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Mobile health (mHealth) apps are dramatically changing how patients and providers manage and monitor chronic health conditions, especially in the area of self-monitoring. African Americans have higher mortality rates from heart failure than other racial groups in the United States. Therefore, self-management of heart failure may improve health outcomes for African American patients. The aim of the present study was to determine the feasibility of using an mHealth app, and explore the outcomes of quality of life, including self-care maintenance, management, and confidence, among African American patients managing their condition after discharge with a diagnosis of heart failure. Prior to development of the app, we conducted qualitative interviews with 7 African American patients diagnosed with heart failure, 3 African American patients diagnosed with cardiovascular disease, and 6 health care providers (cardiologists, nurse practitioners, and a geriatrician) who worked with heart failure patients. In addition, we asked 6 hospital chaplains to provide positive spiritual messages for the patients, since spirituality is an important coping method for many African Americans. These formative data were then used for creating a prototype of the app, named Healthy Heart. Specifically, the Healthy Heart app incorporated the following evidence-based features to promote self-management: one-way messages, journaling (ie, weight and symptoms), graphical display of data, and customized feedback (ie, clinical decision support) based on daily or weekly weight. The educational messages about heart failure self-management were derived from the teaching materials provided to the patients diagnosed with heart failure, and included information on diet, sleep, stress, and medication adherence. The information was condensed and simplified to be appropriate for text messages and to meet health literacy standards. Other messages were derived from interviews conducted during the formative stage of app development, including interviews with African American chaplains. Usability testing was conducted over a series of meetings between nurses, social workers, and computer engineers. A pilot one-group pretest-posttest design was employed with participants using the mHealth app for 4 weeks. Descriptive statistics were computed for each of the demographic variables, overall and subscales for Health Related Quality of Life Scale 14 (HQOL14) and subscales for the Self-Care of Heart Failure Index (SCHFI) Version 6 using frequencies for categorical measures and means with standard deviations for continuous measures. Baseline and postintervention comparisons were computed using the Fisher exact test for overall health and paired t tests for HQOL14 and SCHFI questionnaire subscales. A total of 12 African American participants (7 men, 5 women; aged 51-69 years) diagnosed with heart failure were recruited for the study. There was no significant increase in quality of life (P=.15), but clinically relevant changes in self-care maintenance, management, and confidence were observed. An mHealth app to assist with the self-management of heart failure is feasible in patients with low literacy, low health literacy, and limited smartphone experience. Based on the clinically relevant changes observed in this feasibility study of the Healthy Heart app, further research should explore effectiveness in this vulnerable population.

The life stories of older adults encapsulate an array of personal experiences that reflect their care needs. However, due to inherent fuzzy features, fragmented natures, repetition, and redundancies, the practical application of the life story approach poses challenges for caregivers in acquiring and comprehending these narratives. Addressing this challenge, our study introduces a novel approach called Life Story Hierarchies with Graph-Enhanced Event Feature Refinement (LSH-GEFR). LSH-GEFR constructs a bilayer graph. Firstly, the event element map leverages intricate relationships between event elements to extract environmental features, providing a detailed context for understanding each event element. Secondly, the event map explores the complex web of relationships between the events themselves, allowing LSH-GEFR to generate a comprehensive understanding of each event and enhance its representation. Subsequently, we conducted experiments on different datasets and found that, in comparison with four advanced event tree generation methods, the proposed LSH-GEFR method outperformed them in terms of path coherence, branch reasonableness, and overall readability when generating life story hierarchies. Over 84.91% of the structured life narratives achieved readability, marking a 5.96% increase over the best-performing approach at the baseline.

