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The growing proportion of older adults in the population necessitates improved methods for assessing functional recovery. Objective, continuous monitoring using wearable sensors offers a promising alternative to traditional, often subjective assessments. This study aimed to investigate the utility of inertial measurement unit (IMU)-based data, combined with deep learning, to predict postoperative mobility, activities of daily living, and discharge destination in older adults following surgery. Data from the SURGE-Ahead project was analyzed, involving 39 patients (mean age 79.05 years) wearing lumbar IMU sensors for up to five postoperative days. Deep learning models (TabPFN) were applied and validated using leave-one-out cross-validation to predict the Charité Mobility Index (CHARMI), the Barthel Index, and discharge destination. The TabPFN model achieved R2 values of 0.65 and 0.70 for predicting CHARMI and Barthel Index scores, respectively, with moderate to strong agreement with human assessments (weighted kappa ≥ 0.80). Discharge destination was predicted with an accuracy of 82%. The z-channel IMU data and parameters related to walking bouts were most predictive of outcomes. IMU-based data, combined with deep learning, demonstrates potential for automated functional assessment and discharge decision support in older adults following surgery.

The development and introduction of an artificial intelligence (AI)-based clinical decision support system (CDSS) in surgical departments as part of the \"Supporting Surgery with Geriatric Co-management and AI\" project addresses the challenges of an increasingly aging population. The system enables digital comanagement of older patients by providing evidence-based evaluations of their health status, along with corresponding medical recommendations, with the aim of improving their perioperative care. The use of an AI-based CDSS in patient care raises ethical challenges. Gathering the opinions, expectations, and concerns of older adults (as potential patients) regarding the CDSS enables the identification of ethical opportunities, concerns, and limitations associated with implementing such a system in hospitals. We conducted 5 focus groups with participants aged 65 years or older. The transcripts were evaluated using qualitative content analysis and ethically analyzed. Categories were inductively generated, followed by a thematic classification of participants' statements. We found that technical understanding did not influence the older adults' opinions. Ethical opportunities and concerns were identified. On the one hand, diagnosis and treatment could be accelerated, the patient-AI-physician interaction could enhance medical treatment, and the coordination of hospital processes could be improved. On the other hand, the quality of the CDSS depends on an adequate data foundation and robust cybersecurity. Potential risks included habituation effects, loss of a second medical opinion, and illness severity influencing patients' attitude toward medical recommendations. The risk of overdiagnosis and overtreatment was discussed controversially, and treatment options could be influenced by interests and finances. Additional concerns included challenges with time savings, potential declines in medical skills, and effects on the length of hospital stay. To address the ethical challenges, we recommend allocating sufficient time for use of the CDSS and emphasizing individualized review of the CDSS results. Furthermore, we suggest limiting private financial sponsorship.

Background While predisposing factors for delirium, like old age or surgery, are well documented, less attention has been paid to environmental factors, including hospital transfer processes and caregiver involvement in transitional care of older patients. To address this gap, we developed a pathway to optimize hospital transfer processes and actively involve caregivers in preventing delirium. This complex intervention was tested in a pilot study using a stepped-wedge design across four hospitals, accompanied by a process evaluation to explore the implementation context, mechanisms and outcomes of this intervention. Methods A parallel convergent mixed-methods process evaluation was used. Qualitative data and quantitative data were analyzed separately and integrated using a weaving approach. Analyses were guided by Normalization Process Theory, supplemented by implementation impact ratings based on the Consolidated Framework for Implementation Research rating tool. Results Data included 72 interviews, 2 focus groups, 82 document analyses, 14 status analyses, 424 TRADE questionnaires, 58 Normalization MeAsure Development questionnaires, and website traffic metrics. COVID-19-related constraints resulted in partial implementation of the intervention, with challenges such as limited training opportunities and restricted caregiver involvement. Healthcare professionals reported greater delirium awareness, and educational materials received positive feedback. Conclusion The study underscores the critical role of discharge information, post-discharge support, and education for caregiver and healthcare professionals in preventing delirium. It also provides evidence of how the COVID-19 pandemic impacted standard care and the implementation of clinical interventions, emphasizing the need for adaptable processes and institutional support. Furthermore, it offers theoretical and methodological insights into conducting mixed-methods process evaluations in complex intervention research. Trial registration German Clinical Trials Register (ID: DRKS00017828, retrospectively registered on 17.09.2019, https://drks.de/search/en/trial/DRKS00017828 ).

