Application of machine learning in predicting frailty syndrome in patients with heart failure

Prevention and diagnosis of frailty syndrome (FS) in patients with heart failure (HF) require innovative systems to help medical personnel tailor and optimize their treatment and care. Traditional methods of diagnosing FS in patients could be more satisfactory. Healthcare personnel in clinical settings use a combination of tests and self-reporting to diagnose patients and those at risk of frailty, which is time-consuming and costly. Modern medicine uses artificial intelligence (AI) to study the physical and psychosocial domains of frailty in cardiac patients with HF. This paper aims to present the potential of using the AI approach, emphasizing machine learning (ML) in predicting frailty in patients with HF. Our team reviewed the literature on ML applications for FS and reviewed frailty measurements applied to modern clinical practice. Our approach analysis resulted in recommendations of ML algorithms for predicting frailty in patients. We also present the exemplary application of ML for FS in patients with HF based on the Tilburg Frailty Indicator (TFI) questionnaire, taking into account psychosocial variables

Clinical Frailty Scale - frailty assessment and rehabilitation potential

Background: Studies show a significant increase in frailty prevalence among older adults worldwide. Fortunately, several well-established and user-friendly screening tools can effectively identify frailty in older adults. Objectives: This article examines the Clinical Frailty Scale's effectiveness in informing treatment decisions for older adults in ambulatory care settings, analyzing its potential to improve patient care. Methods: On April 1, 2024, the PubMed database was searched for articles on the Clinical Frailty Scale in elderly patients. The 116 most pertinent and current articles, written in English and published within the past few years, were analyzed, and 38 were selected and categorized by content and topic.   Limitations: This study is limited because it is not a meta-analysis and thus does not examine the quality of the evidence presented in each article. Conclusions: Frailty research has illuminated aging and its potential biological causes. The Clinical Frailty Scale effectively identifies vulnerable individuals. By using the CFS to assess frailty risk, healthcare providers can personalize treatment plans and improve overall care for older adults

Identifying Frail Patients by Using Electronic Health Records in Primary Care: Current Status and Future Directions.

With the rapidly aging population, frailty, characterized by an increased risk of adverse outcomes, has become a major public health problem globally. Several frailty guidelines or consensuses recommend screening for frailty, especially in primary care settings. However, most of the frailty assessment tools are based on questionnaires or physical examinations, adding to the clinical workload, which is the major obstacle to converting frailty research into clinical practice. Medical data naturally generated by routine clinical work containing frailty indicators are stored in electronic health records (EHRs) (also called electronic health record (EHR) data), which provide resources and possibilities for frailty assessment. We reviewed several frailty assessment tools based on primary care EHRs and summarized the features and novel usage of these tools, as well as challenges and trends. Further research is needed to develop and validate frailty assessment tools based on EHRs in primary care in other parts of the world

SHELDON Smart habitat for the elderly.

An insightful document concerning active and assisted living under different perspectives: Furniture and habitat, ICT solutions and Healthcare

Prevention and Management of Frailty

It is important to prevent and manage the frailty of the elderly because their muscle strength and physical activity decrease in old age, making them prone to falling, depression, and social isolation. In the end, they need to be admitted to a hospital or a nursing home. When successful aging fails and motor ability declines due to illness, malnutrition, or reduced activity, frailty eventually occurs. Once frailty occurs, people with frailty do not have the power to exercise or the power to move. The functions of the heart and muscles are deteriorated more rapidly when they are not used. Consequently, frailty goes through a vicious cycle. As one’s physical fitness is deteriorated, the person has less power to exercise, poorer cognitive functions, and inferior nutrition intake. Consequently, the whole body of the person deteriorates. Therefore, in addition to observational studies to identify risk factors for preventing aging, various intervention studies have been conducted to develop exercise programs and apply them to communities, hospitals, and nursing homes for helping the elderly maintain healthy lives. Until now, most aging studies have focused on physical frailty. However, social frailty and cognitive frailty affect senile health negatively just as much as physical frailty. Nevertheless, little is known about social frailty and cognitive frailty. This special issue includes original experimental studies, reviews, systematic reviews, and meta-analysis studies on the prevention of senescence (physical senescence, cognitive senescence, social senescence), high-risk group detection, differentiation, and intervention

Biomarkers of aging in frailty and age-associated disorders: State of the art and future perspective

