2026-03-31
Sara Alves, Natália Duarte, Teodora Figueiredo, Luis Midao, Maria João Bessa, Olalla Rodriguéz, José Fidalgo, Irene Fernandez, Alba Felpete, Maxi Rodriguéz, Juan Carlos Bernardéz, David Facal, Joana Carrilho, Elísio Costa
Background: Dementia affects more than 55 million people worldwide, and its progressive cognitive decline creates substantial challenges for intervention testing and real-world implementation. Living Labs (LLs) have become increasingly relevant for piloting interventions in dementia care, offering real-world environments for cocreation and iterative testing. However, operational, ethical, and governance challenges can hinder the effective implementation of dementia-focused initiatives. Objective: This study aimed to identify and synthesize the facilitators and challenges encountered when piloting dementia-related initiatives within an LL approach. Methods: A systematic review was conducted in PubMed, Web of Science, Scopus, and EBSCOhost from database inception to January 31, 2024. Studies were eligible if they reported the piloting, implementation, or evaluation of dementia-related initiatives in an LL context. A narrative synthesis was performed using content analysis for initial coding and thematic analysis for theme development. The systematic review was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: The 15 included studies were mostly conducted in European countries. Two major themes emerged, namely (1) organizational and operational issues and (2) ethical and legal considerations. Within these, 4 key operational subthemes were identified: engaging people living with dementia (end users), research design and evaluation methods, co-design and testing phases, and LL governance. Ethical and legal considerations covered informed consent procedures and regulatory aspects. Across studies, the most frequently reported facilitators involved familiar environments, stakeholder collaboration, iterative evaluation, and flexible co-design processes. Barriers commonly included fluctuating cognitive symptoms, limited digital literacy, inconsistent stakeholder engagement, time and resource constraints, and fragmented regulatory guidance. Conclusions: Piloting dementia initiatives in LLs requires methodological adaptability, strong governance structures, and ethical procedures tailored to cognitive impairment. These findings provide actionable guidance for researchers, practitioners, industry partners, and policymakers seeking to develop sustainable, user-centered LLs that support innovation in dementia care.
2026-03-23
Eunhee Cho, Sinwoo Hwang, Minhee Yang, Eunkyo Kim, Jungwon Cho, Chang Park
Background: A higher prevalence of behavioral and psychological symptoms of dementia is associated with a greater caregiver burden and increased mortality in people with dementia. Considering the possibility of a reciprocal relationship between sleep disturbances and these symptoms, time series analyses are necessary to explore the associated temporal dynamics. Objective: This study aimed to examine dynamic interdependencies between sleep disturbances and behavioral and psychological symptoms of dementia in older adults. Methods: Daily interactions between sleep patterns and behavioral and psychological symptoms of dementia were analyzed over a 14-day period using a panel vector autoregressive model. Data were collected from June 2018 to June 2020 in community and institutional settings. A total of 154 older adults with dementia wore wrist actigraphy devices continuously for 2 weeks for sleep data, and caregivers recorded behavioral and psychological symptoms of dementia in a daily symptom diary. Results: Using a panel vector autoregressive model, we analyzed data from 154 older adults living with dementia and their caregivers. The results showed unidirectional Granger causality running from the number of awakenings on the previous day to irritability ( P =.03) and appetite or eating disorders ( P =.04) on the following day. Conversely, some of the previous day’s behavioral and psychological symptoms of dementia temporally preceded subsequent changes in sleep patterns. Specifically, delusions had a Granger-causality effect on total sleep time ( P <.001), wake after sleep onset ( P =.01), and the number of awakenings ( P =.006), while irritability had a Granger causality effect on the number of awakenings ( P =.007). Notably, bidirectional Granger causality was observed between irritability and the number of awakenings. Conclusions: This study demonstrates that the relationship between the behavioral and psychological symptoms of dementia and sleep patterns is dynamic and forms a vicious cycle. Consequently, early intervention to alleviate symptoms is imperative, and strategies to enhance sleep quality and address sleep disturbances should be prioritized.
2026-03-17
Bo Zhao, Xiaoyan Wang, Ren Chen, Eun Woo Nam
Background: Rapid population aging and the intensifying digitalization of everyday life are unfolding simultaneously in China. While prior studies have largely examined pairwise associations among digital inclusion, social engagement, mental health, and overall health status, few have evaluated an integrated, theoretically grounded pathway linking these domains in later life. Objective: This study aims to quantify the direct and indirect pathways through which digital inclusion influences older adults’ overall health status, social engagement, and mental health, specified as sequential mediators. Methods: We analyzed the newly released, nationally representative data from the 2023 wave of the China Longitudinal Aging Social Survey, comprising 9918 adults aged 60 years or older. Overall health status was assessed using 3 self-rated health (SRH) indicators: current SRH, SRH relative to age peers, and SRH relative to last year. Digital inclusion was measured through digital access, device proficiency, and digital ability. Social engagement captured social support, frequency of participation in community or voluntary activities, and nononline activities. Mental health included depressive symptoms, social adaptation, and life satisfaction. Analyses included descriptive statistics, multivariable hierarchical linear regressions, and structural equation modeling to estimate direct and mediated effects (2-sided α=.05). Results: Older age, chronic disease, and functional limitations were associated with poorer overall health status, whereas higher education and current employment were associated with better health status. Digital inclusion was positively associated with social engagement (β=.50), which in turn was positively associated with mental health. Mental health showed the strongest association with SRH (β=.74). The direct path from social engagement to overall health status was nonsignificant (=.34), indicating that participation influences health primarily through psychological pathways. In regression analyses, digital inclusion modestly improved model fit for health status outcomes, while adding mental health produced a greater increase. Conclusions: Digital inclusion promoted active aging indirectly, by expanding social engagement and enhancing mental health, thereby improving overall health status. Policy efforts should prioritize narrowing the digital divide by improving digital skills and capability, rather than access alone. Meaningful opportunities for social engagement should also be expanded to strengthen community-based mental health support. In addition, strategies should be tailored to the differing needs of urban and rural settings.