Rose Lin

Introduction: This study examined the moderating role of positive emotion in the relationship between trait-like stress reactivity and negative emotion, and whether this moderating effect varies by cognitive performance and cognitive decline across nine years. Methods: Using data from 2,041 participants in the Midlife in the United States (MIDUS) study (mean age = 65.52 years), hierarchical regression models were conducted to predict negative emotion from trait-like stress reactivity, positive emotion, and their interaction, controlling for age, gender, years of education, depressed mood, and neuroticism. Simple slope analyses were conducted to test the direction of significant interactions. Analyses were repeated within subgroups of cognitive performance and cognitive decline across 9 years. Results: The interaction between positive emotion and trait-like stress reactivity was significant, with higher positive emotion associated with a weaker relationship between stress reactivity and negative emotion. This moderating effect was observed across low, moderate, and high cognitive performance groups; a three-way interaction further indicated that the moderating effect becomes stronger as cognitive performance increases. For cognitive decline, the moderating effect was significant only among individuals with relatively greater cognitive decline, although the three-way interaction was not significant. Conclusion: Positive emotion may buffer the relationship between trait-level stress reactivity and negative emotion across the cognitive performance range, although this moderating effect appears weaker at lower cognitive performance. Findings for cognitive decline were less conclusive, as a subgroup-specific association among participants with greater decline was not confirmed when cognitive decline was analyzed as a continuous moderator.

Background: Informal caregivers are essential in supporting community-dwelling older adults, especially as global populations age. However, caregiving responsibilities often result in high stress, depressive symptoms, and diminished quality of life. Traditional support services are fragmented, and many programs overlook caregivers’ emotional and informational needs. Telecare—the remote delivery of health and social care via digital technologies—offers a promising approach to provide accessible, personalized, and timely support. Objective: This study evaluated the effectiveness of a telecare-based intervention program, developed by a health-social partnership team, in improving psychological well-being and caregiving outcomes among informal caregivers of community-dwelling older adults. We hypothesized that caregivers in the intervention group would show greater improvements in stress, self-efficacy, depression, quality of life, and caregiving burden compared to those receiving usual care. Methods: A single-blind randomized controlled trial was conducted from January to December 2023, with 75 informal caregivers providing care to older adults (aged ≥60 y) for at least 4 hours per week. Participants were randomized to an intervention group (n=38, 51%) or a control group (n=37, 49%). The 3-month intervention included (1) biweekly online nurse case management supported by a multidisciplinary health-social team, (2) personalized WhatsApp videos on caregiving skills, and (3) a password-protected caregiver website offering resources and peer discussion. The control group attended 6 in-person educational sessions at a community center. Outcomes such as stress, self-efficacy, depression, quality of life, and caregiving burden were measured at baseline and postintervention. Results: Participants had a mean age of 65.5 (SD 9.617) years, and 81.3% (61/74) were female. Baseline characteristics were similar between groups. Compared to controls, the intervention group showed significantly higher self-efficacy ( t =1.98; P =.04) and lower depression ( t =−2.24; P =.03) at follow-up. Within-group improvements in the intervention group were also observed for stress, depression, self-efficacy, mental quality of life, and caregiving burden. No significant between-group differences were found for stress, quality of life, or caregiving burden. No significant within-group improvements were observed in the control group. Conclusions: This study provides novel evidence that a digitally delivered, nurse-led telecare program—integrating health and social services—can improve psychological outcomes among informal caregivers. These findings have practical implications for health systems seeking scalable, low-barrier solutions to support caregivers. Telecare models may be a valuable complement to traditional services, enhancing caregiver resilience and promoting aging in place while alleviating long-term strain on institutional care systems.

