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Background: Loneliness and social isolation are considered public health problems among older individuals. In addition, both increase the risk of developing cognitive impairment and dementia. The Social Loneliness construct has been proposed to refer to these harmful social interaction-related factors. Objective: To define the risk factors of Social Loneliness in individuals with mild cognitive impairment (MCI) and to analyze cognitive, emotional, and functional differences according to the participant's degree of Social Loneliness. Methods: Through convenience sampling, 105 participants over 60 diagnosed with MCI were selected. The evaluation consisted of anamnesis and a comprehensive neuropsychological examination. The ESTE-II questionnaire was used to assess Social Loneliness and its three factors: perceived social support, social participation, and use of communication technologies. Personality was measured with the NEO-FFI questionnaire. Results: The predictors of the Social Loneliness factors were as follows; 1) perceived social support (R2 = 0.33): Neuroticism (β= 0.353), depression (β= 0.205), and perceived health (β= 0.133); 2) social participation (R2 = 0.24): Conscientiousness (β= –0.344) and Extraversion (β= –0.263); 3) use of communication technologies (R2 = 0.44): age (β= 0.409), type of cohabitation (β= 0.331), cognitive reserve (β= –0.303), and Conscientiousness (β= –0.247); all p < 0.05. The participants with a higher degree of Social Loneliness showed more depressive symptoms (R2 = 0.133), more memory complaints (R2 = 0.086), worse perceived health (R2 = 0.147), lower attentional performance/processing speed (R2 = 0.094), and more naming difficulties (R2 = 0.132); all p < 0.05. Conclusions: This research represents an advance in detecting individuals with MCI and an increased risk of developing Social Loneliness, which influences the configuration of the clinical profile of MCI. [ABSTRACT FROM AUTHOR]

Older adults' usage of information and communication technology (ICT) is challenged or facilitated by perception of usefulness, technology design, gender, social class, and other unspoken and political elements. However, studies on the use of ICT by older adults have traditionally focused on explicit interactions (e.g., usability). The article then analyzes how symbolic, institutional, and material elements enable or hinder older adults from using ICT. Our ethnographic methodology includes several techniques with Spanish older adults: 15 semi-structured interviews, participant observation in nine ICT classes, online participant observation on WhatsApp and Jitsi for 3 months, and nine phone interviews due to COVID-19. The qualitative data were analyzed through Situational Analysis. We find that the elements hindering or facilitating ICT practice are implicit-symbolic (children's surveillance, paternalism, fear, optimism, low self-esteem, and contradictory speech-act), explicit-material (affordances, physical limitations, and motivations), and structural-political (management, the pandemic, teaching, and media skepticism). Furthermore, unprivileged identities hampered the ICT practices: female gender, blue-collar jobs, illiteracy, and elementary education. However, being motivated to use ICT prevailed over having unprivileged identities. The study concludes that society and researchers should perceive older adults as operative with technologies and examine beyond explicit elements. We urge exploration of how older adults' social identities and how situatedness affects ICT practice. Concerning explicit elements, Spanish authorities should improve and adapt ICT facilities at public senior centers and older adults' homes, and ICT courses should foster tablet and smartphone training over computers. [ABSTRACT FROM AUTHOR]

Diabetes Mellitus is a chronic disease with a high prevalence among older people, and it is related to an increased risk of functional and cognitive decline, in addition to classic micro and macrovascular disease and a moderate increase in the risk of death. Technology aimed to improve elder care and quality of life needs to focus in the early detection of decline, monitoring the functional evolution of the individuals and providing ways to foster physical activity, to recommend adequate nutritional habits and to control polypharmacy. But apart from all these core features, some other elements or modules covering disease-specific needs should be added to complement care. In the case of diabetes these functionalities could include control mechanisms for blood glucose and cardiovascular risk factors, specific nutritional recommendations, suited physical activity programs, diabetes-specific educational contents, and self-care recommendations. This research work focuses on those core aspects of the technology, leaving out disease-specific modules. These central technological components have been developed within the scope of two research and innovation projects (FACET and POSITIVE, funded by the EIT-Health), that revolve around the provision of integrated, continuous and coordinated care to frail older population, who are at a high risk of functional decline. Obtained results indicate that a geriatric multimodal intervention is effective for preventing functional decline and for reducing the use of healthcare resources if administered to diabetic pre-frail and frail older persons. And if such intervention is supported by the CAPACITY technological ecosystem, it becomes more efficient. [ABSTRACT FROM AUTHOR]

