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Community health screening programs frequently report inconsistent follow-up rates and barriers to sustained lifestyle changes. HealthStart is a Self-Determination Theory (SDT)-based intervention that aims to increase the autonomy and competence of participants via volunteer engagement, health and digital coaching, and posthealth screening follow-up. Youth community health volunteers (YCHVs) were taught principles of motivational interviewing, health coaching, and the social determinants of health through a program model anchored in principles of intergenerational and service learning. YCHVs, guided by health care volunteers, served as health and digital advocates for participants over a 3-month postscreening period. This study aims to evaluate the effectiveness and acceptability of the HealthStart program, a structured, layperson-led intergenerational health coaching intervention. This study used a convergent parallel mixed methods design. A total of 192 older adult participants' (mean age 66.9, SD 9.6 years) quantitative data were collected through pre- and postprogram surveys between September 2022 and January 2024. Follow-up with primary care provider (PCP) was the primary outcome; secondary outcomes include health goal attainment, self-efficacy, and digital and health literacy among older adults, and acceptability among all stakeholders. PCP follow-up and health goal attainment were self-reported, while self-efficacy was measured using the Patient Activation Measure-13. Health and digital literacy were assessed with an adapted questionnaire and the eHealth Literacy Scale (eHEALS), respectively. A total of 36 semistructured interviews were conducted with 13 older adults, 17 YCHVs, and 6 health care volunteers in the qualitative study between November 2023 and January 2024, which were qualitatively analyzed using thematic analysis. A joint analysis was conducted to generate meta-inferences. The follow-up rate among PCPs increased significantly from 42.7% to 84.5% (P<.001). A total of 66.2% (92/139) of the participants achieved their health goals, and 81.3% (113/139) reported satisfaction with the program. There were no significant pre-post differences in Patient Activation Measure-13, knowledge, and eHEALS scores. However, a statistically significant correlation was found between postcycle eHEALS scores and the number of follow-up visits (P=.003). The qualitative findings substantiate HealthStart's Theory of Change and its SDT underpinnings. Participants' narratives highlighted the 3 SDT psychological needs, increased autonomy, competence, and relatedness, which are associated with sustained behavior change and health engagement. An increase in the PCP follow-up rate was influenced by individually tailored goal setting and relationship-building that leveraged motivational interviewing to support intrinsic motivation. The program's primary outcome was, to some extent, influenced by digital health onboarding and possibly improvements in health literacy. Participants' self-efficacy could have been enhanced with a structured social prescription framework. HealthStart demonstrated the feasibility of using YCHVs and SDT principles to improve PCP follow-up rates and promote healthier lifestyles through digital enablement among older adults participating in community health screening.

As the population ages, demand for health services among older adults and caregivers increases. Digital health services help meet this demand. However, acceptance and experiences differ between older adults and caregivers. This study aims to explore the specific experiences of home-dwelling older adults and their caregivers with digital health services, identify their willingness to use these services and the factors influencing their adoption, and identify their service needs to inform the subsequent design and optimization of digital health products and services. From December 2023 to February 2024, a descriptive qualitative study was conducted. Researchers used purposive and maximum variation sampling to recruit 18 home-dwelling older adults and 17 family caregivers, including 10 matched dyads. Participants came from 7 community health service centers and a tertiary hospital in Hefei, China. Open-ended, semistructured, face-to-face interviews were conducted separately. Data were analyzed using conventional content analysis. Four main themes emerged. The first were the application characteristics, including usage situations and preferred functions. The second theme described specific service experiences, both positive and negative. The third was the influencing factors. Promoting factors included health needs, user experience, and subjective norms. Obstructive factors differed between groups and included low digital literacy, weak economic foundation, service security concerns, and lack of time. The fourth theme covered suggestions and expectations for improvement. Older adults appreciated the advantages but often had suboptimal experiences due to complex designs and threats to personal dignity. Conversely, caregivers valued efficiency but reported low use, hindered by time constraints and concerns about privacy and safety. This study reveals a critical gap between the potential and actual use of digital health services. Older adults face barriers with usability and digital literacy. Caregivers struggle to integrate these services and have trust issues. Future optimization requires action at several levels. Government support is needed through policies, authoritative platforms, and subsidies. Service providers should offer age-friendly, personalized design, and continuous support. Social support systems are also essential, such as digital reciprocity from family and peer help. These strategies are critical for enhancing user experience, bridging the digital divide, and enabling both older adults and their caregivers to fully benefit from digital health technologies.

