scholarly journals Real-Time Detection of Behavioural Anomalies for Older People, the 3-PEGASE Study: Methods of an Artificial Intelligence Real-life Prospective Trial. (Preprint)

2019 ◽  
Author(s):  
Antoine Piau ◽  
Benoit Lepage ◽  
Carole Bernon ◽  
Marie-Pierre Gleyzes ◽  
Fati Nourhashemi
Keyword(s):  
Artificial Intelligence ◽  
Older Adults ◽  
Health Care Professionals ◽  
Primary Outcome ◽  
Prospective Trial ◽  
Real Life ◽  
Second Phase ◽  
Care Partners ◽  
Over Time

BACKGROUND Most frail older persons are living at home and we face difficulties in achieving seamless monitoring to detect adverse health changes. Even more important, this lack of follow-up could have a negative impact on the living choices made by older individuals and their care partners. People could give up their homes for the more reassuring environment of a medicalized living facility. We have developed a low-cost non-obtrusive sensor-based solution to trigger automatic alerts in case of an acute event or subtle changes over time. It could facilitate the follow-up of older adults in their own homes, and thus support independent living. OBJECTIVE The primary objective of our prospective open-label study is to evaluate the relevance of the automatic alerts generated by our artificial intelligence-driven monitoring solution as judged by the recipients: older adult, caregiver, and professional support worker. The secondary objective is to evaluate its ability to detect subtle functional and cognitive decline and major medical events. METHODS The primary outcome assessment will be performed for each successive 2-month follow-up period to estimate the progression of our learning algorithm performances over time. Twenty-five frail or disabled participants aged 75 and above and living alone in their own homes, will be enrolled for a 6-month follow-up period. RESULTS The first phase with five participants for a 4-month feasibility period has been completed and the expected completion date for the second phase of the study (20 participants for 6 months) is July 2020. CONCLUSIONS The originality of our 6-month real-life project lies in the choice of the primary outcome and in our user-centered design. We will evaluate the relevance of the alerts and the algorithm performances over time according to the end users. The first-line recipients of the information are the older adults and care partners rather than health-care professionals. Despite the fast pace of e-Health device development, no study addressed the specific everyday needs of older adults and their families using such a participatory design and ‘bottom-up’ approach. CLINICALTRIAL ClinicalTrials.gov NCT03484156

scholarly journals Real-Time Detection of Behavioral Anomalies of Older People Using Artificial Intelligence (The 3-PEGASE Study): Protocol for a Real-Life Prospective Trial

10.2196/14245 ◽  
2019 ◽  
Vol 8 (11) ◽  
pp. e14245 ◽  
Author(s):  
Antoine Piau ◽  
Benoit Lepage ◽  
Carole Bernon ◽  
Marie-Pierre Gleizes ◽  
Fati Nourhashemi
Keyword(s):  
Artificial Intelligence ◽  
Older Adults ◽  
Primary Outcome ◽  
Prospective Trial ◽  
Real Life ◽  
Second Phase ◽  
Algorithm Performance ◽  
Care Partners ◽  
Over Time

Background Most frail older persons are living at home, and we face difficulties in achieving seamless monitoring to detect adverse health changes. Even more important, this lack of follow-up could have a negative impact on the living choices made by older individuals and their care partners. People could give up their homes for the more reassuring environment of a medicalized living facility. We have developed a low-cost unobtrusive sensor-based solution to trigger automatic alerts in case of an acute event or subtle changes over time. It could facilitate older adults’ follow-up in their own homes, and thus support independent living. Objective The primary objective of this prospective open-label study is to evaluate the relevance of the automatic alerts generated by our artificial intelligence–driven monitoring solution as judged by the recipients: older adults, caregivers, and professional support workers. The secondary objective is to evaluate its ability to detect subtle functional and cognitive decline and major medical events. Methods The primary outcome will be evaluated for each successive 2-month follow-up period to estimate the progression of our learning algorithm performance over time. In total, 25 frail or disabled participants, aged 75 years and above and living alone in their own homes, will be enrolled for a 6-month follow-up period. Results The first phase with 5 participants for a 4-month feasibility period has been completed and the expected completion date for the second phase of the study (20 participants for 6 months) is July 2020. Conclusions The originality of our real-life project lies in the choice of the primary outcome and in our user-centered evaluation. We will evaluate the relevance of the alerts and the algorithm performance over time according to the end users. The first-line recipients of the information are the older adults and their care partners rather than health care professionals. Despite the fast pace of electronic health devices development, few studies have addressed the specific everyday needs of older adults and their families. Trial Registration ClinicalTrials.gov NCT03484156; https://clinicaltrials.gov/ct2/show/NCT03484156 International Registered Report Identifier (IRRID) PRR1-10.2196/14245