Objective: We aimed to in-depth analyse the Integrated Care Programme for older in- and out-patients implemented for more than 25 years at the Hospital Universitario de Getafe, in Madrid, Spain. We identify the strengths and barriers hindering the full operation, and we proposed a technological solution that overcame these constraints and facilitated integration. Design: First, we carried out a comprehensive analysis of the integrated care program at the HUG following Case Study Research; the primary unit of analysis was the Geriatrics service and its clinical units. Secondary sources of analyses were professionals' insights (obtained thought direct observation and interviews) and statistics on the service. After the identification of the barriers preventing complete success; we designed a Health Information System and developed a mock-up that was validated with the professionals. Finally, we passed the specifications to the Information System Unit at the Hospital to develop and integrate the system into the hospital one. Setting: The Geriatrics Service of the University Hospital of Getafe, pertaining to the public Healthcare System of the Region of Madrid (Spain). Participants: No patient participated in the study. All staff from the Geriatrics Service and the ICT manager of the hospital contributed to the design of the Health Information System; and 3 geriatricians from the Service and 1 primary care physician validated it. Measurements: First, we qualitative analysed the Integrated Care Program taking as dimensions eight facilitators towards integrated care. In response, we proposed an integrated information system solution. Later, we interviewed the staff geriatricians to analyse the Integrated Care Programme. Finally, we validated our proposed system in terms of usability and user experience using the System Usability Score-SUS and the User Experience Questionnaire-UEQ, respectively. Results: The Integrated Care Program has demonstrated a high impact since its launch; however, the lack of integration in terms of information system was hindering the full deployment. We have designed an integrated information system which has been validated by physicians and nurses from the Geriatrics Service in terms of usability. We obtained a SUS score of 81 (68 is considered to be the cut-off point for usable systems). Besides, the perception of these professionals on our system was 'Excellent' in 5 out of the 6 items covered by UEQ (Attractiveness, Perspicuity, Dependability, Stimulation and Novelty) and 'Good' in terms of the 1 remaining (Efficiency), where there is still room for improvement. Conclusions: Our dedicated Health Information System is a robust solution to bridge information gaps and facilitate the complete integration of our Integrated Care Programme for older in- and outpatients. [ABSTRACT FROM AUTHOR]

In recent years, research on convolutional neural networks (CNN) and recurrent neural networks (RNN) in deep learning has been actively conducted. In order to provide more personalized and advanced functions in smart home services, studies on deep learning applications are becoming more frequent, and deep learning is acknowledged as an efficient method for recognizing the voices and activities of users. In this context, this study aims to systematically review the smart home studies that apply CNN and RNN/LSTM as their main solution. Of the 632 studies retrieved from the Web of Science, Scopus, IEEE Explore, and PubMed databases, 43 studies were selected and analyzed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. In this paper, we examine which smart home applications CNN and RNN/LSTM are applied to and compare how they were implemented and evaluated. The selected studies dealt with a total of 15 application areas for smart homes, where activity recognition was covered the most. This study provides essential data for all researchers who want to apply deep learning for smart homes, identifies the main trends, and can help to guide design and evaluation decisions for particular smart home services. [ABSTRACT FROM AUTHOR]

Frailty condition is an intermediate state in the ageing trajectory, preceding the onset of disability, and is becoming both challenging and priority to guarantee the sustainability of healthcare systems. To address it, we designed a software platform for supporting CGA and monitoring the activities performed at patients' dwelling. We have implemented an alert engine to inform the care professionals of intrinsic capacity decline, and a decision support system for referral recommendations. Besides, the platform enables them to provide tailored interventions to their patients. [ABSTRACT FROM AUTHOR]

Frailty predisposes older persons to adverse events, and information and communication technologies can play a crucial role to prevent them. CAPACITY provides a means to remotely monitor variables with high predictive power for adverse events, enabling preventative personalized early interventions. This study aims at evaluating the usability, user experience, and acceptance of a novel mobile system to prevent disability. Usability was assessed using the system usability scale (SUS); user experience using the user experience questionnaire (UEQ); and acceptance with the technology acceptance model (TAM) and a customized quantitative questionnaire. Data were collected at baseline (recruitment), and after three and six months of use. Forty-six participants used CAPACITY for six months; nine dropped out, leaving a final sample of 37 subjects. SUS reached a maximum averaged value of 83.68 after six months of use; no statistically significant values have been found to demonstrate that usability improves with use, probably because of a ceiling effect. UEQ, obtained averages scores higher or very close to 2 in all categories. TAM reached a maximum of 51.54 points, showing an improvement trend. Results indicate the success of the participatory methodology, and support user centered design as a key methodology to design technologies for frail older persons. Involving potential end users and giving them voice during the design stage maximizes usability and acceptance. [ABSTRACT FROM AUTHOR]