Effective preoperative digital health education (DHE) is critical for patients undergoing knee arthroplasty (KA), particularly older adults who face age-related cognitive vulnerabilities. Cognitive Load Theory suggests that presentation modality and learning motivation strongly influence cognitive processing, yet their combined effects in clinical education remain underexplored. This study investigated how learning motivation and presentation modality (text-only, text-graphic composite, and video-based) affect cognitive load and learning performance in older adult patients preparing for KA. A 2×3 factorial psychobehavioral experiment was conducted with 62 patients (≥60 y) stratified by learning motivation (high vs low). Each participant completed 6 DHE modules delivered across the 3 modalities. Cognitive load was measured using subjective ratings (Chinese National Aeronautics and Space Administration Task Load Index) and objective eye-tracking indicators (average fixation duration, number of fixations, and time to first fixation). Learning performance was assessed through knowledge retention and transfer tests (30 items). Data were analyzed using general linear models, analysis of covariance, and correlation analyses, with covariates including knee function, prior knowledge, eHealth literacy, and psychological distress. High-motivation learners demonstrated significantly lower cognitive load (National Aeronautics and Space Administration Task Load Index; large effect size) and superior learning performance (medium effect size) compared to low-motivation learners. Video-based materials consistently yielded the lowest extraneous load and supported efficient knowledge acquisition (medium effect size). Text-graphic composites elicited higher cognitive load but facilitated deeper processing and schema construction, particularly for highly motivated learners (medium-to-large effect sizes). Eye tracking confirmed these dynamics: high-motivation participants showed shorter fixation durations and more efficient allocation of attention across modalities, whereas low-motivation learners displayed scattered fixation patterns, especially in text-graphic conditions. Across the sample, cognitive load was negatively correlated with learning performance (large effect size), reinforcing its role as a key mediator of digital learning outcomes. Both learning motivation and modality exert significant, though partly independent, influences on preoperative DHE outcomes in patients with KA. Video-based content enhances cognitive efficiency, while text-graphic formats may promote germane load among motivated learners. These findings highlight the importance of motivational scaffolding, adaptive modality selection, and the integration of real-time cognitive monitoring in DHE design. Beyond informing digital education for KA, the study demonstrates the feasibility of applying psychobehavioral experimental methods with older surgical patients, offering a framework for optimizing cognitive alignment in clinical education.

The rapid digitalization of health care has reshaped access to medical services. However, older adults often remain disadvantaged due to the digital divide. Electronic health literacy (EHL) is increasingly recognized as a determinant of health-related quality of life (HRQoL); however, its mechanisms and subgroup differences in China remain underexplored. This study aimed to examine the association between EHL and multidimensional HRQoL among Chinese older adults, with a focus on the mediating roles of attitudes toward own aging (ATOA) and self-efficacy (SE), and heterogeneity by age, residence, and lifestyle. A cross-sectional survey (July-November 2024) included 8364 adults aged ≥55 years from 4 provinces using stratified multistage sampling. HRQoL was measured by physical health (PH), mental health (MH), and life satisfaction (LS). EHL was assessed with the eHealth Literacy Scale (eHEALS), ATOA with the Philadelphia Geriatric Center Morale Scale subscale, and SE with the General Self-Efficacy Scale. Analyses used seemingly unrelated regressions, PROCESS (Andrew F. Hayes) macro mediation with 5000 bootstraps, and subgroup regressions. EHL was positively associated with PH (β=0.273; P<.001), MH (β=0.190; P<.001), and LS (β=0.082; P<.001). ATOA and SE significantly mediated these associations (all P<.001). For PH, the association was partially mediated by ATOA and SE. The total effect was 0.273 (P<.001), with indirect effects accounting for 52.7% of the total. For MH, inconsistent mediation was observed. The direct effect was negative (β=-0.069; P<.01), but indirect effects were positive, yielding a positive total effect. For LS, the effect was fully mediated by ATOA and SE. Subgroup analyses showed stronger effects in the younger-old adults (PH: β=0.288, MH: β=0.188, LS: β=0.089; all P<.001), urban residents (PH: β=0.237, MH: β=0.214, LS: β=0.083; all P<.001), and nonexercisers (PH: β=0.322; P<.001). EHL is strongly associated with HRQoL among Chinese older adults. Its effects on MH and LS operate primarily through psychosocial pathways, while PH benefits directly. The findings highlight EHL's compensatory role, particularly for the younger-old group, rural residents, and nonexercisers, underscoring its importance in digital inclusion and healthy aging policies.

