investigated the potential mediation mechanism of loneliness on the association between social isolation and cognitive functioning among Chinese older adults within their cultural context. Design secondary analysis of the baseline wave (2011–12) of the harmonised China Health and Retirement Longitudinal Study. Setting and Subjects community-dwelling older adults in China (N = 7,410 participants aged 60–101 years). Methods we applied a multiple indicator multiple cause approach to determine whether the construct of social isolation is well defined by four indicators (social activity engagement, weekly adult children contact, caregiving for grandchildren and living alone) and used structural equation modelling to examine the direct and indirect effects among variables of interest. Results the re...

How Are Social Isolation and Loneliness Related to Cognitive Functioning Among Chinese Older Adults?

Innovation in Aging, 2019

Older adults have increased risk of social isolation, loneliness, and cognitive functioning decli... more Older adults have increased risk of social isolation, loneliness, and cognitive functioning decline, but the relationships among these factors are not conclusive. We used the 2011 and 2012 waves of the harmonized China Health and Retirement Longitudinal Study to: 1) measure the association between social isolation and cognitive functioning among Chinese older adults within their cultural context, and 2) investigate the potential mediation mechanism of loneliness on this association. Specifically, we applied a multiple indicator multiple cause approach to determine whether the construct of social isolation is well defined by four indicators (social activity engagement, weekly adult children contact, caregiving for grandchildren, and living alone). We used structural equation modeling to examine the direct and indirect effects among variables of interest. The results demonstrated that three indicators of social isolation were significantly associated with cognitive functioning (β =-0....

Usability of an Online Discussion Platform: Development of a Coding Scheme

Innovation in Aging, 2019

Online discussion platforms have the potential to support or even improve older adults’ well-bein... more Online discussion platforms have the potential to support or even improve older adults’ well-being. Nonetheless, potential health benefits are often shaped by the usability of such platforms. Improving usability is imperative to maximize these potential benefits. As a part of a qualitative analysis of a study of an online community for older adults with frailty symptoms, we developed and refined a coding scheme targeting usability. The scheme was derived by reviewing contemporary literature on user experience, usability, and health information technology in older adults. Our review revealed challenges to apply commonly used terms to summarize our qualitative data. For example, the concept of perceived usability has different meanings and definitions in existing frameworks as they pertain to user engagement and technology adoption (specifically, the Technology Acceptance Model) than usability in an online discussion context for older adults. Because none of the meanings of usability ...

Design and Preliminary Testing of the Caregiver-Centered Communication Questionnaire (CCCQ)

Journal of Palliative Care, 2019

The study objective was to develop and test a new survey instrument that measures caregiver-cente... more The study objective was to develop and test a new survey instrument that measures caregiver-centered communication. We developed a questionnaire inspired by the National Cancer Institute framework on patient-centered communication, focusing on family caregiver communication for this tool. The questionnaire includes 5 subscales: exchange of information, relationship with team, emotions, managing care, and decision-making. The initial questionnaire was reviewed by domain experts for face validity and edited further to include 30 items. We administered the modified questionnaire to 115 family caregivers of patients with serious illness in various settings. Cronbach α for the entire scale was 0.97 and ranged from 0.82 to 0.93 for the 5 subscales. Participants found that the survey addressed important concepts and that items were in most cases easy to understand. This instrument provides a structured way to assess caregiver-centered communication, addressing a pressing need for tools tha...

High-value care for older adults with complex care needs: Leveraging nurses as innovators

Nursing Outlook, 2019

Background: Our health care system is facing unprecedented and complex challenges in caring for o... more Background: Our health care system is facing unprecedented and complex challenges in caring for older adults and their families. A paradigm shift is needed that recognizes new roles and competencies for nurses to play a leadership role in the design and implementation of high value care models. Purpose: The purpose of this paper is to introduce a series of recommendations for leveraging nurses to generate innovative tools and solutions for the delivery of value-based care for older adults living with complex health and social needs and their families. Methods: These recommendations were generated by a Think-Tank of national experts based on review of current evidence and focus groups with older adults. Discussion: The generated recommendations focus on positioning nurses to assume leadership roles in implementing evidence-based care models, preparing nurses to serve as health innovators and catalysts of system transformation, and fostering system-level infrastructure that leverages the contributions of nurses for current and emerging roles. Conclusion: Nurses as innovators can address the challenges in providing high quality care for older adults with complex needs and their families. System-level infrastructure, including resources for training and implementation of well-established programs, is necessary to leverage the contributions of nurses and facilitate innovative approaches to care.

Delivering problem‐solving therapy to family caregivers of people with cancer: A feasibility study in outpatient palliative care

Psycho-Oncology, 2018

ObjectiveIn response to the well‐documented need for evidence‐based cancer caregiver support, we ... more ObjectiveIn response to the well‐documented need for evidence‐based cancer caregiver support, we examined the feasibility of problem‐solving therapy for family caregivers of cancer patients receiving outpatient palliative care and investigated the impact of problem‐solving therapy on family caregivers' anxiety, depression, and quality of life.MethodsWe conducted a feasibility study of a structured problem‐solving therapy intervention delivered to family caregivers of cancer patients receiving outpatient palliative care from an academic health center in the Midwestern United States. Participants (N = 83) were randomly assigned to receive usual care or usual care plus a problem‐solving therapy intervention, which was delivered over three sessions via web‐based videoconferencing or telephone. Descriptive statistics were used to determine feasibility relative to recruitment, retention, and fidelity to core intervention components. Outcome data were analyzed using ordinary least squa...

Understanding optimisation processes of electronic health records (EHRs) in select leading hospitals: a qualitative study

BMJ Health & Care Informatics, 2018

BackgroundLittle is known about optimisation of electronic health records (EHRs) systems in the h... more BackgroundLittle is known about optimisation of electronic health records (EHRs) systems in the hospital setting while adoption of EHR systems continues in the United States.ObjectiveTo understand optimisation processes of EHR systems undertaken in leading healthcare organisations in the United States.MethodsInformed by a grounded theory approach, a qualitative study was undertaken that involved 11 in-depth interviews and a focus group with the EHR experts from the high performing healthcare organisations across the United States.ResultsThe study describes EHR optimisation processes characterised by prioritising exponentially increasing requests with predominant focus on improving efficiency of EHR, building optimisation teams or advisory groups and standardisation. The study discusses 16 types of optimisation that interdependently produced 16 results along with identifying 11 barriers and 20 facilitators to optimisation.ConclusionsThe study describes overall experiences of optimisi...

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