Agile development processes are increasing their consideration of usability by integrating various user-centered design techniques throughout development. One such technique is Personas, which proposes the creation of fictitious users with real preferences to drive application design. Since applying this technique conflicts with the time constraints of agile development, Personas has been adapted over the years. Our objective is to determine the adoption level and type of integration, as well as to propose improvements to the Personas technique for agile development. A systematic mapping study was performed, retrieving 28 articles grouped by agile methodology type. We found some common integration strategies regardless of the specific agile approach, along with some frequent problems, mainly related to Persona modelling and context representation. Based on these limitations, we propose an adaptation to the technique in order to reduce the creation time for a preliminary persona. The number of publications dealing with Personas and agile development is increasing, which reveals a growing interest in the application of this technique to develop usable agile software. [ABSTRACT FROM AUTHOR]

Ubiquity (devices becoming part of the context) and transparency (devices not interfering with daily activities) are very significant in healthcare monitoring applications for elders. The present study undertakes a scoping review to map the literature on sensor-based unobtrusive monitoring of older adults' frailty. We aim to determine what types of devices comply with unobtrusiveness requirements, which frailty markers have been unobtrusively assessed, which unsupervised devices have been tested, the relationships between sensor outcomes and frailty markers, and which devices can assess multiple markers. SCOPUS, PUBMED, and Web of Science were used to identify papers published 2010–2020. We selected 67 documents involving non-hospitalized older adults (65+ y.o.) and assessing frailty level or some specific frailty-marker with some sensor. Among the nine types of body worn sensors, only inertial measurement units (IMUs) on the waist and wrist-worn sensors comply with ubiquity. The former can transparently assess all variables but weight loss. Wrist-worn devices have not been tested in unsupervised conditions. Unsupervised presence detectors can predict frailty, slowness, performance, and physical activity. Waist IMUs and presence detectors are the most promising candidates for unobtrusive and unsupervised monitoring of frailty. Further research is necessary to give specific predictions of frailty level with unsupervised waist IMUs. [ABSTRACT FROM AUTHOR]

The present paper describes a system for older people to self-administer the 30-s chair stand test (CST) at home without supervision. The system comprises a low-cost sensor to count sit-to-stand (SiSt) transitions, and an Android application to guide older people through the procedure. Two observational studies were conducted to test (i) the sensor in a supervised environment (n = 7; m = 83.29 years old, sd = 4.19; 5 female), and (ii) the complete system in an unsupervised one (n = 7; age 64–74 years old; 3 female). The participants in the supervised test were asked to perform a 30-s CST with the sensor, while a member of the research team manually counted valid transitions. Automatic and manual counts were perfectly correlated (Pearson's r = 1, p = 0.00). Even though the sample was small, none of the signals around the critical score were affected by harmful noise; p (harmless noise) = 1, 95% CI = (0.98, 1). The participants in the unsupervised test used the system in their homes for a month. None of them dropped out, and they reported it to be easy to use, comfortable, and easy to understand. Thus, the system is suitable to be used by older adults in their homes without professional supervision. [ABSTRACT FROM AUTHOR]

Lower-limb strength is a marker of functional decline in elders. This work studies the feasibility of using the quasi-periodic nature of the distance between a subjects' back and the chair backrest during a 30-s chair–stand test (CST) to carry out unsupervised measurements based on readings from a low-cost ultrasound sensor. The device comprises an ultrasound sensor, an Arduino UNO board, and a Bluetooth module. Sit-to-stand transitions are identified by filtering the signal with a moving minimum filter and comparing the output to an adaptive threshold. An inter-rater reliability (IRR) study was carried out to validate the device ability to count the same number of valid transitions as the gold-standard manual count. A group of elders (age: mean (m) = 80.79 years old, SD = 5.38; gender: 21 female and seven male) were asked to perform a 30-s CST using the device while a trained nurse manually counted valid transitions. Ultimately, a moving minimum filter was necessary to cancel the effect of outliers, likely produced because older people tend to produce more motion artefacts and, thus, noisier signals. While the intra-class correlation coefficient (ICC) for this study was good (ICC = 0.86, 95% confidence interval (CI) = 0.73, 0.93), it is not yet clear whether the results are sufficient to support clinical decision-making. [ABSTRACT FROM AUTHOR]

