Search Results (144)

Background/Objectives: Emergency department short-stay units (ED SSUs) manage patients requiring short-term observation and treatment. For a small number of patients, a longer hospital admission is required. Care for these patients is provided by an inpatient team and the responsibility for managing acute clinical deterioration falls to a rapid response team, activated by an emergency call. While emergency calls have primarily been a feature of the inpatient setting, admitted patients are increasingly boarding within ED SSUs and the occurrence and impact of emergency calls in this setting remains largely unreported. This study aimed to determine the incidence and characteristics of emergency calls within an ED SSU, describing patient demographics, clinical triggers, and outcomes. Methods: This retrospective cohort study utilised the Tasmanian Emergency Care Outcomes Registry (TECOR) to analyse emergency calls in the ED SSU of a tertiary emergency department between 1 February 2024 and 28 February 2025. Inclusion criteria were defined as adult patients (≥14 years) admitted to an inpatient service who had emergency calls whilst in the ED SSU. Descriptive statistics were used to characterise this cohort. Results: Of 83,238 ED presentations, 11,775 adult patients were transferred to the ED SSU. 1464 (12.4%) of these patients were subsequently admitted under an inpatient service but remained boarding in the ED SSU, with 54 emergency calls occurring in 38 unique patients (2.6%). The median age was 81.5 years (IQR 65–86), older than both the main ED cohort with a median age of 71 years, and median ages of 65 to 69.5 years reported in ward-based cohorts. Most calls were medical emergency team (MET) activations (52, 96.30%) with only 2 (3.7%) code blues. The most common triggers were hypotension (20, 37.04%), reduced level of consciousness (7, 12.96%) and serious concern (7, 12.96%). Delays occurred in 18.52% of calls (mean 82 min). The median ED SSU length of stay for patients having an emergency call was 40.15 h, substantially exceeding the intended ED SSU admission criteria threshold of 24 h. Goals of care remained incomplete in 33.33% of calls, even after emergency team review. Conclusions: ED SSU emergency calls are infrequent but clinically significant, involving an elderly, vulnerable population with late sign triggers and prolonged boarding. These findings highlight fundamental mismatches between patient acuity and ED SSU environment capabilities, emphasising the need for improved monitoring, more selective admission criteria, and enhanced systems for recognising deterioration for patients boarding in ED SSUs. Full article

Elderly welfare institutions in Taiwan have experienced multiple severe fire incidents, with smoke inhalation accounting for the majority of fatalities. Hot smoke can rapidly propagate through interconnected ceiling spaces, complicating evacuation for residents with limited mobility who depend heavily on caregiving staff and external responders. Field inspections conducted in this study indicate that 82% of residents require assisted evacuation, underscoring the critical role of early detection, staff-mediated response, and effective smoke control. Drawing on disaster management theory, this study examines key determinants of fire safety performance in elderly welfare institutions, where caregiving staff are primarily trained in medical care rather than fire safety. A total of 64 licensed institutions in Tainan City were investigated through on-site inspections, structured checklist-based surveys, and statistical analyses of fire protection systems. In addition, a comparative review of building and fire safety regulations in Taiwan, the United States, Japan, and China was conducted to contextualize the findings. Using the defense-in-depth framework, this study proposes a three-layer fire safety strategy comprising (1) prevention of fire occurrence, (2) rapid fire detection and early suppression, and (3) containment of fire and smoke spread. From a sustainability perspective, this study conceptualizes fire safety in elderly welfare institutions as a problem of risk governance, illustrating how defense-in-depth can be operationalized as a governance-oriented framework for managing fire and smoke risks, safeguarding vulnerable older adults, and sustaining the resilience and continuity of long-term care systems in an aging society. Full article

Background/Objectives: Complete denture rehabilitation in edentulous patients presents functional and biomechanical challenges. Mini-implant-supported overdentures improve retention, stability, function, and comfort, particularly in complex class II or class III mandibulo-maxillary relationships. However, mechanical complications such as ball abutment wear may compromise long-term success. This case report aims to describe the clinical context, methods employed to manage ball abutment wear, and related complications in a patient with a mandibular mini-implant overdenture. Methods: This retrospective case report presents two approaches to managing abutment wear and enhancing overdenture retention: silicone matrices (Retention.Sil, Bredent Medical GmbH & Co.KG, Senden, Germany) and abutment reconstruction using prefabricated cemented spheres (Concave Reconstructive Sphere, Rhein83, Bologna, Italy). Results: A significant mechanical complication associated with mini-implant overdentures is the wear of ball abutments, which may develop over time as a result of continuous interaction between the O-ring system and the abutment surfaces. Both techniques effectively preserved mini-implants while enhancing denture retention, function, and comfort. Conclusions: Mechanical complications, such as ball abutment wear, may compromise the retention and functional performance of mandibular overdentures. Alternatives like silicone matrices and reconstructive spheres address abutment wear in mandibular overdentures, ensuring long-term retention and sustainable, patient-centered care for the elderly. Full article