Background: Neuropsychiatric symptoms (NPS) are highly prevalent among older adults with mild cognitive impairment (MCI) and predict faster cognitive decline. These symptoms likely reflect maladaptive emotional responses to everyday stressors, yet retrospective assessments cannot capture stress–affect dynamics as they unfold in daily life. Although ecological momentary assessment (EMA) has been adopted to measure emotions and cognitive functioning in MCI, whether older adults with MCI can identify and report stressor sources in real-time, which is essential for understanding stress appraisal processes underlying NPS, remains understudied. We evaluated the feasibility and acceptability of a tailored 7-day smartphone EMA protocol for older adults with MCI to capture momentary emotions and stress responses. Methods: Sixteen participants with MCI (mean age=76.45; 50% female) received four semi-random EMA prompts daily for 7 days, assessing perceived stress, positive and negative emotions, and stressor exposure. Feasibility criteria: retention ≥80%, adherence ≥80% of delivered prompts, completion time< 3 minutes, no survey fatigue, and technical support requests. Acceptability was evaluated through user experience surveys and semi-structured interviews. Results: All participants completed the protocol (100% retention). Mean adherence was 86.8% (range: 53.57%–100%), yielding 404 of 448 completed prompts (mean 25.25 surveys per participant; 2.21 minutes per survey). Time-series plots showed meaningful affective variability without evidence of fatigue. Participants described the protocol as non-burdensome, and several reported stressors via open-ended responses. Visual inspection suggested that mood fluctuations were aligned with stressor exposure. Conclusion: Smartphone-based EMA is feasible and acceptable for capturing daily stressors and emotions among older adults with MCI, advancing our understanding of stress-emotion dynamics in this population.

Background: Survivors of stroke often face persistent challenges accessing postdischarge care due to mobility limitations, transportation burdens, and inflexible scheduling. Teleconsultation has emerged as a potential solution to improve continuity of care, but its perceived strengths and limitations from the patient perspective remain insufficiently understood. Objective: This study aimed to explore the experiences of survivors of stroke with a nurse-led teleconsultation program to (1) identify perceived capabilities; (2) understand limitations in usability, accessibility, and clinical function; and (3) generate patient-informed recommendations for improvement. Methods: A qualitative study was embedded within a 3-month nurse-led teleconsultation intervention delivered by advanced practice nurses. A total of 21 survivors of ischemic stroke (aged 45-76 y; female: n=11, 52%) who had preserved cognitive function (Montreal Cognitive Assessment score ≥22) and smartphone access participated in 6 focus groups conducted via Zoom. Data were analyzed thematically using an established framework. Data saturation was achieved. Results: Participants widely valued teleconsultation for reducing logistical burdens; enhancing access; and offering a more comfortable, emotionally supportive setting for follow-up care. Many reported increased awareness and motivation for self-monitoring. However, limitations included an inability to perform physical assessments or respond to emergencies; digital and usability barriers, especially among older users; and scheduling inflexibility. Participants emphasized the need for patient-initiated follow-up mechanisms, physician collaboration for medication management, and greater support for users considered digitally marginalized. They also highlighted the potential of teleconsultation to serve as a triage tool, reserving in-person care for complex cases. Conclusions: Nurse-led teleconsultation was perceived as a convenient and supportive modality for poststroke care, particularly for stable follow-ups and psychosocial support. However, its long-term viability depends on addressing clinical and technical limitations, enhancing user autonomy, and integrating interdisciplinary input. By centering the lived experiences of survivors of stroke, this study offers concrete recommendations to guide the development of more inclusive, responsive, and patient-centered teleconsultation models.

Objective: With the increasing incidence of dementia, lifestyle interventions are key for long‐term risk reduction. Understanding the psychological factors affecting lifestyle change motivation is crucial to developing effective policy strategies for dementia risk reduction. This study explores the moderating role of dementia‐related fear on the relationship between perceived cognitive decline and engagement in dementia risk reduction behaviors. Methods: A cross‐sectional study was conducted among 200 Chinese community‐dwelling middle‐aged and older adults. Hierarchical regression and simple slope analysis were used to assess the moderating effect of dementia‐related fear on the relationship between perceived cognitive decline and motivation to engage in dementia risk reduction behaviors. Results: A significant correlation was found between perceived cognitive decline and increased motivation to engage in dementia risk reduction behaviors ( r = 0.44). Dementia‐related fear acted as a significant moderator; motivation was positively associated with low to moderate levels of fear, whereas this association diminished and became non‐significant at higher levels of fear. Conclusions: The findings suggest that while lower levels of dementia‐related fear may be linked to increased motivation for engaging in risk reduction behaviors, elevated levels of fear do not appear to support such engagement. Rather than emphasizing the negative impacts of dementia, public health strategies should empower individuals with actionable messages to engage in dementia risk reduction behaviors.