Digital health literacy (DHL) has the potential to improve health among older adults by enhancing access to health-related information and health care services. The aim of this study was to analyze the relationship between DHL and technology commitment in adults aged 65 years and older, while also investigating possible gender differences. The analytical sample consisted of 1824 individuals. The analysis included descriptive comparisons in terms of DHL, technology acceptance, competency, support, and internet use. Multivariate regression models (generalized linear models) were applied in order to test the association between DHL and technology commitment, controlling for internet use as well as health-related and sociodemographic characteristics. Male and female participants did not differ in terms of DHL (mean score: 3.5, SD 1.2 [men] and 3.5, SD 1.3 [women]; P=.70); however, male participants reported significantly higher technology acceptance (P<.001) and higher technology competencies (P<.001), but less support with regard to technology use (P<.001). Within regression models, only higher technology acceptance (coefficient=0.023, 95% CI 0.006-0.041; P=.01) and support (coefficient=0.027, 95% CI 0.014-0.040; P<.001) were significantly linked to greater DHL. The subgroup analysis revealed that DHL was significantly associated with technology acceptance among men (coefficient=0.036, 95% CI 0.012-0.060; P=.003) but not women (coefficient=0.024, 95% CI 0.008-0.040; P=.44). According to the current results, DHL is highly related to technology commitment. Gender differences should be taken into account when developing and evaluating appropriate interventions to improve DHL by addressing the acceptance of technologies and optimizing support infrastructures.

Health care systems are increasingly facing challenges posed by the aging of populations. In particular, hospitalization, both initial and subsequent, is often observed among older adult patients. However, research suggests that nearly 23% of all hospitalizations could be avoided. In this perspective, remote patient monitoring (RPM) systems are emerging as a promising solution, enabling professionals to detect and manage patient complexities early within home-based care settings. This study aims to provide additional analyses regarding the impact of the EPOCA RPM system for polypathological older adult patients on the total number of unplanned hospitalization days and admissions, as well as emergency department (ED) visits. In a prior study, we evaluated the impact when the operator of the RPM system is a geriatrician. In this study, we assess the impact when the general practitioner is the operator. We used a retrospective, before-and-after cohort design. Polypathological older adult patients aged 70 and older, who benefited from the EPOCA RPM system for at least 1 year (between February 2022 and August 2024), were included in the analysis. We compared the outcomes between the previous year (Y-1) and the follow-up year (Y) by the EPOCA RPM system. Statistical analyses were significant at P value <.05. In total, 80 patients were included in the analysis, with an average age of 87. The results showed a significant reduction (P<.001) between Y-1 and Y in the total number of unplanned hospital admissions (by 57%), hospitalization days (by 49%), and ED visits (by 62%). Our findings reflected a significant decrease per patient from 0.99 to 0.42 in hospital admissions, from 0.99 to 0.37 in ED visits, and a reduction of 9.7 hospitalization days per year (P<.001). Additional analyses stratifying by hospitalization history, disability level, and caregiver status showed that the greatest effect of the RPM system was on patients with high risk and severe disability. Finally, there was no observed increase in mortality or transfers to intensive care units. Our findings are consistent with our previous results regarding the potential benefits of the EPOCA RPM system in managing care for polypathological older adult patients, this time with general practitioners as system operators. They also support existing evidence on the promise of RPM in improving care and health outcomes for older adult patients while alleviating hospital burdens by reducing unplanned hospitalizations and ED visits. It is, therefore, essential to incorporate reimbursement policies for these RPM initiatives so as to facilitate their adoption within health care systems and enhance their impact on health outcomes.