As the Buddhist monastic community in Korea has entered an era marked by aging demographics, the issues surrounding the welfare of the order’s monastics in their retirement years have become increasingly pressing. In response, in 2011, the Jogye Order enacted the Monastic Welfare Act and established the Monastic Welfare Society with the aim of enabling monks to fully devote themselves to their religious duties by assuming institutional responsibility for their healthcare, pension, residential welfare, and end-of-life needs. Over a decade since the system’s implementation, the Jogye Order has achieved notable progress towards achieving the Monastic Welfare Act’s aims. However, while the order has stabilized medical coverage for its clergy, there remain considerable gaps in its provisions for income and housing for elderly monastics. This article surveys the Jogye Order’s efforts to establish systemic care for its elderly monastics, with a particular focus on the Jogye Order’s 2011 Monastic Welfare Act and subsequent activities of the Monastic Welfare Society. It then critically examines the current state of eldercare within the order, along with its strengths and weakness, before engaging in a comparative discussion regarding the clerical eldercare and welfare systems provided by both the Korean Catholic Church and the Thai Buddhist community. Full article

Background and Objectives: Pre-frailty is characterized by a lack of social interaction, mental instability, and decreased interest in health behaviors and oral health. Thus, this study aimed to explore the relationship between oral function and social participation among community-dwelling older adults. Methods: The study participants were community-dwelling older adults who underwent dental and oral health examinations and health checkups conducted by the Shimane Extended Union of the Medical Care System for Latter-Stage Elderly People between April 2020 and March 2022. General background data, oral health status, and social participation data were collected. Logistic regression analysis was performed as the primary analysis, with social participation as the objective variable. Results: The participants included 4196 cases, excluding 513 cases with missing data. Logistic regression analysis of the presence of going out at least once a week demonstrated significant correlations in age, lower leg circumference, masticatory function, and oral hygiene status (p < 0.05). Significant correlations were found in sex, lower leg circumference, masticatory function, swallowing function, and oral hygiene status for regular meetings with family or friends (p < 0.05). Conclusions: There may be an association between social participation and a decline in oral function and hygiene status among community-dwelling older adults. Full article

The increasing elderly population presents major challenges to traditional healthcare due to the need for continuous care, a shortage of skilled professionals, and increasing medical costs. To address this, smart elderly care homes where multiple residents live with the support of caregivers and IoT-based assistive technologies have emerged as a promising solution. For their effective operation, a reliable high speed network like 5G is essential, along with intelligent resource allocation to ensure efficient service delivery. This study proposes a deep reinforcement learning (DRL)-based resource management framework for smart elderly homes, formulated as a Markov decision process. The framework dynamically allocates computing and network resources in response to real-time application demands and system constraints. We implement and compare two DRL algorithms, emphasizing their strengths in optimizing edge utilization and throughput. System performance is evaluated across balanced, high-demand, and resource-constrained scenarios. The results demonstrate that the proposed DRL approach effectively learns adaptive resource management policies, making it a promising solution for next-generation intelligent elderly care environments. Full article

Background/Objectives: Elderly patients who require aftercare in an intramural care (IMC) facility may contribute to “bed blocking,” which occurs when patients who are ready for discharge remain hospitalized longer than medically necessary. While most bed-blocking studies focus on capacity issues, this study also investigates the coordination process. In a regional hospital in the Netherlands, we examine the extent to which bed blocking occurs due to patients awaiting IMC, and how this issue can be characterized in terms of capacity and coordination challenges. Methods: The case study employs a mixed-methods approach, analyzing system data, documents, and interviews from the hospital, IMC organizations, and a health insurance provider. The location of each patient (organization and department) was collected and reconstructed to a patient path. All patient paths together formed a network enabling data analysis both on the level of patient paths as well as on the level of the networks as they developed through time. This gave insight into the complexity of the total network that has to be coordinated. Results: In 2023, 6% of the hospital capacity was occupied by patients awaiting IMC. Delays were observed at various coordination stages. Due to a lack of data on IMC bed capacity, we were unable to establish whether capacity limitations also contributed to bed blocking. Conclusions: The coordination system is complex and includes waiting times at each coordination stage, resulting in bed blocking. The absence of a centralized capacity overview, coupled with limited data, prevents decision-makers from identifying bed blocking arising from capacity shortages. Greater insight is needed to coordinate patient flow and determine the required slack capacity. Full article

