Barriers to AI-supported health management among older adults with chronic orthopedic conditions in China: implications for healthcare delivery and access.
Older adults with chronic orthopedic conditions face structural barriers to adopting AI-supported health management and effective implementation requires age-friendly design and stronger integration within primary healthcare systems.
Abstract
Background
Artificial intelligence (AI) is increasingly applied in chronic disease management, yet its adoption among older adults with chronic orthopedic conditions remains limited and poorly understood in China.
Methods
A qualitative study using semi-structured interviews was conducted with 13 older adults recruited from two tertiary hospitals in Beijing and Harbin. Thematic analysis was performed to identify key themes.
Results
Five themes were identified: (1) preference for traditional health management over AI; (2) limited understanding of AI-supported health management; (3) perceived constraints in technological capability and affordability; (4) lack of external support from family and community; and (5) optimistic yet unrealistic expectations of AI capabilities.
Conclusions
Older adults with chronic orthopedic conditions face structural barriers to adopting AI-supported health management. Effective implementation requires age-friendly design and stronger integration within primary healthcare systems.
Background Artificial intelligence (AI) has the potential to improve health among older adults, yet how different stakeholders decide to develop, finance, and adopt AI innovations is not well understood. Objective This study aimed to understand the decision-making of different stakeholders regarding AI and technologies for the health care of older adults. Methods We conducted semistructured interviews with 15 older adults and care partners, 15 clinicians, 8 health system or insurance leaders, 5 investors, and 6 technology developers. Data were analyzed using thematic content analysis. Results All stakeholders considered cost, value, and usability important in adopting AI health technologies but emphasized different aspects of each concept. Older adults and care partners prioritized out-of-pocket costs and ease of use, whereas payers emphasized disease prevalence and implementation feasibility. Developers and investors focused on profitability and scalability, resulting in tension with end users’ priorities. Participant suggestions included problem-driven design, greater stakeholder engagement, public-private partnerships, and educating older adults about AI. Conclusions As with prior health-related technology innovations, aligning decisional priorities across stakeholders is critical to motivate impactful AI health technologies for older adults.
Zhang Zhang, Thomas Km Cudjoe, Sato Ashida et al.· JMIR Aging· 0 citations
Background Hong Kong is experiencing rapid population aging, with the population of older adults expected to reach 36.0% by 2046. The rise in life expectancy is often accompanied by increased chronic diseases and mental health challenges. The healthcare system remains heavily focused on tertiary care, leading to increased system burden and suboptimal health outcomes. Strengthening engagement with primary care for older adults, particularly through community-based services such as District Health Centers, is essential for improving long-term health outcomes. This approach promotes early detection, better management of chronic conditions, and prevention of unnecessary hospitalizations. Objective This pilot study aims to evaluate the feasibility, acceptability, and preliminary effectiveness of a hybrid intergenerational home-based and AI-generated digital intervention for increasing the proportion of District Health Center members among older adults in Hong Kong. Methods This is a two-group parallel cluster randomized controlled trial, involving 180 older adults recruited from 6 clusters. Participants will receive home-based DHC intervention by trained students, followed by 1-month of AI-generated digital interventions, including infographics, videos, and messages on the introduction and promotion of DHC, via WhatsApp. The feasibility indicators include recruitment rate, retention rates, dose delivered, dose received, and participant engagement. Acceptability outcomes are workshop and digital intervention satisfaction. The primary outcome is to increase the proportion of District Health Center members. Secondary outcomes include the proportion of participants utilizing DHC, health status, behavioral modifiable risk factors, eHealth literacy, infectious disease prevention behaviors, and feasibility metrics. Data will be collected via surveys at baseline and follow-ups (1, 3, and 6 months). Discussion This proposed pilot study aims to use hybrid intergenerational home-based and AI-generated digital intervention to improve primary healthcare engagement among older adults in Hong Kong. By promoting awareness and utilization of primary healthcare services like District Health Centers, the study seeks to promote healthier aging, improve health outcomes, alleviate hospital strain, and provide a framework for addressing the needs of aging populations. Clinical trial registration https://clinicaltrials.gov/, NCT07252934.