The Namaste Care program is a person-centered intervention that has been shown to improve the quality of life of people with dementia and to alleviate caregiver burden. However, its application in China remains underexplored. Given China's unique sociocultural norms, cultural adaptation is essential to ensure feasibility, acceptability, and contextual fit. The primary objective is to culturally adapt the Namaste Care Home Program to the Chinese community context. The secondary objective is to evaluate the feasibility and acceptability of the adapted program (qualitative analysis), and to explore its preliminary effects (quantitative analysis) on quality of life and related outcomes for people with dementia and their family caregivers. A 3-stage, 11-step mixed methods design is used in this study. The process includes a baseline stage for community assessment and stakeholder consultations, a formulation stage for adapting the intervention and training materials, and an execution and evaluation stage in which trained family caregivers deliver the intervention. A 1-group, pretest-posttest design will be used, with quantitative assessments at baseline (T0), immediately after intervention (T1), and at the 3-month follow-up (T2), complemented by qualitative process evaluations. The study was approved in April 2025 (2025-NZY-4-01) and registered on April 18, 2025 (ChiCTR2500101042). Recruitment occurred from January to April 2025, enrolling 15 caregiver-people with dementia dyads. As of April 2025, baseline data collection is complete, and analysis is ongoing. Primary results are expected in mid-2026. The cultural adaptation of the Namaste Care Home Program is a critical step toward advancing person-centered, home-based dementia care in China. Findings will provide evidence on feasibility and cultural appropriateness and will inform the design of future large-scale trials to test effectiveness in cross-cultural settings.

In China, the population is rapidly ageing and the capacity of the system that cares for older people is increasingly a concern. In this Review, we provide a profile of the long-term care system and policy landscape in China. The long-term care system is characterised by rapid growth of the residential care sector, slow development of home and community-based services, and increasing involvement of the private sector. The long-term care workforce shortage and weak quality assurance are concerning. Public long-term care financing is minimal and largely limited to supporting welfare recipients and subsidising the construction of residential care beds and operating costs. China is piloting social insurance long-term care financing models and, concurrently, programmes for integrating health care and long-term care services in selected settings across the country; the effectiveness and sustainability of these pilots remain to be seen. Informed by international long-term care experiences, we offer policy recommendations to strengthen the evolving care system for older people in China.

Accurately assessing the needs of elders and their families is critical to developing an effective elderly service program or successful aging policy. In China and other Asian countries, such as Japan and South Korea, where the aging population is rapidly growing, this need is particularly apparent. Using case examples collected from a pilot study in urban China, we explore challenges in using the interview method for conducting needs assessments among elders and their family caregivers, including socio-cultural, cognitive, and conceptual limitations. To address these limitations, strategies are discussed to improve the use of interview methods for accurate assessments of needs among elders and their family caregivers, especially among those in developing countries, like China.

There are several mobile apps that offer tools for disease prevention and management among older adults, and promote health behaviors that could potentially reduce or delay the onset of disease. A classification scheme that categorizes apps could be useful to both older adult app users and app developers. The objective of our study was to build and evaluate the effectiveness of a classification scheme that classifies mobile apps available for older adults in the \"Health & Fitness\" category of the iTunes App Store. We constructed a classification scheme for mobile apps according to three dimensions: (1) the Precede-Proceed Model (PPM), which classifies mobile apps in terms of predisposing, enabling, and reinforcing factors for behavior change; (2) health care process, specifically prevention versus management of disease; and (3) health conditions, including physical health and mental health. Content analysis was conducted by the research team on health and fitness apps designed specifically for older adults, as well as those applicable to older adults, released during the months of June and August 2011 and August 2012. Face validity was assessed by a different group of individuals, who were not related to the study. A reliability analysis was conducted to confirm the accuracy of the coding scheme of the sample apps in this study. After applying sample inclusion and exclusion criteria, a total of 119 apps were included in the study sample, of which 26/119 (21.8%) were released in June 2011, 45/119 (37.8%) in August 2011, and 48/119 (40.3%) in August 2012. Face validity was determined by interviewing 11 people, who agreed that this scheme accurately reflected the nature of this application. The entire study sample was successfully coded, demonstrating satisfactory inter-rater reliability by two independent coders (95.8% initial concordance and 100% concordance after consensus was reached). The apps included in the study sample were more likely to be used for the management of disease than prevention of disease (109/119, 91.6% vs 15/119, 12.6%). More apps contributed to physical health rather than mental health (81/119, 68.1% vs 47/119, 39.5%). Enabling apps (114/119, 95.8%) were more common than reinforcing (20/119, 16.8%) or predisposing apps (10/119, 8.4%). The findings, including face validity and inter-rater reliability, support the integrity of the proposed classification scheme for categorizing mobile apps for older adults in the \"Health and Fitness\" category available in the iTunes App Store. Using the proposed classification system, older adult app users would be better positioned to identify apps appropriate for their needs, and app developers would be able to obtain the distributions of available mobile apps for health-related concerns of older adults more easily.