Background and Objectives: Ankle fractures represent one of the most common injuries to the lower limb, particularly impacting women and the elderly. The coronavirus disease 2019 (COVID-19) pandemic greatly disrupted both the incidence of these fractures and their treatment patterns globally. This retrospective epidemiological study analyzed 1010 cases of ankle fractures treated at the Orthopedics Department of Policlinico University Hospital in Catania from 2018 to 2023. The study aimed to evaluate trends in incidence, patient demographics, fracture types, treatment modalities, and hospital stay across the pre-COVID-19, COVID-19, and post-COVID-19 periods. Materials and Methods: A retrospective observational study was conducted including all patients diagnosed with ankle fractures from 1 January 2018 to 31 December 2023. Data were collected from hospital medical records using ICD-9-CM codes and radiographic classification systems (Danis–Weber, Lauge-Hansen, and AO/OTA). Variables analyzed included demographics, fracture type and side, treatment modality, and hospitalization details. Statistical analyses were performed using t-tests, chi-square tests, and linear regression, with significance set at p < 0.05. Results: In 2020, there was a 31.7% decrease in fracture incidence. Although overall fracture rates rebounded after COVID-19, they did not reach pre-pandemic levels. During the pandemic, trimalleolar fractures increased significantly, occurring more frequently in older women, likely due to bone fragility. The rate of surgical treatments rose during and after the pandemic, with a distinct shift from ORIF to external fixation. Hospital stays were longer, especially for patients with cardiovascular risk factors. Conclusions: The pandemic significantly altered the epidemiology, treatment strategies, and outcomes of ankle fractures. These findings highlight the necessity for adaptable care models and preventive strategies, particularly for vulnerable populations such as older women. Full article

As people age, more careful health monitoring becomes increasingly important. The article presents the development and implementation of an integrated system for monitoring the health of elderly individuals using Internet of Things (IoT) technology and a wearable bracelet to continuously collect vital data. The device integrates MAX30100 sensors for heart rate monitoring and MPU-6050 for step counting and sleep quality analysis (deep and superficial sleep). The collected data for average heart rate (AR), minimum (mR), maximum (MR), number of steps (S), deep sleep time (DST), and superficial sleep time (SST) is processed in real-time through a health anomaly detection algorithm (HADA), based on the dimensionality reduction method using PCA. The system is connected to the Azure cloud infrastructure, ensuring secure data transmission, preprocessing, and the automatic generation of alerts for prompt medical interventions. Studies conducted over two years demonstrated a sensitivity of 100% and an accuracy of 98.5%, with a tendency to generate additional alerts to avoid overlooking critical events. The results outline the importance of personalizing the analysis, adapting algorithms to individual characteristics, and the system’s potential to prevent medical complications and improve the quality of life for elderly individuals. Full article

Introduction: Hypoglossal nerve stimulation (HNS) “Inspire_© therapy” has garnered popularity among obstructive sleep apnea (OSA) patients seeking an alternative to continuous positive airway pressure (CPAP) therapy. The growth in HNS has been particularly high in older adults living with OSA. Consistent and proper use of HNS in the geriatric population faces unique age-associated barriers: a high rate of multiple chronic conditions (MCC) and polypharmacy (being on five or more drugs). Early recognition and patient-centered management of these barriers will allow older patients to obtain maximum benefits from HNS. HNS has distinct advantages in the geriatric population because it overcomes many concerns related to CPAP therapy adherence, such as mechanical limitations due to manual dexterity, maxillofacial anatomy, dental issues such as usage of dentures, allergy/otolaryngology-related disorders, and pre-existing post-traumatic stress disorder-related claustrophobia. This paper describes how we worked with older patients with OSA and their care partners to overcome these barriers so patients can continue to derive cardiovascular, neurologic, and quality of life benefits resulting from optimal OSA management. These benefits are especially important in the older population because of higher rates of comorbidities (dementia, coronary artery disease, and atrial fibrillation) exacerbated by sub-optimally treated OSA. In this article, we describe our clinical experience with elderly patients on Inspire_© therapy, with a focus on the everyday difficulties faced by these patients and the measures implemented to address and mitigate these barriers. Methods: A retrospective chart review was conducted to identify patients aged 65 and above who underwent hypoglossal nerve stimulator insertion. Experiences of older patients during and after the insertion procedure were documented and compared to a younger population of patients on HNS therapy. We specifically collected information on difficulties encountered during activation or follow-up visits and compared them between the different age groups. Using this information, we identified areas to improve treatment adherence from the patients’ perspectives. Results: We identified 43 geriatric (65 to 86 years old) patients who received the Inspire implant at a tertiary academic medical center and compared them to a younger population of 23 patients. Most common challenges noted—with a potential to impact adherence—included orofacial and lingual neuropraxia (ischemic or demyelination-induced neuropathy) at activation, cognitive dysfunction (memory problems), preexisting anxiety, and insomnia. Other difficulties that are less commonly reported but equally important to consistent and proper use of HNS included headaches, concerns of device malfunction, change in comfort levels after cardiac procedures, and general intolerance of the device. The older patient population had a statistically significant higher incidence of cognitive difficulties (30.2% vs. 4.4%) and a smaller social support system (62.8% vs. 91.3%) affecting device usage compared to the younger population. There were no statistically significant differences in the rates of other more commonly reported adverse effects such as headaches, dry mouth, and anxiety between the two age groups. Conclusion: Despite several challenges faced by geriatric patients, Inspire_© hypoglossal nerve stimulation remains a viable, alternative treatment option for OSA with improved tolerance and adherence compared to CPAP. After identifying less commonly reported barriers such as cognitive decline, sensory deficits, and decreased social support systems, minor adjustments and appropriate education on use allows older patients to correctly use and benefit from Inspire_© device therapy, with subsequent improvement in sleep and overall quality of life. Full article