Caring for Older Adults During and After Critical Illness

2021 ◽  
pp. 216-234
Author(s):  
Maria C. Duggan ◽  
Julie Van ◽  
E. Wesley Ely
Keyword(s):  
Older Adults ◽  
Critical Illness ◽  
Health Care Professionals ◽  
Interdisciplinary Approach ◽  
Adverse Outcomes ◽  
Evidence Based ◽  
Complex Population ◽  
Multiple Domains ◽  
Over Time

Over half of people with critical illness are older adults, and the number of older adults admitted to intensive care units has been increasing over time. Older adults have increased vulnerability to disease, disability, and adverse outcomes across many domains. To address this most effectively, a unique, interdisciplinary approach is necessary to optimize not only survival but also functional status and quality of life. A shortage of health care professionals equipped to care for the aging population makes it imperative that all professionals become aware of basic principles of caring for older adults. To equip them to care for this complex population, this chapter provides an overview of how aging impacts multiple domains of an older person with critical illness and describes evidence-based approaches to caring for older adults with critical illness.

scholarly journals Association between meniscal volume and development of knee osteoarthritis

Rheumatology ◽  
2020 ◽  
Author(s):  
Dawei Xu ◽  
Jan van der Voet ◽  
Nils M Hansson ◽  
Stefan Klein ◽  
Edwin H G Oei ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Primary Outcome ◽  
Joint Space Narrowing ◽  
Joint Space ◽  
Primary Outcome Measure ◽  
Obese Women ◽  
Knee Oa ◽  
Kellgren And Lawrence ◽  
Over Time

Abstract Objective To assess the association between meniscal volume, its change over time and the development of knee OA after 30 months in overweight/obese women. Methods Data from the PRevention of knee Osteoarthritis in Overweight Females study were used. This cohort included 407 women with a BMI ≥ 27 kg/m2, free of OA-related symptoms. The primary outcome measure was incident OA after 30 months, defined by one out of the following criteria: medial or lateral joint space narrowing (JSN)  ≥ 1.0 mm, incident radiographic OA [Kellgren and Lawrence (K&L)  ≥ 2], or incident clinical OA. The secondary outcomes were either of these items separately. Menisci at both baseline and follow-up were automatically segmented to obtain meniscal volume and delta-volumes. Generalized estimating equations were used to evaluate associations between the volume measures and the outcomes. Results Medial and lateral baseline and delta-volumes were not significantly associated to the primary outcome. Lateral meniscal baseline volume was significantly associated to lateral JSN [odds ratio (OR) = 0.87; 95% CI: 0.75, 0.99], while other measures were not. Medial and lateral baseline volume were positively associated to K&L incidence (OR = 1.32 and 1.22; 95% CI: 1.15, 1.50 and 1.03, 1.45, respectively), while medial and lateral delta-volume were negatively associated to K&L incidence (OR = 0.998 and 0.997; 95% CI: 0.997, 1.000 and 0.996, 0.999, respectively). None of the meniscal measures were significantly associated to incident clinical OA. Conclusion Larger baseline meniscal volume and the decrease of meniscal volume over time were associated to the development of structural OA after 30 months in overweight and obese women.

scholarly journals Longitudinal relationships between subjective fatigue, cognitive function, and everyday functioning in old age

2012 ◽  
Vol 25 (2) ◽  
pp. 275-285 ◽  
Author(s):  
Feng Lin ◽  
Ding-Geng Chen ◽  
David E. Vance ◽  
Karlene K. Ball ◽  
Mark Mapstone
Keyword(s):  
Older Adults ◽  
Cognitive Function ◽  
Latent Class ◽  
Growth Mixture Modeling ◽  
Community Dwelling ◽  
Everyday Functioning ◽  
Subjective Fatigue ◽  
Community Dwelling Older Adults ◽  
Over Time