The shift to video care during the COVID-19 pandemic exacerbated disparities in health care access, especially among high-need, high-risk older adults with frailty. The objective of this study was to quantify the ability of high-need, high-risk older veterans to use video visits for health care and identify factors associated with successful video visit completion. Veterans in a Veterans Affairs Frailty Intervention and Treatment (FIT) clinic underwent a physical, functional, psychological, social, and technology assessment at baseline. During the pandemic, the FIT clinic switched to televisits. We sorted patients into 4 groups: video visit, telephone visit, reached but no visit, and unable to contact. We performed a t test to compare normal variables and a chi-square test to compare categorical variables to identify factors associated with completing a video visit versus a telephone visit. We attempted to contact 110 patients from the FIT clinic. They were 73.5 (SD 5.6) years old on average. A total of 46 (41.8%) patients were White, 46 (41.8%) patients were Black, and 17 (15.5%) patients were Hispanic. Sixty-seven (60.9%) patients had at least some college education, and 49 (44.5%) patients were very confident in filling out medical forms. Of the 110 patients, 72 patients were reached, and 65 patients agreed to a televisit. Of the 65 patients who agreed to a televisit, 19 (29.2%) patients completed a video visit, while 37 (57%) completed a telephone visit. A total of 19 patients out of 25 (76%) of those who scheduled a video visit completed it successfully. Compared with those who completed a telephone visit, veterans who completed a video visit were more likely to have access to a computer with a camera, microphone, and high-speed internet/data plan, as well as the ability to use email and be confident in internet use. They were more likely to have a higher health literacy score and be cognitively intact with a Montreal Cognitive Assessment score of ≥26, and were less likely to experience issues with walking, stepping, and balance. Our study found that completing a video visit requires access to technology, the ability to use it, and a willingness to do so. Among older veterans with frailty, only a quarter completed a video visit, and this group comprised patients who already had access to video-capable technology, used it, and were comfortable with it. They were also more often physically and cognitively intact compared with those who used telephone visits. Strategies to expand the use of video visits in the care of older adults include screening older adults to identify individuals most likely to succeed and increasing access to simple home telehealth technology.

With China's aging population and increasing prevalence of chronic diseases, the Internet+Nursing Service has emerged as a new care model, enabling registered nurses from medical institutions to provide home-based care through a web-based application and offline service model. This care model is particularly beneficial for vulnerable populations, such as patients with dysphagia, who face significant risks like malnutrition and aspiration pneumonia. Nurses play a critical role in delivering these services, yet their experiences, challenges, and support needs remain underexplored. Understanding these factors is essential for improving service quality and establishing standardized care guidelines. This study aims to explore the experiences and challenges of nurses providing the dysphagia-related Internet+Nursing Service, offering insights to guide the standardization and sustainable development of this innovative care model. A qualitative study was conducted with 18 nurses who had been providing the Internet+Nursing Service for patients with dysphagia for over 6 months. Purposive sampling ensured the selection of participants with relevant expertise. Semistructured interviews were used for data collection, focusing on nurses' experiences, challenges, and recommendations. Data were analyzed using conventional content analysis, following an inductive approach to identify recurring themes and patterns. The analysis revealed 3 key themes: value representation and social impact; nursing resources and staffing; and safety and management support. Nurses emphasized that patient-centered nursing services enhanced their sense of professional fulfillment and helped alleviate pressure on hospital nursing resources. However, challenges such as insufficient time and energy, inadequate manpower, and underexploitation of service potential limited service effectiveness. To ensure sustainability, nurses highlighted the need for standardized service processes, regular experience exchange, and stronger hospital involvement in managing and supporting the Internet+Nursing Service. This study highlights both the opportunities and challenges of delivering the dysphagia-related Internet+Nursing Service. While nurses acknowledge the value of this care model, addressing staffing shortages, improving training programs, and strengthening regulatory frameworks are essential for optimizing service delivery. Policy makers and health care institutions should develop standardized guidelines and supportive policies to enhance service sustainability and accessibility.