Background and Objectives: Elderly trauma patients face unique physiological challenges that often lead to undertriage under the current guidelines. The present study aimed to develop machine-learning (ML)-based, age-specific triage guidelines to improve predictions for intensive care unit (ICU) admissions and in-hospital mortality. Materials and Methods: A total of 274,347 trauma cases transported via Emergency Medical System (EMS)-119 in Seoul (2020–2022) were analyzed. Physiological indicators (e.g., systolic blood pressure; saturation of partial pressure oxygen; and alert, verbal, pain, unresponsiveness scale) were incorporated. Bayesian optimization was used to fine-tuned models for sensitivity and specificity, emphasizing the F2 score to minimize undertriage. Results: Compared with the current guidelines, the alternative guidelines achieved superior sensitivity for ICU admissions (0.728 vs. 0.541) and in-hospital mortality (0.815 vs. 0.599). Subgroup analyses across injury severities, including traumatic brain and chest injuries, confirmed the enhanced performance of the alternative guidelines. Conclusions: ML-based, age-specific triage guidelines improve the sensitivity of triage decisions, reduce undertriage, and optimize elderly trauma care. Implementing these guidelines can significantly enhance patient outcomes and resource allocation in emergency settings. Full article

With the intensification of aging, the imbalance between the supply and demand of elderly care services has become increasingly prominent. Taking Changsha as a case study, this research constructs an accessibility evaluation system based on the 15-min life circle theory, utilizing multi-source data. Spatial weighting characteristics of elderly care facility locations were analyzed through machine learning algorithms, and service coverage disparities between urban districts and suburban towns were assessed under 5-, 10-, and 15-min walking thresholds. Street view semantic segmentation technology was employed to extract street environmental elements in central urban areas, and a multiple regression model was established to elucidate the impact mechanisms of the built environment on walking accessibility. Key findings include: (1) Significant urban-rural service disparities exist, with 91.4% of urban core facilities offering seven service categories within 15-min walking catchments compared to 26.86% in township areas, demonstrating suburban infrastructure’s heavy reliance on administrative resource allocation. (2) Street environmental factors exhibit significant correlations with walking accessibility scores. At the 15-min walking threshold, building space ratio and transportation infrastructure coverage positively influenced walking convenience, while sky view ratio showed a negative correlation. (3) A random forest-based location prediction framework identified multiple service gaps in existing facilities. Suburban service deficiencies (e.g., 59.8% medical facility coverage within walkable catchments) emerge as critical equity barriers, prompting recommendations for integrated “micro-clinic + smart pharmacy” networks and prioritized mixed-use zoning in new urban planning. This research advances a data-driven framework for reconciling urbanization-aging conflicts, offering practical insights for developing nations in creating age-friendly urban environments. Full article