ABSTRACTBackground: The present study examined the prospective relationships between subjective fatigue, cognitive function, and everyday functioning.Methods: A cohort study with secondary data analysis was conducted using data from 2,781 community-dwelling older adults without dementia who were enrolled to participate in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) randomized intervention trial. Measures included demographic and health information at baseline, and annual assessments of subjective fatigue, cognitive function (i.e. speed of processing, memory, and reasoning), and everyday functioning (i.e. everyday speed and everyday problem-solving) over five years.Results: Four distinct classes of subjective fatigue were identified using growth mixture modeling: one group complaining fatigue “some of the time” at baseline but “most of the time” at five-year follow-up (increased fatigue), one complaining fatigue “a good bit of the time” constantly over time (persistent fatigue), one complaining fatigue “most of the time” at baseline but “some of the time” at five-year follow-up (decreased fatigue), and the fourth complaining fatigue “some of the time” constantly over time (persistent energy). All domains of cognitive function and everyday functioning declined significantly over five years; and the decline rates, but not the baseline levels, differed by the latent class of subjective fatigue. Except for the decreased fatigue class, there were different degrees of significant associations between the decline rates of subjective fatigue and all domains of cognitive function and everyday functioning in other classes of subjective fatigue.Conclusion: Future interventions should address subjective fatigue when managing cognitive and functional abilities in community-dwelling older adults.

scholarly journals Dairy Food Intake Is Not Associated With Frailty or Frailty Progression Over Time in Adults: Framingham Offspring Study

2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 48-48
Author(s):  
Shivani Sahni ◽  
Alyssa Dufour ◽  
Courtney Millar ◽  
Douglas Kiel ◽  
Paul Jacques ◽  
...  
Keyword(s):  
Older Adults ◽  
Food Intake ◽  
High Fat ◽  
Low Fat ◽  
Frailty Phenotype ◽  
Dairy Food ◽  
Dairy Foods ◽  
Self Reported Health Status ◽  
Over Time

Abstract Objectives High-fat dairy foods are calorically dense, which may prevent anorexia and malnutrition that are often seen in frail persons. We determined the association of dairy food intake [milk, yogurt, cheese, total dairy (milk + yogurt + cheese), low-fat, and high-fat dairy, serv/wk] with frailty and frailty progression in older adults from the Framingham Offspring study. Methods This prospective cohort study included non-frail participants at index exam (1998–01) with food frequency questionnaires (FFQ) and ≤2 follow-up frailty assessments (2005–08, 2011–14). Average dairy food intakes were calculated from index and prior FFQs (1998–01 and 1995–98). Fried's frailty phenotype was used: presence of ≥3 criteria of unintentional weight loss, exhaustion, slow gait speed, low physical activity, and low grip strength. Frailty progression was defined as an increased number of frailty criteria over follow-up. Repeated measures logistic regression estimated odds ratios (OR) and 95% confidence intervals (CI) for frailty and frailty progression (separate models) adjusting for age, sex, energy intake (residual analysis), current smoking, multivitamin use, and self-reported health status. Results Mean baseline age was 60y ± 9 (range 33–86 y) and 45% were female. Mean dairy food intakes [serv/wk] were: 5.7 ± 5 (milk), 1.1 ± 1.9 (yogurt), 2.8 ± 3.0 (cheese), 9.6 ± 6.9 (total dairy), 6.2 ± 6.0 (low-fat dairy), and 4.5 ± 4.3 (high-fat dairy). Of the 2550 non-frail individuals at baseline, 8.8% (2005–08) and 13.5% (2011–14) became frail over time. Frailty progression was seen in 34% (2005–08) and 40% (2011–14) of the participants. In age and sex adjusted models, high-fat dairy foods were associated with 2% increased odds of frailty (95%CI: 1.00–1.04, P = 0.01). This association did not change after further adjustment (OR: 1.02, 95%CI: 0.99–1.05, P = 0.07). Other dairy foods were not associated with frailty (P range: 0.23–0.78) or with frailty progression (P range: 0.32–0.86). Conclusions In this study of healthy older adults, most dairy food intake was not associated with frailty or frailty progression after considering important covariables. The observed trend for slightly increased odds of frailty with high-fat dairy intake should be re-examined in other studies with frailty assessed over time. Funding Sources Boston Pepper Center OAIC, NHLBI & Dairy Management Inc.