The rapid growth of internet health care (IH) offers older adults convenient medical services like remote consultations and health monitoring. However, its adoption among this group remains low, highlighting a significant digital divide. Understanding the behavioral patterns and determinants of IH use in the older population is crucial for optimizing digital health design and improving service accessibility. This study aimed to analyze the multidimensional influencing factors of Chinese older adults' use of IH services based on the integrated framework of the technology acceptance model and social ecological model, and explore their behavioral patterns and key driving factors. A cross-sectional study design was adopted to conduct a multistage stratified cluster random sampling survey in 3 cities in Shandong Province from May 2024 to July 2024, with a total of 1828 older adults aged 60 to 75 years included. The study uses latent category analysis to classify the use of IH service behaviors and employs multiple logistic regression, decision tree models, and structural equation modeling to analyze influencing factors and mediating pathways. Five distinct user groups were identified: nonusers (n=911), registration-dominant users (n=286), low-activity users (n=320), moderate comprehensive users (n=288), and full-service users (n=23). Multinomial logistic regression with nonusers as the reference group identified key determinants: individuals with below primary education had 96% lower odds of membership (odds ratios [OR] 0.039, 95% CI 0.012-0.084) compared to the reference group with junior college education or above in moderate comprehensive users, while male participants had higher odds of being full-service (OR 1.980, 95% CI 1.126-3.514) or moderate comprehensive (OR 1.310, 95% CI 1.012-1.705) users. Older age was consistently associated with lower adoption across all classes. Full-service users exhibited exceptionally high social support (OR 4.502, 95% CI 3.601-5.627), while moderate comprehensive users showed the highest technology acceptance (OR 2.803, 95% CI 2.355-3.342). The decision tree model (area under the curve of 0.94) found the optimal path: sufficient social support (≥2), good health status (>5), and high technical acceptance (≥30) yield the highest use probability (92%→96%). Mediation analysis indicated that social support influences usage willingness through both direct and indirect pathways. The direct effect was 0.712 (95% CI 0.552-0.972; P<.001). Among indirect pathways, technology availability and practicality accounted for the largest proportion of mediation (19.7%, 95% CI 16.8%-22.6%), followed by technology acceptance (13.7%, 95% CI 11.1%-16.3%) and social influence (8.9%, 95% CI 6.9%-10.9%). Optimizing age-friendly design, strengthening social support networks, and improving technological usability are keys to increasing the adoption of IH services among the older population. Future policies should develop targeted intervention strategies for different user groups to narrow the digital health divide.

eHealth literacy is an essential skill for pursuing electronic health information, particularly for older people whose health needs increase with age. South Korea is now at the intersection of a rapidly digitalizing society and an increasingly aged population. eHealth literacy enables older people to maximize the effective use of emerging digital technology for their health and quality of life. Understanding the eHealth literacy of Korean older adults is critical to eliminating the gray digital divide and inequity in health information access. This study aims to investigate factors influencing eHealth literacy in older Korean adults and its impact on health outcomes and eHealth use. This was a cross-sectional survey. Community-dwelling older adults 65 years and older in 2 urban cities in South Korea were included. eHealth literacy was measured by the eHealth Literacy Scale. Ordinal logistic regression was used to analyze factors associated with eHealth literacy and multivariate ANOVA for the impact of eHealth literacy on health outcomes and eHealth use. In total, 434 participants were analyzed. A total of 22.3% (97/434) of participants had high eHealth literacy skills. Increasing age, higher monthly income, and time spent on the internet were significantly associated with eHealth literacy (P<.001), and social media users were 3.97 times (adjusted odds ratio 3.97, 95% CI 1.02-15.43; P=.04) more likely to have higher skill. Higher eHealth literacy was associated with better self-perceived health and frequent use of digital technologies for accessing health and care services (P<.001). Disparity in socioeconomic status and engagement on the internet and social media can result in different levels of eHealth literacy skills, which can have consequential impacts on health outcomes and eHealth use. Tailored eHealth interventions, grounded on the social and digital determinants of eHealth literacy, could facilitate eHealth information access among older adults and foster a digitally inclusive healthy aging community.