According to the Geroscience concept that organismal aging and age-associated diseases share the same basic molecular mechanisms, the identification of biomarkers of age that can efficiently classify people as biologically older (or younger) than their chronological (i.e. calendar) age is becoming of paramount importance. These people will be in fact at higher (or lower) risk for many different age-associated diseases, including cardiovascular diseases, neurodegeneration, cancer, etc. In turn, patients suffering from these diseases are biologically older than healthy age-matched individuals. Many biomarkers that correlate with age have been described so far. The aim of the present review is to discuss the usefulness of some of these biomarkers (especially soluble, circulating ones) in order to identify frail patients, possibly before the appearance of clinical symptoms, as well as patients at risk for age-associated diseases. An overview of selected biomarkers will be discussed in this regard, in particular we will focus on biomarkers related to metabolic stress response, inflammation, and cell death (in particular in neurodegeneration), all phenomena connected to inflammaging (chronic, low-grade, age-associated inflammation). In the second part of the review, next-generation markers such as extracellular vesicles and their cargos, epigenetic markers and gut microbiota composition, will be discussed. Since recent progresses in omics techniques have allowed an exponential increase in the production of laboratory data also in the field of biomarkers of age, making it difficult to extract biological meaning from the huge mass of available data, Artificial Intelligence (AI) approaches will be discussed as an increasingly important strategy for extracting knowledge from raw data and providing practitioners with actionable information to treat patients

State of the art on ethical, legal, and social issues linked to audio- and video-based AAL solutions - Uploaded on December 29, 2021

Ambient assisted living (AAL) technologies are increasingly presented and sold as essential smart additions to daily life and home environments that will radically transform the healthcare and wellness markets of the future. An ethical approach and a thorough understanding of all ethics in surveillance/monitoring architectures are therefore pressing. AAL poses many ethical challenges raising questions that will affect immediate acceptance and long-term usage. Furthermore, ethical issues emerge from social inequalities and their potential exacerbation by AAL, accentuating the existing access gap between high-income countries (HIC) and low and middle-income countries (LMIC). Legal aspects mainly refer to the adherence to existing legal frameworks and cover issues related to product safety, data protection, cybersecurity, intellectual property, and access to data by public, private, and government bodies. Successful privacy-friendly AAL applications are needed, as the pressure to bring Internet of Things (IoT) devices and ones equipped with artificial intelligence (AI) quickly to market cannot overlook the fact that the environments in which AAL will operate are mostly private (e.g., the home). The social issues focus on the impact of AAL technologies before and after their adoption. Future AAL technologies need to consider all aspects of equality such as gender, race, age and social disadvantages and avoid increasing loneliness and isolation among, e.g. older and frail people. Finally, the current power asymmetries between the target and general populations should not be underestimated nor should the discrepant needs and motivations of the target group and those developing and deploying AAL systems. Whilst AAL technologies provide promising solutions for the health and social care challenges, they are not exempt from ethical, legal and social issues (ELSI). A set of ELSI guidelines is needed to integrate these factors at the research and development stage

State of the art on ethical, legal, and social issues linked to audio- and videobased AAL solutions

Working Group 1. Social responsibility: Ethical, legal, social, data protection and privacy issuesAbstract Ambient assisted living (AAL) technologies are increasingly presented and sold as essential smart additions to daily life and home environments that will radically transform the healthcare and wellness markets of the future. An ethical approach and a thorough understanding of all ethics in surveillance/monitoring architectures are therefore pressing. AAL poses many ethical challenges raising questions that will affect immediate acceptance and long-term usage. Furthermore, ethical issues emerge from social inequalities and their potential exacerbation by AAL, accentuating the existing access gap between high-income countries (HIC) and low and middle-income countries (LMIC). Legal aspects mainly refer to the adherence to existing legal frameworks and cover issues related to product safety, data protection, cybersecurity, intellectual property, and access to data by public, private, and government bodies. Successful privacy-friendly AAL applications are needed, as the pressure to bring Internet of Things (IoT) devices and ones equipped with artificial intelligence (AI) quickly to market cannot overlook the fact that the environments in which AAL will operate are mostly private (e.g., the home). The social issues focus on the impact of AAL technologies before and after their adoption. Future AAL technologies need to consider all aspects of equality such as gender, race, age and social disadvantages and avoid increasing loneliness and isolation among, e.g. older and frail people. Finally, the current power asymmetries between the target and general populations should not be underestimated nor should the discrepant needs and motivations of the target group and those developing and deploying AAL systems. Whilst AAL technologies provide promising solutions for the health and social care challenges, they are not exempt from ethical, legal and social issues (ELSI). A set of ELSI guidelines is needed to integrate these factors at the research and development stage. Keywords Ethical principles, Privacy, Assistive Living Technologies, Privacy by Design, General Data Protection Regulation.publishedVersio

Co-creation of a person-centred integrated digital health model of care for fragility hip fractures: a mixed methods pragmatic research