Home Telemonitoring of Arterial Hypertension with Antihypertensive Treatment Titration: Protocol of a Randomized Controlled Prospective Trial (HOROSCOPE Study) (Preprint)

2020 ◽  
Author(s):  
SONIA Ben Hafaiedh ◽  
Yosra Ben Daya ◽  
Amina Hadjer Radoui ◽  
Mohamed Bouchoucha ◽  
Rabie Razgallah ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Primary Care Physicians ◽  
Primary Outcome ◽  
Prospective Trial ◽  
Treatment Compliance ◽  
Therapeutic Education ◽  
Randomized Controlled ◽  
Sahel Region

BACKGROUND Despite the availability of effective treatment, the control of hypertension remains insufficient. Telemonitoring in the management of hypertension would be an effective way to improve blood pressure (BP) control. OBJECTIVE The aim of this study is to evaluate the effects of telemonitoring with anti-hypertensive treatment titration on blood pressure control in Tunisian hypertensive patients. METHODS It will be a prospective, rater blinded, randomized, controlled trial carried out with primary care physicians in the Sahel region of Tunisia. Patients will be eligible for enrolment if they are over 35 years of age, newly diagnosed with hypertension, or known to be poorly controlled on antihypertensive therapy. Participants will be randomly assigned in a 1:1 ratio to the telemonitoring or usual care arm. The telemonitoring arm involves of a weekly telephone call for collection of the home BP measurements, therapeutic education, treatment compliance assessment, as well as having a monthly call for treatment titration and side effects check. Randomization will be done by use of interactive web responsive system (IWRS) and will be stratified by investigation centers. Neither participants nor investigators will be masked to groups’ assignment. The primary outcome is the change from baseline in the 2 groups of mean 24-hour systolic blood pressure (SBP) at 6 months of follow-up. All randomized patients who will attend the follow-up visit at 6 months and have no missing data for the primary outcome will be included in the analysis. RESULTS Recruitment to the trial started in July 2020. The study was initiated with 17 primary care physicians. We expect the inclusion period to last for approximately 6 months. We expect to complete data collection at the end of 2021 and plan the dissemination of the results subsequently. CONCLUSIONS The HOROSCOPE trial will provide important new evidence that could shed some light on the feasibility and impact of telemonitoring along with self-monitoring in a Tunisian hypertensive population consulting in primary care. CLINICALTRIAL Trial Registration: ClinicalTrials.gov identifier: NCT04607239;

scholarly journals Change in Medication Adherence and Beliefs in Medicines Over Time in Older Adults

2015 ◽  
Vol 8 (5) ◽  
pp. 39 ◽  
Author(s):  
Elizabeth Unni ◽  
Olayinka O Shiyanbola ◽  
Karen B Farris
Keyword(s):  
Older Adults ◽  
Medication Adherence ◽  
Adherence Behavior ◽  
Improve Medication Adherence ◽  
Lower Baseline ◽  
Item Scale ◽  
Over Time ◽  
Lower Adherence ◽  
Predictors Of Change

<p><strong>OBJECTIVE:</strong> The temporal component of medication adherence is important while designing interventions to improve medication adherence. Thus, the objective of this study was to determine how medication adherence and beliefs in medicines change over time in older adults.</p> <p><strong>METHODS:</strong> A two-year longitudinal internet-based survey among adults 65+ years was used to collect data on medication adherence (Morisky 4-item scale) and beliefs in medicines (Beliefs about Medicines Questionnaire). Paired t-test and one-way ANOVA determined if a change in beliefs in medicines and medication adherence over time was significant. A multiple linear regression was used to determine the significant predictors of change in medication adherence over time.</p> <p><strong>RESULTS:</strong> 436 respondents answered both baseline and follow-up surveys. Among all respondents, there was no significant change in adherence (0.58 ± 0.84 vs. 0.59 ± 0.84; p &gt; 0.05), necessity beliefs (17.13 ± 4.31 vs. 17.10 ± 4.29; p &gt; 0.05), or concern beliefs (11.70 ± 3.73 vs. 11.68 ± 3.77; p &gt; 0.05) over time. For older adults with lower baseline adherence, there was a statistically significant improvement in adherence (1.45 ± 0.70 vs. 0.99 ± 0.97; p &lt; 0.05); but no change in beliefs in medicines over time. The significant predictors of change in medication adherence over time were baseline adherence and baseline concern beliefs in medicines.</p> <p><strong>CONCLUSION:</strong> With baseline adherence and baseline concern beliefs in medicines playing a significant role in determining change in adherence behavior over time, especially in individuals with lower adherence, it is important to alleviate medication concerns at the beginning of therapy for better adherence.</p>

Psychological distress and frailty transitions over time in community-dwelling older adults

2016 ◽  
Vol 33 (2) ◽  
pp. 111-119 ◽  
Author(s):  
J. E. McHugh ◽  
M. Dowling ◽  
A. Butler ◽  
B. A. Lawlor
Keyword(s):  
Older Adults ◽  
Psychological Distress ◽  
Physical Health ◽  
Negative Symptoms ◽  
Community Dwelling ◽  
Ageing Population ◽  
Observational Study Design ◽  
Community Dwelling Older Adults ◽  
Over Time

