Examining Engagement and Usability in an Online Discussion Platform for Older Adults: Findings From Pilot Studies.

Social media may facilitate older adults' ability to engage socially and explore health information, but it can present difficulties for older adults. Therefore, it is important to explore older adults' experience of usability and user engagement. We conducted two rounds of pilot studies where we used Facebook to engage older adults. We performed a mixed-methods evaluation of user engagement and usability. A directed content analysis of qualitative data from the pilot studies was used to explore engagement and perceived usability, and the Mann-Whitney U test was used to examine differences in feature usage and engagement. We analyzed qualitative data from 13 participants. Qualitative data analysis yielded themes pertaining to three main domains: user engagement , usability , and usability related to aging-related changes . In terms of user engagement and usability, participants in both pilot studies reported positive feedback on felt involvement and endurability, and the second pilot group reported more positive comments regarding perceived usefulness compared with the first pilot group. There was no statistically significant difference in usage over the two studies. The findings of this study suggest opportunities to improve older adults' experience of online discussion platforms. Considering changes that improve perceived aesthetic appeal and focused attention will be helpful.

Virtual Intervention for Caregivers of Persons With Lewy Body Dementia: Pilot Quasi-Experimental Single-Arm Study.

BACKGROUND: Compared to other types of dementia, family caregivers of people with Lewy body dementia (LBD) report higher stress levels and more severe depressive symptoms. Although several digital support interventions for caregivers of persons with dementia exist, few target LBD specifically or leverage a fully remote and asynchronous approach suitable for pandemic circumstances. OBJECTIVE: We performed a pilot evaluation of a digital intervention designed to help caregivers of people with LBD address challenges they have experienced, with the end goal of reducing psychological distress in this population. METHODS: We recruited 15 family caregivers of people with LBD to participate in the quasi-experimental, single-arm, mixed methods study titled Virtual Online Communities for Aging Life Experience-Lewy Body Dementia (VOCALE-LBD). The study offers an 8-week web-based intervention that uses a digital discussion platform and involves moderation, peer-to-peer support, didactic training, and problem-solving skill enactment. RESULTS: Participants' baseline characteristics were the following: mean age 66 (SD 8) years; 14 of 15 (93%) of them were female; all (15/15, 100%) were White; and 8 (53%) of them had at least a postgraduate degree. Throughout the intervention, participants engaged in weekly web-based discussions, generating a total of 434 posts (average 4 posts per week). Attrition was 20% (3/15). Upon study exit, participants showed the following average improvements: 3.0 (SD 6.0) in depression, 8.3 (SD 16.7) in burden, 2.9 (SD 6.8) in stress, and 0.3 (SD 0.8) in loneliness. When looking at the proportion of participants with clinically significant improvement versus those with a worsening of ≥0.5 SD for each outcome, we observed net improvements of 50% (6/12), 33% (4/12), 25% (3/12), and 25% (3/12) in depression, loneliness, burden, and stress, respectively. In terms of the benefits of participation, participants reported that participation helped them "a great deal" to (1) improve their understanding of LBD (9/12, 75%), (2) gain confidence in dealing with difficult behaviors of the care recipient (6/12, 50%), and (3) improve in one's abilities to provide care to the care recipient (4/12, 33%). CONCLUSIONS: The study generated promising feasibility and preliminary efficacy data for a low-cost, web-based intervention designed for caregivers of persons with LBD. Though the study was not powered for significance, we observed nominal average and net improvements in important psychological outcomes. Moreover, many caregivers reported that study participation helped them better understand the disease, feel more confident in dealing with difficult behaviors of the care recipient, and improve their ability to care for the care recipient. If validated in future studies, the intervention could be an accessible, on-demand resource for caregivers, enabling them to engage in moderated remote discussions with peers at their own convenience in terms of location, time of the day, and frequency.

The use of visual methods to support communication with older adults with cognitive impairment: A scoping review.

Older adults with cognitive impairment often face difficulties with comprehension and communication, which can impact other cognitive processes such as decision-making. This scoping review investigates how visual methods can support older adults with cognitive impairment. The review involved querying four databases. From these databases, eleven articles fit inclusion criteria. This paper examines the purposes, use contexts, types, and effectiveness of the visual methods described in each study. The two major use contexts were elicitation of thoughts, feelings, and preferences in everyday life and health/healthcare related uses. Studies that used visual methods for eliciting preferences generally employed static visualizations. Health-related contexts employed more complex and interactive visualizations. Three studies used visual tools to support older adults in understanding; six, communication; and three, decision-making. None addressed all three outcomes of interest. This study provides recommendations and future directions for visual communication research with older adults with cognitive impairment.