Introduction: In the last 50 years, life expectancy has increased an average of 20 years, and by the year 2050, it will surpass 90 years of age. Thus, elderly-associated conditions e.g. frailty and illnesses are becoming a huge challenge to the sustainability of healthcare systems. Frailty is a state of increased vulnerability to adverse outcomes due to a reduction in the ability to respond to stressors; usually characterized by a progression of functional decline. That culminates in dependency and disability. We aimed to design a home monitoring system to prevent onset and worsening of frailty. Methods: We iteratively designed a home monitoring system to early detect changes in the functional capacity. We used a user-centred approach working together with geriatricians, geriatric nurses, psychologists, and frail people. Each version was tested with them to create an improved new version, until requirements were met. Technically, we evaluated the accuracy of sensors and algorithms towards the current standard at the hospital. For the user tests, we used usability and acceptability tests as System Usability Scale SUS. Results: The resulted system consists of a set of ultrasound sensors, a weight scale; anda mobile application that receives, processes and sends the data to the hospital. The sensors monitored the gait speed along 2.4 meters, and the chair stand test. Clinicians monitor patients' functional status and react based on the received data. In total, 57 elderly users participated in the evaluation, with an average age of 80 years; 54.8% were women. Out of them, 49 technically tested the sensors' accuracy. Error in the sensor measures is below the deviation when manually measured by professionals. Final version was validated with 8 elderly at their homes with very positive results: SUS of 84.06%, and acceptability results of 80%. In addition, 3 clinical professionals reported a SUS of 91.67%. Discussions: There is an existing gap in home monitoring systems that are done with and for frail elderly. Thanks to co-creation our solution meets the real needs of this target population. Traditionally, telemedicine systems failed due to lack of adoption, which is highly correlated to low levels of usability and acceptability. Then, it is essential that usability and acceptability lead the system design. Conclusions: We have demonstrated that the system is accurate, robust and usable. Moreover, frail people will potentially accept it. Our home system will allow elderly, at risk of frailty or already diagnosed, to stay living at their home. Early detection of functional decline permits intervention, impacting on the health and social outcome. Lessons learned: Infra diagnosis of frail patients derives in critical outcomes. The iterative design and the involvement of clinicians and frail patients have resulted in a final system with high usability and acceptability, which ensures future adoption. Limitations: Direct observation in usability tests may affect the users' behaviour. Suggestions for future research: Automatic data collection to infer usability and acceptability in the long term. Clinical validation, including intervention and control group, to prove the impact on health and quality of life. [ABSTRACT FROM AUTHOR]

Introduction: The University Hospital of Getafe (HUG) is a public reference Hospital belonging to the Servicio Madrileño de Salud (SERMAS). It provides service to patients older than 65 (in most cases over 75), showing the usual features of older frail patients: multiple chronic comorbid conditions, multi-drug intake and high risk of developing new disability when acutely stressed. Their status must be continuously assessed and they often undergo recurrent hospitalisation. The Geriatrics Service (GS) has implemented an Integrated Care Program (ICP) to fill service gaps, to prevent tasks overlapping and to assure continuum of care. HUG shifted Disease Management Processes (DMP) to new models, engaging different professionals from different units and at different levels both horizontally and vertically. Description of practice: The ICP at HUG and the research described in this paper are aligned with the World Report on Ageing and Health (WHO), which recommends the organisation of services for the older focused in function and not on disease. They also follow the 'Consensus document on frailty and falls prevention among the elderly' released by the Spanish Ministry of Health as a part of the 'Prevention and health promotion strategy of the Spanish NHS' and approved by the Inter-territorial Council of the NHS in 2014. The ICP promotes the transition from costly inpatient settings to the community. Discharge Criteria from impatient settings were modified and the Acute Care Unit collaborates with the Community Care Unit (CCU) and the General Outpatient Unit (GOC) to devise discharge plans guaranteeing assessment in the community and care delivery until stabilization. These include ICT-supported continuous follow up in the community (CCU) and visits to outpatient settings in the HUG (GOC). Besides, the GS created a Day Hospital to implement training and preventive programs for frail patients (i.e. recurrent fallers accomplish personalized physical training programs to prevent sarcopenia and are educated on action protocols to react if a fall occurs; neuropsychological rehabilitation is conducted for cognitive impaired patients and education ; education on desirable life habits and physical therapy are devised and implemented for diabetic patients). A multidisciplinary team (geriatricians, nurses and occupational therapists) devises personalized programs following a patient centered approach, in which patients are engaged and empowered to self-manage their chronic conditions. The ICP enhances the seamless delivery of care and improves patient outcomes in the GS. However, the implementation of the CGA and the new care processes enlarged the set of data harvested. Before, this information is stored on dedicated data tables that are independent from the General Health Information System (GHIS). This gap constraints information availability within the Service and with other Units and care levels, and hinders integration. An in-depth analysis of the ICP at HUG through case study research identified the barriers for its operation. We designed an innovative information management system to overcome these drawbacks and facilitate full integration, engaging finals users (healthcare professionals). This Integrated Health Information System (IHIS) has the following characteristics: (1) it is an extension of the GHIS, it avoids duplicities; (2) it structures information and make it available; (3) it enables dynamic patient evolution visualization; (4) it is interoperable (following CDA architecture) and scalable. Key findings: The average length of stay in the GS Acute Care Unit is lower than at other departments treating similar patient segments (6.8 vs 9.1 days). Moreover, mortality and readmissions have not increased and patients' functional status has improved thanks to the Day Hospital performance. The number of unnecessary hospitalisations has been reduced by around 400 patients/year with a direct impact of €1.5 million. Highlights: Integration must be built over the complete understanding of the environment and its requirements. Otherwise, it may not become a facilitator for integration but a burden for users. The multilevel and multidisciplinary integrated delivery of care services requires the comprehensive knowledge of patient status and care processes. In this sense ICT become an unavoidable tool enhancing information availability. User collaboration led to more effective, efficient and user-friendly system and contributed to the acceptance of the final model. After the modelling stage and validation, the HUG ICT department and the GS are working together to fully develop the IHIS. Conclusion: The GS had already built a successful ICP, but the absence of dedicated information management tools prevents complete integration. We proposed an IHIS devoted to the real requirements at GS. The functional status and frailty determine the outcome of elderly chronic patients. In this sense, IHIS provides Geriatric Teams with a tool to perform CGA, improving the availability of information and allowing the efficient follow-up of older patients. [ABSTRACT FROM AUTHOR]