The use of assistive technologies (ATs) to support older people has been fueled by the demographic change and technological progress in many countries. These devices are designed to assist seniors, enable independent living at home or in residential facilities, and improve quality of life by addressing age-related difficulties. We aimed to evaluate the effectiveness of ATs on relevant outcomes with a focus on frail older adults. A systematic literature review of randomized controlled trials evaluating ATs was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The Ovid Medline, PsycINFO, SocIndex, CINAHL (Cumulative Index to Nursing and Allied Health Literature), CENTRAL (Cochrane Central Register of Controlled Trials), and IEEEXplore databases were searched from January 1, 2009, to March 15, 2019. ATs were included when aiming to support the domains autonomy, communication, or safety of older people with a mean age ≥65 years. Trials performed within a laboratory setting were excluded. Studies were retrospectively categorized according to the physical frailty status of participants. A total of 19 trials with a high level of heterogeneity were included in the analysis. Six device categories were identified: mobility, personal disease management, medication, mental support, hearing, and vision. Eight trials showed significant effectiveness in all or some of the primary outcome measures. Personal disease management devices seem to be the most effective, with four out of five studies showing significant improvement of disease-related outcomes. Frailty could only be assessed for seven trials. Studies including participants with significant or severe impairment showed no effectiveness. Different ATs show some promising results in well-functioning but not in frail older adults, suggesting that the evaluated ATs might not (yet) be suitable for this subgroup. The uncertainty of the effectiveness of ATs and the lack of high-quality research for many promising supportive devices were confirmed in this systematic review. Large studies, also including frail older adults, and clear standards are needed in the future to guide professionals, older users, and their relatives. PROSPERO CRD42019130249; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=130249.

Background The association of frailty based on the accumulation of deficits with postoperative delirium (POD) has been poorly examined. We aimed to analyze this association in older patients undergoing elective surgery. Methods Preoperative data was used to build a 30-item frailty index (FI) for participants of the PAWEL-study. Delirium was defined by a combination of I-CAM and chart review. Using logistic regressions models we analysed the association between frailty and POD adjusting for age, sex, smoking, alcohol consumption, education and type of surgery. Results Among 701 participants (mean age 77.1, 52.4% male) median FI was 0.27 (Q1 0.20| Q3 0.34), with 528 (75.3%) frail participants (FI ≥ 0.2). Higher median FI were seen in orthopedic than cardiac surgery patients (0.28 versus 0.23), and in women (0.28 versus 0.25 in men). Frail participants showed a higher POD incidence proportion (25.4% versus 17.9% in non-frail). An increased odds for POD was observed in frail versus non-frail participants (OR 2.14 [95% CI 1.33, 3.44], c-statistic 0.71). A 0.1 increment of FI was associated with OR 1.57 [95% CI 1.30, 1.90] (c-statistic 0.72) for POD. No interaction with sex or type of surgery was detected. Adding timed-up-and-go-test and handgrip strength to the FI did not improve discrimination. Conclusion Our data showed a significant association between frailty defined through a 30-item FI and POD among older adults undergoing elective surgery. Adding functional measures to the FI did not improve discrimination. Hence, our preoperative 30-item FI can help to identify patients with increased odds for POD. Trial registration PAWEL and PAWEL-R (sub-) study were registered on the German Clinical Trials Register (number DRKS00013311 and DRKS00012797).