Challenges and opportunities in conducting research with older adults with dementia during COVID-19 and beyond.

The coronavirus disease 19 (COVID-19) pandemic has created significant and new challenges for the conduct of clinical research involving older adults with Alzheimer's disease and related dementias (ADRD). It has also stimulated positive adaptations in methods for engaging older adults with ADRD in research, particularly through the increased availability of virtual platforms. In this paper, we describe how we adapted standard in-person participant recruitment and qualitative data collection methods for virtual use in a study of decision-making experiences in older adults with ADRD. We describe key considerations for the use of technology and virtual platforms and discuss our experience with using recommended strategies to recruit a diverse sample of older adults. We highlight the need for research funding that supports the community-based organizations on which improving equity in ADRD research participation often depends.

Simplified data science approach to extract social and behavioural determinants: a retrospective chart review.

OBJECTIVES: We aim to extract a subset of social factors from clinical notes using common text classification methods. DESIGN: Retrospective chart review. SETTING: We collaborated with a local level I trauma hospital located in an underserved area that has a housing unstable patient population of about 6.5% and extracted text notes related to various social determinants for acute care patients. PARTICIPANTS: Notes were retrospectively extracted from 43 798 acute care patients. METHODS: We solely use open source Python packages to test simple text classification methods that can potentially be easily generalisable and implemented. We extracted social history text from various sources, such as admission and emergency department notes, over a 5-year timeframe and performed manual chart reviews to ensure data quality. We manually labelled the sentiment of the notes, treating each text entry independently. Four different models with two different feature selection methods (bag of words and bigrams) were used to classify and predict housing stability, tobacco use and alcohol use status for the extracted clinical text. RESULTS: From our analysis, we found overall positive results and metrics in applying open-source classification techniques; the accuracy scores were 91.2%, 84.7%, 82.8% for housing stability, tobacco use and alcohol use, respectively. There were many limitations in our analysis including social factors not present due to patient condition, multiple copy-forward entries and shorthand. Additionally, it was difficult to translate usage degrees for tobacco and alcohol use. However, when compared with structured data sources, our classification approach on unstructured notes yielded more results for housing and alcohol use; tobacco use proved less fruitful for unstructured notes.

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

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 post-intervention. Participants posted at least two times per week. Content analysis of 210 posts showed participants were able to apply the problem solving skills taught, and exit interviews showed participants' increased awareness of the need to manage health, and enjoyment in learning about others. Conclusion: This mixed-methods evaluation provides insight into feasibility and design considerations for online interventions to promote health management among vulnerable older adults.

Reactions to COVID-19, information and technology use, and social connectedness among older adults with pre-frailty and frailty.

The emergence of Coronavirus Disease 2019 (COVID-19) and social distancing measures has serious implications, particularly those age 65 and older. We performed a qualitative analysis of online discussion data generated by older adults with pre-frailty and frailty while subject to a state stay-at-home order. We provided participants with prompts relating to the public health emergency, collected 60 posts, and analyzed them using a general inductive analytic method. We report on: (1) the impact of the pandemic on daily life; (2) preparedness, perceptions, and behavior; (3) information and technology use; and (4) social impacts. Participants' lives of changed in many ways, including the adoption of precautionary measures and altered daily routines. Participants experienced negative emotional consequences including stress, worry, and anxiety. Information and technology use kept participants informed and connected. Participants reported varying degrees of preparedness. Our study findings provide insight into ways to support vulnerable older adults in pandemic circumstances.

A Review of Predictive Analytics Solutions for Sepsis Patients.

BACKGROUND: Early detection and efficient management of sepsis are important for improving health care quality, effectiveness, and costs. Due to its high cost and prevalence, sepsis is a major focus area across institutions and many studies have emerged over the past years with different models or novel machine learning techniques in early detection of sepsis or potential mortality associated with sepsis. OBJECTIVE: To understand predictive analytics solutions for sepsis patients, either in early detection of onset or mortality. METHODS AND RESULTS: We performed a systematized narrative review and identified common and unique characteristics between their approaches and results in studies that used predictive analytics solutions for sepsis patients. After reviewing 148 retrieved papers, a total of 31 qualifying papers were analyzed with variances in model, including linear regression (n = 2), logistic regression (n = 5), support vector machines (n = 4), and Markov models (n = 4), as well as population (range: 24-198,833) and feature size (range: 2-285). Many of the studies used local data sets of varying sizes and locations while others used the publicly available Medical Information Mart for Intensive Care data. Additionally, vital signs or laboratory test results were commonly used as features for training and testing purposes; however, a few used more unique features including gene expression data from blood plasma and unstructured text and data from clinician notes. CONCLUSION: Overall, we found variation in the domain of predictive analytics tools for septic patients, from feature and population size to choice of method or algorithm. There are still limitations in transferability and generalizability of the algorithms or methods used. However, it is evident that implementing predictive analytics tools are beneficial in the early detection of sepsis or death related to sepsis. Since most of these studies were retrospective, the translational value in the real-world setting in different wards should be further investigated.