ObjectivesPhysical health and, in particular, frailty may be associated with psychological factors among older adults. We aimed to investigate the relationships between aspects of psychological distress and progression of frailty over time among older adults.MethodsWe used a longitudinal observational study design with 624 participants aged over 60 years (mean age=72.75, s.d.=7.21, 68% female) completing a baseline comprehensive biopsychosocial geriatric assessment, and 447 returning for a follow-up assessment 2 years later. Aspects of psychological distress, physical health, and frailty were analysed for the purposes of this study. We employed a series of logistic regression analyses to determine psychological predictors of changing states of aspects of frailty over time.ResultsWith individual components of frailty, neuroticism and age predicted negative transitions of exhaustion and grip strength, respectively, whereas age alone was a predictor of transitions in overall frailty scores based on four components.ConclusionWe conclude that neuroticism and age may impact upon physical frailty and its progression over time in an ageing population. These findings may reflect the tendency for those with high levels of neuroticism to endorse negative symptoms, or alternatively, neuroticism may result in exhaustion via worry in an older population. Further research is required to further elucidate this relationship.

scholarly journals Letter to the Editor - Evaluation of Four Artificial Intelligence–Assisted Self-Diagnosis Apps on Three Diagnoses: Two-Year Follow-Up Study (Preprint)

2020 ◽  
Author(s):  
Stephen Gilbert ◽  
Matthew Fenech ◽  
Anisa Idris ◽  
Ewelina Türk
Keyword(s):  
Artificial Intelligence ◽  
Learning Algorithms ◽  
Symptom Assessment ◽  
Normal Process ◽  
Repeated Testing ◽  
Follow Up Study ◽  
Clinical Vignettes ◽  
Letter To The Editor ◽  
Over Time

UNSTRUCTURED We have several comments on the recent publication of [1], in which repeated testing of four symptom assessment applications with clinical vignettes was carried out to look for “hints of ‘non-locked learning algorithms’”. As the developer of one of the symptom assessment applications studied by [1], we are supportive of studies evaluating app performance, however there are important limitations in the methodology of the study. Most importantly, the methodology used in this study is not capable of addressing its main objective. The approach used to look for evidence of non-locked algorithms was the quantification of differences in performance using three ophthalmology vignettes, first in 2018 then in 2020. This methodology, although highly limited due to the use of only three vignettes in one medical specialism, could be used to detect changes in app performance over time. It however cannot be used to distinguish between non-locked algorithms and the manual updating of the apps’ medical intelligence, through the normal process of manual release of updated app versions.

scholarly journals Robot-Assisted Training for Upper Limb in Stroke (ROBOTAS): An Observational, Multicenter Study to Identify Determinants of Efficacy

2021 ◽  
Vol 10 (22) ◽  
pp. 5245
Author(s):  
Rocco Salvatore Calabrò ◽  
Giovanni Morone ◽  
Antonino Naro ◽  
Marialuisa Gandolfi ◽  
Vitalma Liotti ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Upper Limb ◽  
Primary Outcome ◽  
Real Life ◽  
Chronic Phase ◽  
Robot Assisted ◽  
End Effector ◽  
End Effectors ◽  
Practice Methods

Background: The loss of arm function is a common and disabling outcome after stroke. Robot-assisted upper limb (UL) training may improve outcomes. The aim of this study was to explore the effect of robot-assisted training using end-effector and exoskeleton robots on UL function following a stroke in real-life clinical practice. Methods: A total of 105 patients affected by a first-ever supratentorial stroke were enrolled in 18 neurorehabilitation centers and treated with electromechanically assisted arm training as an add-on to conventional therapy. Both interventions provided either an exoskeleton or an end-effector device (as per clinical practice) and consisted of 20 sessions (3/5 times per week; 6–8 weeks). Patients were assessed by validated UL scales at baseline (T0), post-treatment (T1), and at three-month follow-up (T2). The primary outcome was the Fugl-Meyer Assessment for the upper extremity (FMA-UE). Results: FMA-UE improved at T1 by 6 points on average in the end-effector group and 11 points on average in the exoskeleton group (p < 0.0001). Exoskeletons were more effective in the subacute phase, whereas the end-effectors were more effective in the chronic phase (p < 0.0001). Conclusions: robot-assisted training might help improve UL function in stroke patients as an add-on treatment in both subacute and chronic stages. Pragmatic and highmethodological studies are needed to confirm the showed effectiveness of the exoskeleton and end-effector devices.

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