Alcohol misuse is a growing public health concern for older adults, particularly among primary care patients. To determine alcohol consumption patterns and the characteristics associated with at-risk drinking in a large sample of elderly primary care patients. Cross-sectional analysis of multisite screening data from 6 VA Medical Centers, 2 hospital-based health care networks, and 3 Community Health Centers. Patients, 43,606, aged 65 to 103 years, with scheduled primary care appointments were approached for screening; 27,714 (63.6%) consented to be screened. The final sample of persons with completed screens comprised 24,863 patients. Quantity and frequency of alcohol use, demographics, social support measures, and measures of depression/anxiety. Of the 24,863 older adults screened, 70.0% reported no consumption of alcohol in the past year, 21.5% were moderate drinkers (1-7 drinks/week), 4.1% were at-risk drinkers (8-14 drinks/week), and 4.5% were heavy (>14 drinks/week) or binge drinkers. Heavy drinking showed significant positive association with depressive/anxiety symptoms [Odds ratio (OR) (95% CI): 1.79 (1.30, 2.45)] and less social support [OR (95% CI): 2.01 (1.14, 2.56)]. Heavy drinking combined with binging was similarly positively associated with depressive/anxiety symptoms [OR (95%): 1.70 (1.33, 2.17)] and perceived poor health [OR (95% CI): 1.27 (1.03, 1.57)], while at-risk drinking was not associated with any of these variables. The majority of participants were nondrinkers; among alcohol users, at-risk drinkers did not differ significantly from moderate drinkers in their characteristics or for the 3 health parameters evaluated. In contrast, heavy drinking was associated with depression and anxiety and less social support, and heavy drinking combined with binge drinking was associated with depressive/anxiety symptoms and perceived poor health.

Stigma of mental illness is a major obstacle to its diagnosis and treatment and may be worse among Asians than Caucasians. This study compared the stigma of depression in 50 Chinese Americans (CA) and 50 Caucasian Americans (WA). Subjects were asked to read 5 case vignettes in the following order: diabetes mellitus (DB), major depressive disorder (MDD), somatoform depression (SD), psychotic depression (PD), and fever of unknown origin (HA). Diagnosis of each case was not revealed. Subjects then rated their response to each case, on a Likert scale from \"strongly disagree\" to \"strongly agree,\" to 25 statements that contained 6 stigma factors: fear, shame, cognitive distortion, social consensus, discrimination, and sanction. Composite scores constructed from ratings of each factor were used to calculate the severity of stigma. Stigma of all 5 cases was worse in CA than WA. Both groups ranked DB and HA to be least and PD to be most stigmatizing. CA rated SD to be less stigmatizing than MDD but not WA. We concluded that stigma formation and severity were determined by fear, shame, cognitive distortion, social communication, consensus, and sanction. Mental symptoms, particularly psychotic symptoms, were more stigmatizing than physical symptoms, especially for CA. Belief that depression was like a physical illness did not diminish its stigma.

Despite increasing awareness of mental health problems among older adults, limited mental health services are available to meet their needs. The proposed study aimed to evaluate the need for mental health services among older adults in Shanghai, China, and identify gaps in the existing service system to inform policy making. Based on 80 face-to-face interviews amongst several groups of older adults and community officers, doctors and government stakeholders, the study found that (a) the mental health needs of older adults living with family members mainly present as needs for social interaction, sense of belonging, and self-realization; (b) special groups, such as older adults living alone, mainly desire support to address loneliness, older adults with physical disabilities desire social respect, and those with mental disabilities seek social acceptance; and (c) community cadres and other stakeholders have paid little attention to demands related to mental well-being among older people. It is necessary to deliver mental health education to community stakeholders and the public, popularize mental health knowledge, and publicize professional psychological counseling and treatment services. Meanwhile, policy makers should allocate resources to train professional mental health services personnel to meet these growing mental health needs and increase financial support for mental health services for older adults.