Hip fracture is among the most devastating events faced by older people. These fragility fractures often occur due to trivial or low trauma falls. Current treatment efforts have led to best practice management guidelines and clinical audits at the level of the acute hospital setting and, to a certain extent, immediate post-hospital discharge. However, concerns still exist in the areas of prevention and rehabilitation outcomes including quality of life, and functional independence. Based on emerging evidence, a more nuanced approach is required for future health services delivery which incorporates: 1) musculoskeletal health; 2) increasing burden of multimorbidities; and 3) societal influences and circumstances shaping individual’s health literacy including access to digital technology. The aim of this thesis work is to conduct a program of research focused on establishing a personcentred and integrated model of care for older people with hip fractures assisted by digital health technology and modern educational approaches. The goal is to improve outcomes such as health literacy, access, functional rehabilitation, and quality of life. Objectives 1. To map out digital health interventions by conducting a comprehensive systematic review, which evaluates the effectiveness of digital health supported targeted patient communication versus usual provision of health information, on the recovery from fragility fractures. 2. To determine different phases of a research program for the development of a digital health hub enabled model of care focused on hip fracture rehabilitation through a dynamic conceptual framework. 3. To understand the perspective of older people with hip fractures, their family members, and residential aged carers, to inform the development of a personalised digital health hub and factors impacting the likelihood of potential usage. 4. To understand the perspectives of clinicians from various medical and surgical disciplines, allied health, and other relevant non-health stakeholders to inform the development of a digital health enabled model of care for fragility fractures. 5. To examine the process and management of innovation, and the strategic directions required to improve musculoskeletal healthcare at macro (policy), meso (service delivery), and micro (clinical practice) levels and discuss the critical role of different stakeholders in driving innovations in healthcare. 6. To describe a vision for future health care to address increasing population multimorbidity through the co-creation of personalised digital health hubs that recognise the importance of patient agency in driving the evolution of health services. This study emphasises that digital health solutions must be co-created and co-implemented by engaging relevant stakeholders including end consumers at the local contextual level. Developed countries such as Australia are emerging global leaders in contemporary research focused on advancing knowledge and filling gaps within existing health service delivery for older people.Thesis (Ph.D.) -- University of Adelaide, Adelaide Medical School, 202

Aplicaciones psicosociales de la tecnología para la capacitación en salud y bienestar de adultos mayores con demencia y deterioro cognitivo leve y sus cuidadores en zonas rurales

