Lorena Rossi

Prognostic Stratification of Elderly Patients in the Emergency Department: A Comparison Between the “Identification of Seniors at Risk” and the “Silver Code”

BACKGROUND The increasing number of elderly patients accessing emergency departments (EDs) requires use of validated assessment tools. We compared the Identification of Seniors at Risk (ISAR), using direct patient evaluation, with the Silver Code (SC), based on administrative data. METHODS Subjects aged 75+ years accessing a geriatric ED over an 8-month period were enrolled. Outcomes were need for hospital admission and mortality at the index ED access, ED return visit, hospitalization, and death at 6 months. RESULTS Of 1,632 participants (mean age 84 ± 5.5 years), 75% were ISAR positive, and the sample was homogeneously distributed across the four SC risk categories (cutoffs of 0-3, 4-6, 7-10, and 11+). The two scores were mildly correlated (r = .350, p < .001) and had a similar area under the receiver-operating characteristic curve in predicting hospital admission (ISAR: 0.65, SC: 0.63) and mortality (ISAR: 0.72, SC: 0.70). ISAR-positive subjects were at greater risk of hospitalization and death (odds ratio 2.68 and 5.23, respectively, p < .001); the risk increased across SC classes (p < .001). In the 6-month follow-up of discharged patients, the tools predicted similarly ED return visit, hospital admission, and mortality. The SC predicted these outcomes even in participants not hospitalized at the index ED access. CONCLUSIONS Prognostic stratification of elderly ED patients with the SC is comparable with that obtained with direct patient evaluation. The SC, previously validated in hospitalized patients, predicts ED readmissions and future hospitalizations even in patients discharged directly from the ED.

Risk Stratification of Older Patients in the Emergency Department: Comparison Between the Identification of Seniors At Risk and Triage Risk Screening Tool

BACKGROUND AND OBJECTIVES The increasing number of elderly patients accessing emergency departments (ED) requires use of validated, rapid assessment instruments. The aim of this study was to compare the Identification of Seniors at Risk (ISAR) and Triage Risk Screening Tool (TRST), based on direct patient evaluation. RESEARCH DESIGN AND SUBJECTS This study was a prospective observational study with 6 months follow-up. Subjects were 2,057 residents in the Marche Region, aged 65 or more years, accessing the first-level ED of a geriatric hospital in Ancona, Italy, over a 6-month period. METHODS ISAR and TRST were administered at triage by nurse. Outcomes were in need of hospital admission and mortality at the index ED access, early (within 30 days) and late ED revisit, hospitalization, and death in 6 months. RESULTS ISAR (cutoff of≥2) was positive in 68% of patients, whereas 64% were TRST-positive. The two scores were significantly correlated and had similar areas under the receiver operating characteristic (ROC) curves in predicting hospital admission (ISAR, 0.68; TRST, 0.66) and mortality (ISAR, 0.74; TRST, 0.68), as well as early ED revisit (ISAR, 0.63; TRST, 0.61). In the 6-month follow-up of patients discharged alive, the tools predicted comparably ED return visit (ISAR, 0.60; TRST, 0.59), hospital admission (ISAR, 0.63; TRST, 0.60), and mortality (ISAR, 0.74; TRST, 0.73). A similar performance was observed in the subgroup of participants discharged directly from the ED. CONCLUSIONS Risk stratification of elderly ED patients with ISAR or TRST is substantially comparable for selecting elderly ED patients who could benefit from geriatric interventions. ISAR had slightly higher sensitivity and lower specificity than TRST.

Interoperability issues among smart home technological frameworks

Population aging may be seen both as a human success story, the triumph of public health, medical advancements and economic development over diseases and injures, and as one of the most challenging phenomena that society faces in this century. Assistive technology in all its possible implementations (from Telemedicine to Ambient Assisted Living, and Ambient Intelligence) represents an emerging answer to the needs of the new generation of older adults whose desire is to live longer with a higher quality of life. Objective of this paper is to present the results of a public financed action for the development and implementation of an “integration platform” for Ambient Assisted Living that includes features of home automation (energy management, safety, comfort, etc.) and introduces “smart objects”, to monitor activities of daily living and detect any abnormal behavior that may represent a danger, or highlight symptoms of some incipient disease.

Concurrent validation of an index to estimate fall risk in community dwelling seniors through a wireless sensor insole system: A pilot study

Falls are a major health problem for older adults with immediate effects, such as fractures and head injuries, and longer term effects including fear of falling, loss of independence, and disability. The goals of the WIISEL project were to develop an unobtrusive, self-learning and wearable system aimed at assessing gait impairments and fall risk of older adults in the home setting; assessing activity and mobility in daily living conditions; identifying decline in mobility performance and detecting falls in the home setting. The WIISEL system was based on a pair of electronic insoles, able to transfer data to a commercially available smartphone, which was used to wirelessly collect data in real time from the insoles and transfer it to a backend computer server via mobile internet connection and then onwards to a gait analysis tool. Risk of falls was calculated by the system using a novel Fall Risk Index (FRI) based on multiple gait parameters and gait pattern recognition. The system was tested by twenty-nine older users and data collected by the insoles were compared with standardized functional tests with a concurrent validity approach. The results showed that the FRI captures the risk of falls with accuracy that is similar to that of conventional performance-based tests of fall risk. These preliminary findings support the idea that theWIISEL system can be a useful research tool and may have clinical utility for long-term monitoring of fall risk at home and in the community setting.