A. W. He, Ferrina Hoi Yan Cheung, Yuna Shao et al.· Frontiers in Public Health· 0 citations
Objective Proactive health, as an important strategy for addressing population aging in China, has not yet developed into a systematic service model for the care of older adults with functional impairment in LTCFs. This study aimed to systematically explore the unmet needs of proactive health services among older adults with functional impairment in LTCFs through a qualitative approach, and to provide a theoretical basis for the construction of a capability-based care system. Methods A combination of purposive and maximum variation sampling was used to recruit 15 older adults with functional impairment (mild to severe) and 13 frontline nursing staff from an LTCF in Chongqing for semi-structured interviews conducted between July and September 2025. The interview data were analyzed using qualitative content analysis. Results Four interrelated main themes were identified, covering individual capacity, psychosocial support, and systemic resource dimensions: autonomy and health decision-making involvement, health literacy enhancement and cognitive empowerment, psychological motivation and social connectedness, and structural health promotion resources and service systems. Conclusion These unmet needs collectively hinder the transition from passive compensatory care to proactive health management. Meeting the proactive health needs of older adults with functional impairment in LTCFs requires the construction of a three-dimensional empowerment system of “individual-institution-society”: restoring autonomy through decision-making empowerment, enhancing cognitive capacity through tiered health education, strengthening psychological connection through social network reconstruction, and integrating service resources through mechanisms for coordinating medical and older adult care.
Yixin Wang, Lan-Yue Luo, Liyu Chen et al.· Frontiers in Public Health· 0 citations
BACKGROUND
Patients undergoing interventional treatment (e.g., TAVR) are predominantly older adults characterized by frailty and multiple comorbidities. While exercise-based cardiac rehabilitation is beneficial, existing guidelines are often generalized, with limited structured protocols specifically tailored to the safety needs and physical limitations of this vulnerable population.
OBJECTIVES
To construct an evidence-based, expert consensus protocol for exercise rehabilitation specifically tailored for older adults after interventional treatment for valvular heart disease.
METHOD
A systematic literature review and evidence synthesis were conducted, followed by two rounds of modified Delphi consultations with 17 multidisciplinary experts from six provinces in China. Authority coefficients (Cr) were calculated to assess expert validity, and consensus was evaluated using Kendall's W and coefficients of variation.
RESULTS
Expert engagement was high, with response rates of 77.3% and 100% in the two rounds, and high authority (Cr > 0.7). Consensus was achieved across feasibility, appropriateness, and effectiveness (Kendall's W, P < 0.05). The final protocol comprises 8 dimensions and 36 items. Key geriatric-focused features include preoperative frailty and fall risk assessments, staged low-intensity prehabilitation, and culturally adapted home-based exercises (e.g., Tai Chi/Baduanjin) to support safety and adherence. A multi-level safety-oriented framework was developed, incorporating risk stratification, individualized low-intensity exercise prescription, continuous physiological monitoring, and structured follow-up during rehabilitation.
CONCLUSIONS
This consensus-based protocol addresses the needs of older valve intervention patients by integrating safety monitoring with individualized, progressive exercise prescriptions. It provides a practical, safety-oriented framework for healthcare professionals to implement early mobilization and home-based rehabilitation, ultimately supporting functional recovery in high-risk elderly patients.
Rongxiang Zhang, Linjing Wu, Xiaoyan Lan et al.· Geriatric Nursing· 0 citations
Entering an aging society is a social dynamic that affects economic structures, quality of life, and public health systems particularly in everyday elderly healthcare, where risks of chronic diseases and accidents increase due to age-related physical decline. Although a wide range of health-monitoring products and smart products are now available, most designs primarily target working-age users or those familiar with technology. This creates a usability gap for older adults who may face limitations in perception, mobility, and digital literacy. This research focuses on identifying suitable attributes of smart health products for older adults and developing industrial design guidelines that integrate functionality, user experience, and aesthetics.
This research has two objectives: 1) to explore the required attributes of smart healthcare products that are appropriate for older adults, and 2) to identify design approaches for smart healthcare products that respond to older adults’ needs. A mixed-methods approach was employed, including in-depth interviews with five healthcare experts, an evaluation of four prototype design approaches by three industrial design experts, and a satisfaction survey with older adults.