Tesis por compendio de publicaciones.[EN]Introduction: The transition to an ageing population has brought several challenges to societies and healthcare systems around the world. The need for new healthcare approaches and interventions to adjust to the new situation is one of the most relevant issues worldwide. This project particularly targets three of these challenges: the complexity of older adult care, the increase of people living with dementia and their caregivers, and the poor accessibility of rural populations to access healthcare services to face these challenges. Aims: To develop a proof of concept of a technological platform integrating several innovative digital tools for health and wellness coaching of older adults with dementia and cognitive impairment and their carers, and to study the effects of utilisation of the platform on physical health, mental and emotional wellbeing, activities of daily living, social and cognitive functioning and professional care use. To involve older adults with dementia and their carers in the design and development of the platform, assessing their satisfaction, the impact of the system in realistic settings, acceptability and usability, to enable them to manage the system autonomously in daily life. Methodologies: Two systematic reviews were conducted in July 2021 and April 2023 in PubMed, CINAHL, and Web of Science. A qualitative appraisal/risk of bias was performed for the studies included. Three qualitative studies were conducted, implementing online and face-to-face workshops, semi-structured interviews, focus groups, and co-design and co-production processes with Patient and Public Involvement (PPI). Thematic analysis was the chosen approach for the analysis of the results. A mixed-methods usability and user experience study and a pilot study of an online training and support programme for caregivers of people living with dementia are being carried out, implementing semi-structured interviews and questionnaires targeting usability, dementia knowledge and caregiver burden. Results: A series of steps necessary to create the foundations of a technological platform were identified: a) the interRAI LTFC and the interRAI HC were recommended as the CGAs to be used for the assessment and monitoring of potential users in long-term care facilities and home care, respectively; b) the barriers for the usability and implementation of DHTs to assist and to help to reach the full potential of CGAs are described, as well as a series of recommendations to improve its usability and implementation by healthcare professionals and clinical settings; c) a framework to study the pros and cons of developing digital patient and public involvement and suggestions to improve the implementation of e-PPI were developed and identified; d) the facilitators and barriers to implementing the socio-community intervention of the Meeting Centre Support Programme were identified and several recommendations were described to overcome the limitations for a successful implementation; and e) as an attempt to offer a support service alternative for caregivers of PLwD in remote rural areas, the cultural adaptation of the iSupport training and support programme for carers of PLwD was developed, and its usability and user-experience, and impact on dementia knowledge and caregiver burden are under study. Conclusions: This project described a series of steps necessary to create the foundations of a technological platform for health and wellness coaching of older adults with dementia and cognitive impairment and their carers. By embedding the findings in this project and including novel technologies such as AI, robotics, wearable technologies, and monitoring devices, the idea of the technological platform could be feasible. Further projects could implement these initiatives to generate an impact on facing the current challenges of the ageing population. [ES]Introducción: La transición hacia una población que envejece ha planteado varios retos a las sociedades y los sistemas sanitarios de todo el mundo. La necesidad de nuevos enfoques e intervenciones sanitarias para adaptarse a la nueva situación es una de las cuestiones más relevantes en todo el mundo. Este proyecto se centra especialmente en tres de estos retos: la complejidad de la atención a los adultos mayores, el aumento del número de personas que viven con demencia y de sus cuidadores, y la escasa accesibilidad de las poblaciones rurales a los servicios sanitarios para hacer frente a estos retos. Objetivos: Desarrollar una prueba de concepto de una plataforma tecnológica que integre varias herramientas digitales innovadoras para la capacitación en salud y bienestar de adultos mayores con demencia y deterioro cognitivo y sus cuidadores, y estudiar los efectos de la utilización de la plataforma en la salud física, el bienestar mental y emocional, las actividades de la vida diaria, el funcionamiento social y cognitivo y el uso para los cuidados profesionales. Involucrar a los adultos mayores con demencia y a sus cuidadores en el diseño y desarrollo de la plataforma, evaluando su satisfacción, el impacto del sistema en entornos realistas, su aceptabilidad y usabilidad, para permitirles manejar el sistema de forma autónoma en la vida diaria. Métodos: Se realizaron dos revisiones sistemáticas en julio de 2021 y abril de 2023 en PubMed, CINAHL y Web of Science. Se realizó una valoración cualitativa/riesgo de sesgo de los estudios incluidos. Se realizaron tres estudios cualitativos, implementando talleres online y presenciales, entrevistas semiestructuradas, grupos focales y procesos de codiseño y coproducción con Participación de Pacientes y Público (PPI). El análisis temático fue el enfoque elegido para el análisis de los resultados. Se está llevando a cabo un estudio de usabilidad y experiencia de usuario con métodos mixtos y un estudio piloto de un programa en línea para la capacitación y formación de cuidadores de personas que viven con demencia, en los que se aplicarán entrevistas semiestructuradas y cuestionarios sobre usabilidad, conocimiento de la demencia y sobrecarga de los cuidadores. Resultados: Se identificaron una serie de pasos necesarios para crear las bases de una plataforma tecnológica: a) se recomendaron el interRAI LTFC y el interRAI HC como las Evaluaciones Geriátricas Integrales (EGI) que se utilizarán para la evaluación y el seguimiento de los usuarios potenciales en los centros de larga estancia y en la atención domiciliaria, respectivamente; b) se describen las barreras para la usabilidad y la implementación de las Tecnologías de Salud Digital (TSD) para asistir y ayudar a alcanzar todo el potencial de las EGI, así como una serie de recomendaciones para mejorar su usabilidad e implementación por parte de los profesionales sanitarios y los entornos clínicos; c) se desarrolló e identificó un marco para estudiar los pros y los contras del desarrollo de la participación digital de pacientes y público (e-PPI, por sus siglas en inglés) y sugerencias para mejorar la implementación de e-PPI; d) se identificaron los factores que facilitan y dificultan la aplicación de la intervención sociocomunitaria del Programa de Atención de Centros de Encuentro (MCSP, por sus siglas en inglés) y se describieron varias recomendaciones para superar las limitaciones y lograr una aplicación satisfactoria; y e) como intento de ofrecer una alternativa de servicio de apoyo a los cuidadores de personas que viven con demencia en zonas rurales remotas, se desarrolló la adaptación cultural del programa de formación y apoyo iSupport para cuidadores de personas que viven con demencia, y se está estudiando su usabilidad y experiencia de usuario, así como su impacto en los conocimientos sobre la demencia y la sobrecarga en los cuidadores. Conclusión: Este proyecto describe una serie de pasos necesarios para crear los cimientos de una plataforma tecnológica para la capacitación en salud y bienestar de los adultos mayores con demencia y deterioro cognitivo y sus cuidadores. La idea de la plataforma tecnológica podría ser factible si se incorporan los resultados de este proyecto y se incluyen tecnologías novedosas como la inteligencia artificial, la robótica, las tecnologías ponibles y los dispositivos de monitorización. Otros proyectos podrían poner en práctica estas iniciativas para generar un impacto a la hora de afrontar los retos actuales del envejecimiento de la población