Background Among potentially modifiable risk factors for delirium, transfers between wards, hospitals and other facilities have been mentioned with low evidence. TRADE (TRAnsport and DElirium in older people) was set up to investigate i) the impact of transfer and/or discharge on the onset of delirium in older adults and ii) feasibility and acceptance of a developed complex intervention targeting caregiver’s participation during and after hospital discharge or transfer on cognition and the onset of delirium in older adults. Methods The study is designed according to the guidelines of the UK Medical Research Council (MRC) for development and evaluation of complex interventions and comprises two steps: development and feasibility/piloting. The development phase includes i) a multicenter observational prospective cohort study to assess delirium incidence and cognitive decline associated with transfer and discharge, ii) a systematic review of the literature, iii) stakeholder focus group interviews and iv) an expert workshop followed by a Delphi survey. Based on this information, a complex intervention to better and systematically involve family caregivers in discharge and transport was developed. The intervention will be tested in a pilot study using a stepped wedge design with a detailed process and health economic evaluation. The study is conducted at four acute care hospitals in southwest Germany. Primary endpoints are the delirium incidence and cognitive function. Secondary endpoints include prevalence of caregiver companionship, functional decline, cost and cost effectiveness, quality of discharge management and quality of admission management in admitting hospitals or nursing homes. Data will be collected prior to discharge as well as after 3, 7 and 90 days. Discussion TRADE will help to evaluate transfer and discharge as a possible risk factor for delirium. In addition, TRADE evaluates the impact and modifiability of caregiver’s participation during patient’s transfer or discharge on delirium incidence and cognitive decline providing the foundation for a confirmatory implementation study. Trial registration DRKS (Deutsches Register für klinische Studien) DRKS00017828 . Registered on 17th September 2019. Retrospectively registered.

Preventing falls is an international priority. There is a need to synthesize the highest-quality falls prevention evidence in one place for clinicians. The aim of this study was to conduct an umbrella review of meta-analyses of randomized controlled trials (RCTs) of falls prevention interventions in community-dwelling older adults. The MEDLINE, EMBASE, CINAHL, AMED, BNI, PsycINFO, Cochrane Library, PubMed, and PEDro databases were searched. Meta-analyses with one pooled analysis containing ≥3 RCTs that investigated any intervention to prevent falls in community-dwelling older adults aged ≥60 years were eligible. Sixteen meta-analyses, representing 47 pooled analyses, were included. Two authors independently extracted data. Data were narratively synthesized. The methodological quality of the meta-analyses was moderate. Three meta-analyses defined a fall, and 3 reported adverse events (although minor). There is consistent evidence that exercise reduces falls (including the rate, risk, and odds of falling), with 13/14 pooled analyses (93%) from 7 meta-analyses demonstrating a significant reduction. The methodological quality of meta-analyses investigating exercise were medium/high, and effect sizes ranged from 0.87 (relative risk 95% confidence interval=0.81, 0.94; number of studies=18; number of participants=3,568) to 0.39 (rate ratio 95% confidence interval=0.23, 0.66; number of meta-analyses=6). There is consistent evidence that multifactorial interventions reduce falls (5/6, 83% reported significant reduction). There is conflicting evidence regarding the influence of vitamin D supplementation (7/12, 58.3% reported significant reduction). Meta-analyses often used different methods of analysis, and reporting of key characteristics (eg, participants, heterogeneity, publication bias) was often lacking. There may be some overlap among included meta-analyses. There is consistent evidence that exercise and individually tailored multifactorial interventions are effective in reducing falls in community-dwelling older adults.

Background Postoperative delirium is a common disorder in older adults that is associated with higher morbidity and mortality, prolonged cognitive impairment, development of dementia, higher institutionalization rates, and rising healthcare costs. The probability of delirium after surgery increases with patients’ age, with pre-existing cognitive impairment, and with comorbidities, and its diagnosis and treatment is dependent on the knowledge of diagnostic criteria, risk factors, and treatment options of the medical staff. In this study, we will investigate whether a cross-sectoral and multimodal intervention for preventing delirium can reduce the prevalence of delirium and postoperative cognitive decline (POCD) in patients older than 70 years undergoing elective surgery. Additionally, we will analyze whether the intervention is cost-effective. Methods The study will be conducted at five medical centers (with two or three surgical departments each) in the southwest of Germany. The study employs a stepped-wedge design with cluster randomization of the medical centers. Measurements are performed at six consecutive points: preadmission, preoperative, and postoperative with daily delirium screening up to day 7 and POCD evaluations at 2, 6, and 12 months after surgery. Recruitment goals are to enroll 1500 patients older than 70 years undergoing elective operative procedures (cardiac, thoracic, vascular, proximal big joints and spine, genitourinary, gastrointestinal, and general elective surgery procedures). Discussion Results of the trial should form the basis of future standards for preventing delirium and POCD in surgical wards. Key aims are the improvement of patient safety and quality of life, as well as the reduction of the long-term risk of conversion to dementia. Furthermore, from an economic perspective, we expect benefits and decreased costs for hospitals, patients, and healthcare insurances. Trial registration German Clinical Trials Register, DRKS00013311 . Registered on 10 November 2017.