Background/objectives: Depression is a common complication of cancer and is associated with distress and reduced participation in medical care. The prevalence is still uncertain in advanced cancer due to methodological problems. Our aim was to study depression in the last year of life and related variables. Methods: We used an administrative database and analyzed clinically verified diagnoses of depression during the last year of life for 27,343 persons (nursing home residents excluded) and related the data to age, sex, socioeconomic status on an area level (Mosaic system), and frailty risk as calculated by the Hospital Frailty Risk Score (HFRS). T-tests, chi-2 tests, and binary logistic regression models were used. Results: During the last year of life, a clinical diagnosis of depression was found in 1168/27,343 (4.3%) cases and more frequently seen in women (4.8% vs. 3.8%, p = 0.001), in the elderly aged 80 years or more, p = 0.03, and especially in persons with a frailty risk according to the HFRS, with rates of 3.3%, 5.3% and 7.8% in the low-risk, intermediate and high-risk groups, respectively (p < 0.001), whereas no differences were found based on socioeconomic status. In a multiple logistic regression model, being female (aOR 1.30, 95% CI 1.16–1.46) or having an intermediate (1.66, 1.46–1.88) or high frailty risk (2.57, 2.10–3.14) retained the predictive value (p < 0.001, respectively). Conclusions: Depression is more common in women and, above all, in people with multimorbidity. Depression affects the amount of health care needed, including the need for psychiatric care. Therefore, it should be included in clinical decision-making, especially as depression is associated with poorer prognosis in cancer. Full article

The aging global population requires innovative remote monitoring systems to assist doctors and caregivers in assessing the health of elderly patients. Doctors often lack access to continuous behavioral data, making it difficult to detect deviations from normal patterns when elderly patients arrive for a consultation. Without historical insights into common behaviors and potential anomalies detected with unobtrusive techniques (e.g., non-wearable devices), timely and informed medical interventions become challenging. To address this, we propose an edge-based Internet of Things (IoT) framework that enables real-time monitoring and anomaly detection using non-wearable sensors to assist doctors and caregivers in assessing the health of elderly patients. By processing data locally, the system minimizes privacy concerns and ensures immediate data availability, allowing healthcare professionals to detect unusual behavioral patterns early. The system employs advanced machine learning (ML) models to identify deviations that may indicate potential health risks. A prototype of our system has been developed to test its feasibility and demonstrate, through the application of two of the most frequently used ML models, i.e., isolation forest and Long Short-Term Memory (LSTM) networks, that it can provide scalability, efficiency, and reliability in the context of elderly care. Further, the provided dashboard enables caregivers and healthcare professionals to access real-time alerts and longitudinal trends, facilitating proactive interventions. The proposed approach improves healthcare responsiveness by providing instant insights into patient behavior, facilitating more accurate diagnoses and interventions. This study lays the groundwork for future advancements in the field and offers valuable insights for the research community to harness the full potential of combining edge computing, artificial intelligence (AI), and the IoT in elderly care. Full article

Background: Diabetic ketoacidosis (DKA), a life-threatening complication, can occur in individuals with type 2 diabetes during illness, stress, or medication use. This study examines DKA signals in type 2 diabetes, focusing on sodium–glucose cotransporter-2 (SGLT2) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, and dipeptidyl-peptidase-4 (DPP-4) inhibitors. Methods: DKA reports from Q1 2019 to Q3 2024 were retrieved from the FDA Adverse Event Reporting System (FAERS). Associations between primary exposure and outcomes were ascertained using four key metrics: Reporting Odds Ratio (ROR), Proportional Reporting Ratio (PRR), Empirical Bayes Geometric Mean (EBGM), and Information Component (IC). Results: SGLT2 inhibitors exhibited the higher DKA risk in 2019–2021 (ROR: 314.86 [95% CI 301.76–328.53], PRR of 245.69 [95% CI 235.47–256.36], IC of 6.90, and EBGM of 120), declining in 2022–2024. GLP-1 receptor agonists showed an ROR increase from 2.88 [95% CI 2.56–3.25] in 2019–2021 to 4.64 [95% CI 4.06–5.29] in 2022–2023, slightly declining to 3.95 [95% CI 3.27–4.74] in 2024. DPP-4 inhibitors exhibited a steady ROR rise from 6.81 [95% CI 5.52–8.40] in 2019–2021 to 8.57 [95% CI 6.24–11.76] in 2022–2023 and further to 11.02 [95% CI 6.71–18.10] in 2024. PRR, EBGM, and IC values followed similar trends. The age groups 41–60 and 61–91 years were the most affected, with hospitalization at its highest rate for DPP4-inhibitors in Q1–Q3 of 2024. Hospitalizations were also observed with GLP-1 receptor agonists and SGLT2 inhibitors. Life-threatening events and fatalities were also reported, with physicians contributing to most reports. Conclusions: DKA signals were observed for all three drug classes, particularly among elderly patients, highlighting the need for careful monitoring, especially during periods of illness or stress. However, the risk was higher in the SGLT2 inhibitor group than in the other groups. Full article