Positive emotions can buffer stress‐related negative emotions; however, it remains unclear whether such protective benefits extend to middle‐aged and older adult caregivers of family members with dementia, a population particularly vulnerable to stress and its health consequences. This secondary analysis of laboratory data from a parent clinical trial (R01AG049764) examined the role of sustaining positive affect in buffering the effects of stress‐related emotional reactivity on subsequent negative mood. This study recruited 192 cognitively healthy, middle‐aged, and older adults who were dementia caregivers (mean age = 68.14) reported high stress and/or caregiver burden. During a laboratory session, emotional reactivity to an acute stressor (a math and working memory task) was assessed using changes in valence and arousal from the Self‐Assessment Manikin (SAM) before and after the stressor. Positive and Negative Affect Schedule (PANAS) was completed 10 min before and 40 min after stressor task. Hierarchical regression models tested whether the changes of positive affect across the session moderated associations between SAM valence/arousal reactivity to the stressor and later negative mood. As hypothesised, greater negative valence and arousal reactivity to acute stressor were each associated with higher negative mood later. Among caregivers with less decline in positive affect across session, associations between valence/arousal reactivity and later negative mood were weakened. Our findings support the undoing hypothesis, demonstrating that maintaining positive affect mitigates the impact of emotional reactivity on negative mood. This suggested that interventions fostering sustained positive emotions may be a promising strategy to enhance caregivers' stress adaptation and promote healthier ageing.

Background: Mobile health (mHealth) is increasingly being used in contemporary health care provision owing to its portability, accessibility, ability to facilitate communication, improved interprofessional collaboration, and benefits for health outcomes. However, there is limited discourse on patient safety in real-world mHealth implementation, especially as care settings extend beyond traditional center-based technology usage to home-based care. Objective: This study aimed to explore health care professionals’ perspectives on the safety aspects of mHealth integration in real-world service provision, focusing on Hong Kong Special Administrative Region (SAR) and Wuhan city in mainland China. In Hong Kong SAR, real-world mHealth care provision is largely managed by the Hospital Authority, which has released various mobile apps for home-based care, such as Stoma Care, Hip Fracture, and HA Go. In contrast, mHealth care provision in Wuhan is institutionally directed, with individual hospitals or departments using consultation apps, WeChat mini-programs, and the WeChat Official Accounts Platform (a subapp within the WeChat ecosystem). Methods: A multicenter qualitative study design was used. A total of 27 participants, including 22 nurses and 5 physicians, from 2 different health care systems were interviewed individually. Thematic analysis was used to analyze the data. Results: The mean age of the participants was 32.19 (SD 3.74) years, and the mean working experience was 8.04 (SD 4.05) years. Most participants were female (20/27, 74%). Nearly half of the participants had a bachelor’s degree (13/27, 48%), some had a master’s degree (9/27, 33%), and few had a diploma degree (3/27, 11%) or a doctoral degree (2/27, 7%). Four themes emerged from the data analysis. Considering the current uncertainties surrounding mHealth implementation, participants emphasized “liability” concerns when discussing patient safety. They emphasized the need for “change management,” which includes appropriate referral processes, adequate resources and funding, informed mHealth usage, and efficient working processes. They cautioned about the risks in providing mHealth information without ensuring understanding, appreciated the current regulations available, and identified additional regulations that should be considered to ensure information security. Conclusions: As health care systems increasingly adopt mHealth solutions globally to enhance both patient care and operational efficiency, it becomes crucial to understand the implications for patient safety in these new care models. Health care professionals recognized the importance of patient safety in making mHealth usage reliable and sustainable. The promotion of mHealth should be accompanied by the standardization of mHealth services with institutional, health care system, and policy-level support. This includes fostering mHealth acceptance among health care professionals to encourage appropriate referrals, accommodate changes, ensure patient comprehension, and proactively identify and address threats to information security.