Using an Innovative Discussion Platform to Give Voice to Aging-Related Experiences: A Pilot Study.

Exchanging information with peers may support older adults' management of aging-related health changes, including frailty. The current pilot study used a mixed-methods approach to develop and evaluate an online virtual community for older adults to discuss aging-related health issues and management strategies. Eight older adults (mean age = 84) were enrolled at the start of the study. During a 10-week moderated discussion, participants contributed a total of 133 responses. Common themes included (a) symptoms (e.g., pain, weakness/tiredness, sleep difficulties) and (b) management strategies (e.g., health behavior changes, psychosocial support). A positive trend of change was noted in participants' average self-reported health and chronic disease management self-efficacy scores. This platform could facilitate information exchange among older adults, empowering them to leverage their own knowledge to improve their health management strategies. Future research should expand on this study to include older adults of diverse racial, educational, and cultural backgrounds. [Journal of Gerontological Nursing, 45(12), 33-40.].

Genetic disease risks can be misestimated across global populations.

BACKGROUND: Accurate assessment of health disparities requires unbiased knowledge of genetic risks in different populations. Unfortunately, most genome-wide association studies use genotyping arrays and European samples. Here, we integrate whole genome sequence data from global populations, results from thousands of genome-wide association studies (GWAS), and extensive computer simulations to identify how genetic disease risks can be misestimated. RESULTS: In contrast to null expectations, we find that risk allele frequencies at known disease loci are significantly different for African populations compared to other continents. Strikingly, ancestral risk alleles are found at 9.51% higher frequency in Africa, and derived risk alleles are found at 5.40% lower frequency in Africa. By simulating GWAS with different study populations, we find that non-African cohorts yield disease associations that have biased allele frequencies and that African cohorts yield disease associations that are relatively free of bias. We also find empirical evidence that genotyping arrays and SNP ascertainment bias contribute to continental differences in risk allele frequencies. Because of these causes, polygenic risk scores can be grossly misestimated for individuals of African descent. Importantly, continental differences in risk allele frequencies are only moderately reduced if GWAS use whole genome sequences and hundreds of thousands of cases and controls. Finally, comparisons between uncorrected and corrected genetic risk scores reveal the benefits of considering whether risk alleles are ancestral or derived. CONCLUSIONS: Our results imply that caution must be taken when extrapolating GWAS results from one population to predict disease risks in another population.

Genetic Hitchhiking and Population Bottlenecks Contribute to Prostate Cancer Disparities in Men of African Descent.

Prostate cancer incidence and mortality rates in African and African American men are greatly elevated compared with other ethnicities. This disparity is likely explained by a combination of social, environmental, and genetic factors. A large number of susceptibility loci have been reported by genome-wide association studies (GWAS), but the contribution of these loci to prostate cancer disparities is unclear. Here, we investigated the population structure of 68 previously reported GWAS loci and calculated genetic disparity contribution statistics to identify SNPs that contribute the most to differences in prostate cancer risk across populations. By integrating GWAS results with allele frequency data, we generated genetic risk scores for 45 African and 19 non-African populations. Tests of natural selection were used to assess why some SNPs have large allele frequency differences across populations. We report that genetic predictions of prostate cancer risks are highest for West African men and lowest for East Asian men. These differences may be explained by the out-of-Africa bottleneck and natural selection. A small number of loci appear to drive elevated prostate cancer risks in men of African descent, including rs9623117, rs6983267, rs10896449, rs10993994, and rs817826. Although most prostate cancer-associated loci are evolving neutrally, there are multiple instances where alleles have hitchhiked to high frequencies with linked adaptive alleles. For example, a protective allele at 2q37 appears to have risen to high frequency in Europe due to selection acting on pigmentation. Our results suggest that evolutionary history contributes to the high rates of prostate cancer in African and African American men.Significance: A small number of genetic variants cause an elevated risk of prostate cancer in men of West African descent. Cancer Res; 78(9); 2432-43. ©2018 AACR.