Towards an Impact Assessment Framework for ICT-Based Systems Supporting Older People: Making Evaluation Comprehensive Through Appropriate Concepts and Metrics

Although it is internationally acknowledged that ICT-based systems have the potential to provide cost-effective services, their deployment is still limited. Through the User Centred Design, it is possible to draw up information on key concepts, such as attitude towards technology, acceptance and usability of any new products. The collected information will serve for the technological development on one side, and for the Impact Assessment Analysis on the other one, that will describe the future path of the devices. The paper describes in details the most important metrics—attitude towards technology, usability and accessibility—for conducting a prompt evaluation of a new device for the older people, suggesting common guidelines and critical issues to solve.

Chapter 4 – The Human Factor in the Design of Successful Ambient Assisted Living Technologies

The increasing incidence of ageing population in modern societies challenges the ability of families, states and communities to sustain new emerging needs. Assistive devices can help older people to maintain their ability in performing activities of daily living and, therefore, their independence. However, despite the huge public and private investments and efforts in research and development, the so-called silver market has not been able to grow at the expected pace: many barriers stand in the way leading from prototypes to products, especially when the target is an inhomogeneous group, as elderly people, and an explicit understanding of users, their needs, expectations and limitations, is not accounted for during the design process. This Chapter discusses the basic role of the human centric approach in the design of assistive technologies, and, by analyzing the outcomes of previous experiences, provides a set of guidelines that can help transforming a disruptive prototype into a successful product.

Toward a Connected Health System for Older Adults: Lessons Learned

This paper aims to provide some lessons learned during the development of the Wireless Insole for Independent and Safe Elderly Living (WIISEL) system that can be generalized for all connected health devices for older adults. The analysis of the different results confirms that there is a clear challenge for modern technologically driven healthcare systems to meet the complex needs of an ageing society. We observed three major themes which should be taken into considerations when tackling the barriers to the uptake of technology enabled care: 1. Face cultural resistance and concerns toward technology enabled care; 2. Improve engagement of users in design; 3. Built or Increase users trust in connected health by spreading awareness and knowledge among end users about technology’s benefit and utility.

A Wireless Sensor Insole to Collect and Analyse Gait Data in Real Environment: The WIISEL Project

In Europe 30 % of population will be aged 65 or more in 2060. Falls are a major health problem for older adults with immediate effects, such as fractures and head injuries, and longer term effects, as fear of falling, loss of independence and disability. Therefore, falls are a huge social and economic problem. The goals of the WIISEL project is to develop an unobtrusive, self-learning and wearable system aimed at assessing gait impairments and fall risk in the home setting of older adults; assessing activity and mobility in daily living conditions; identifying decline in mobility performance and detecting falls in the home setting. A high-tech insole with wireless communication capabilities will be worn by the elderly, monitorizing their posture and evaluating gait dynamics via a matrix of printed pressure sensors.

Does culture affect usability? A trans-European usability and user experience assessment of a falls-risk connected health system following a user-centred design methodology carried out in a single European country.

BACKGROUND User-centred design (UCD) is a process whereby the end-user is placed at the centre of the design process. The WIISEL (Wireless Insole for Independent and Safe Elderly Living) system is designed to monitor fall risk and to detect falls, and consists of a pair of instrumented insoles and a smartphone app. The system was designed using a three-phase UCD process carried out in Ireland, which incorporated the input of Irish end-users and multidisciplinary experts throughout. OBJECTIVE In this paper we report the results of a usability and user experience (UX) assessment of the WIISEL system in multiple countries and thus establish whether the UCD process carried out in Ireland produced positive usability and UX results outside of Ireland. METHODS 15 older adults across three centres (Ireland, Italy and Israel) were recruited for a three-day trial of the system in their home. Usability and UX data were captured using observations, interviews and usability questionnaires. RESULTS The system was satisfactory in terms of the usability and UX feedback from the participants in all three countries. There was no statistically significant difference in the usability scores for the three countries tested, with the exception of comfort. CONCLUSIONS A connected health system designed using a UCD process in a single country resulted in positive usability and UX for users in other European countries.

Multifaceted Factors That Influence the Housing Decision-MakingProcess: A Pilot Study with Older Adults

Housing is central to health, wellbeing and social inclusion, but inappropriate homes currently risk damaging millions of older people. One of the main challenges faced by many researchers is determining the reasons why individuals choose or refuse housing transition. In this pilot study, a housing demonstration unit is used as a test bed for a sample of fifteen older adults approaching the crucial problem of relocation. The demonstration unit consists of a prototypal eco-friendly sustainable housing unit of 55 square meters, equipped with smart home technologies. Overall, data collected through a questionnaire draw a positive picture of the older adults’ perceptions on this alternative housing solution. Respondents seem to consider home security, customizable options, and smart technology features as the most important factors influencing their decision to relocate. Results demonstrate the potential of this housing demonstration unit for (1) documenting how joint efforts among cross sectoral partnerships can work together to support sustainable new option in the emerging sector of housing; (2) offering a real example of alternative housing solutions for older adults facing the decision to remain at home or relocate; (3) offering a study to replicate in order to search those evidences that are urgently needed in literature. These findings might be a good starting point to encourage discussion for policy-making and employ practicable changes for the housing sector.