Introduction: Around 10% of all persons over 70 years of age suffer heart failure in Spain. This is the most common cause of hospitalization amongst patients aged 65 years and over, being the third leading cause of cardiovascular mortality. Although some works have demonstrated that the use of telemedicine in the monitoring after discharge has improved the rates of readmission in patients with heart failure, there are no many works focused on older people, which represents a population with special clinical and functional characteristics. Our main hypothesis was that by telemonitoring functional status and vital signs, we can early detect heart failure exacerbation, minimising readmissions and length of hospitalisations. Methods: We conducted a two-year randomized non-blind trial with a follow-up of 3 months after discharge from a hospitalisation due to heart failure exacerbation. The intervention included a telemonitoring system which collected vital signs, symptoms of decompensated heart failure and functional status. The control group received the routine follow-up including home visits. Following a descriptive analysis of the data, we evaluated through logistic regressions the effect of the intervention and the predictive value of the monitored variables. We assessed the impact on the patients' worsening, measured through the emergency visits and the readmissions. Results: A total of 90 patients participated in the study, 72.2% were women and the median age was 86 years. 50 patients were selected for the intervention group, out of which, 47 participated in the studied; and 40 were controlled. Both groups were compared using Mann-Whitney and they only differed in the age (median age in the intervention group is one year higher). Amongst the intervention group, the adherence to the program was high, being the minimum rate of observations 70%. The intervention group had a better clinical outcome than control group, OR 0.411 (95% CI 0.171-0.993), measured by a composed outcome (number of visits to the emergency rooms plus number of readmissions). Moreover, in the intervention group, the 80% of the readmissions were shorter or equal than 7 days of length stay. In contrast, in the control group, this percentage was reached at 13th day. The difference of medians was 3.5 days (p-value 0.02). Finally, in the intervention group, the gait speed variability and the oxygen saturation as clinical markers were statistically significant, OR 1.34 (95% CI 1.04-1.72) and 0.743 (95% CI 0.566-0.976) respectively. The models for the other recorded variables were not statistically significant. Conclusions: We demonstrated the feasibility and effectiveness of using telemonitoring to followup older heart failure patients. In this particular group, functional variables as gait demonstrated to have a predictive value, opening new ways of managing such patients. Lessons learned: Functional variables early detect exacerbation in older patients with heart failure. The use of telemonitoring may improve the follow-up of patients after discharge, improving their quality of life. Limitations: The difficulty of conducting a blind trial with telemonitoring may generate a bias in the selection of the sample. Suggestions for future research: Studies focusing on the predictive variables. Economic assessment of telemonitoring. [ABSTRACT FROM AUTHOR]