The research methodology began with secondary data review and the collection of 24 case studies of smart healthcare products that had been published or received international awards, in order to classify usage formats and types of technology. Research instruments were then developed as in-depth interview protocols, and interviews were conducted with five experts in older adult healthcare to assess the suitability of different smart health product features. A suitability rating criterion was applied to rank these features. Next, the findings were used to develop four prototype concepts, focusing on a body temperature measuring device for older adults as an experimental platform to explore form, grip and handling, light/symbol-based feedback, and overall user experience. Subsequently, three product/industrial design experts evaluated the suitability of the four prototypes across multiple dimensions, including design concept, form/size, color and surface texture, strength/safety, materials, and functional features. In addition, quantitative data were collected from 15 older adults aged 60 and above, following a user-centered approach through direct observation of users’ needs and contexts and prototype testing. Satisfaction was measured using a 5-point Likert scale questionnaire, and the results were analyzed using descriptive statistics.
The research findings indicate that: 1) Based on the analysis of 24 smart healthcare product samples, the products can be classified into three main usage categories: wearable devices, portable devices, and home-based and service devices. Across these categories, commonly observed technologies include sensor systems, connectivity with smartphones or the Internet of Things (IoT), and alert mechanisms for safety or monitoring. 2) Interview results and suitability ratings from five healthcare experts reveal that the most appropriate attributes for older adults are body temperature measurement, blood pressure measurement, heart rate monitoring, activity tracking, blood oxygen measurement, and sleep detection, while fall detection was rated as moderately suitable. In contrast, blood glucose monitoring and gluten detection in food received low suitability ratings. 3) The researcher used these findings to develop four prototype concepts, employing a body temperature measuring device for older adults as a test case to explore form, grip/handling, light or symbol-based information display, and status communication. Evaluation by three industrial design experts across multiple dimensions—concept, form/size, color and surface texture, durability/safety, materials, and functional features—found that Prototype 3 achieved the highest overall suitability. The criterion “the design concept is interesting” was rated at the highest level (x ̅ = 5.00, S.D. = 0), while criteria related to appropriate form/size are appropriate and easy to use, colors and texture are attractive, non-hazardous materials, safe durability, and functional usefulness were rated high (x ̅ = 4.67, S.D. = 0.58); strength and safety were also rated high (x ̅ = 4.33, S.D. = 0.58). 4) Prototype testing with 15 older adults showed that Prototype 4 received the highest satisfaction across nearly all aspects, particularly clear and engaging information display (x ̅ = 4.93), technological modernity (x ̅ = 4.80), and color/surface texture (x ̅ = 4.73). These results suggest that prototypes with clear status communication, reduced learning burden, and appropriate aesthetics are more suitable for older adults’ use. Therefore, classifying smart health products by usage patterns and technologies, together with defining essential and suitable healthcare attributes for older adults, provides a design strategy that links ergonomic principles, light- or symbol-based information communication, material safety, and a balance between aesthetics and usability. The outcomes can be extended as a framework for developing and evaluating smart health products for older adults, contributing to industrial design scholarship and digital health innovation for effective monitoring, follow-up, and risk prevention in aging societies in a sustainable manner.
OBJECTIVES
Chronic conditions represent a growing global health challenge, requiring ongoing management in which patients play an active role. Although patient empowerment is increasingly recognized as important, practical insights on how to support it remain limited. This scoping review aims to identify key factors promoting patient empowerment in managing chronic conditions.
METHODS
A literature search was conducted in Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus in March 2025. Studies were included if they described factors, strategies, interventions, experiences, or perspectives related to promoting patient empowerment in adults (≥18 years) with chronic conditions (i.e. cardiovascular diseases, osteoarthritis, respiratory conditions, and/or diabetes). Papers focusing on acute conditions, non-empirical work, studies without full-text availability, or those not published in English were excluded. Article screening was conducted using the artificial intelligence (AI)-based tool Automated Systematic Review (ASReview), applying the SAFE procedure to determine an appropriate stopping point.
RESULTS
The literature search yielded 29,929 articles, of which 66 were included in the final analysis. Key factors promoting patient empowerment included knowledge and skills education, personalized care planning and goal setting, social and peer support, patient-provider communication, and (remote) monitoring and follow-up. Additionally, digital tools, such as mobile health applications and online platforms, emerged as important facilitators.
CONCLUSION
This review shows that patient empowerment in chronic care can be promoted by multiple factors that appear broadly relevant across chronic conditions and healthcare contexts. Digital tools may further strengthen this process.
PRACTICE IMPLICATIONS
Future efforts should focus on bridging the gap between these theoretical insights and real-world practice.
L. H. Peters, V.H.J. Debie, M. Vervloet et al.· Patient Education and Counse...· 0 citations