One Month Prediction of Pressure Ulcers in Nursing Home Residents with Bayesian Networks.

OBJECTIVES: Pressure ulcers (PUs) are a common and avoidable condition among residents of nursing homes, and their consequences are severe. Reliable and simple identification of high-risk residents is a major challenge for prevention. Available tools like the Braden and Norton scale have imperfect predictive performance. The objective is to predict the occurrence of PUs in nursing home residents from electronic health record (EHR) data. DESIGN: Longitudinal retrospective nested case-control study. SETTING AND PARTICIPANTS: EHR database of French nursing homes from 2013 to 2022. METHODS: Residents who suffered from PUs were cases and those who did not were controls. For cases, we analyzed the data available in their EHR 1 month before the occurrence of the first PU. For controls, we used available data 1 month before an index date adjusted on the delays of PU onset. We conducted a Bayesian network (BN) analysis, an explainable machine learning method, using 136 input variables of potential medical interest determined with experts. To validate the model, we used scores, features selection, and explainability tools such as Shapley values. RESULTS: Among 58,368 residents analyzed, 29% suffered from PUs during their stay. The obtained BN model predicts the occurrence of a PU at a 1-month horizon with a sensitivity of 0.94 (±0.01), a precision of 0.32 (±0.01) and an area under the curve of 0.69 (±0.02). It selects 3 variables: length of stay, delay since last hospitalization, and dependence for transfer. This BN model is suitable and simpler than models provided by other machine learning methods. CONCLUSIONS AND IMPLICATIONS: One-month prediction for incident PU is possible in nursing home residents from their EHR data. The study paves the way for the development of a predictive tool fueled by routinely collected data that do not require additional work from health care professionals, thereby opening a new preventive strategy for PUs.

Assessment of Frailty by the French Version of the Vulnerable Elders Survey-13 on Digital Tablet: Validation Study.

BACKGROUND: Frailty assessment is a major issue in geriatric medicine. The Vulnerable Elders Survey-13 (VES-13) is a simple and practical tool that identifies frailty through a 13-item questionnaire completed by older adults or their family caregivers by self-administration (pencil and paper) or by telephone interview. The VES-13 provides a 10-point score that is also a recognized mortality predictor. OBJECTIVE: This study aims to design an electronic version of the Echelle de Vulnérabilité des Ainés-13, the French version of the VES-13 (eEVA-13) for use on a digital tablet and validate it. METHODS: The scale was implemented as a web App in 3 different screens and used on an Android tablet (14.0× 25.6 cm). Participants were patients attending the outpatient clinic of a French geriatric hospital or hospitalized in a rehabilitation ward and family caregivers of geriatric patients. They completed the scale twice, once by a reference method (self-administered questionnaire or telephone interview) and once by eEVA-13 using the digital tablet. Agreement for diagnosis of frailty was assessed with the κ coefficient, and scores were compared by Bland and Altman plots and interclass correlation coefficients. User experience was assessed by a self-administered questionnaire. RESULTS: In total, 86 participants, including 40 patients and 46 family caregivers, participated in the study. All family caregivers had previously used digital devices, while 13 (32.5%) and 10 (25%) patients had no or infrequent use of them previously. We observed no failure to complete the eEVA-13, and 70% of patients (28/40) and no family caregivers needed support to complete the eEVA-13. The agreement between the eEVA-13 and the reference method for the diagnosis of frailty was excellent (κ=0.92) with agreement in 83 cases and disagreement in 3 cases. The mean difference between the scores provided by the 2 scales was 0.081 (95% CI-1.263 to 1.426). Bland and Altman plots showed a high level of agreement between the eEVA-13 and the reference methods and interclass correlation coefficient value was 0.997 (95% CI 0.994-0.998) for the paper and tablet group and 0.977 (95% CI 0.957-0.988) for the phone and tablet groups. The tablet assessment was found to be easy to use by 77.5% (31/40) of patients and by 96% (44/46) of caregivers. Finally, 85% (39/46) of family caregivers and 50% (20/40) of patients preferred the eEVA-13 to the original version. CONCLUSIONS: The eEVA-13 is an appropriate digital tool for diagnosing frailty and can be used by older adults and their family caregivers. The scores obtained with eEVA-13 are highly correlated with those obtained with the original version. The use of health questionnaires on digital tablets is feasible in frail and very old patients, although some patients may need help to use them.

Real-world Implementation of an eHealth System Based on Artificial Intelligence Designed to Predict and Reduce Emergency Department Visits by Older Adults: Pragmatic Trial.

BACKGROUND: Frail older people use emergency services extensively, and digital systems that monitor health remotely could be useful in reducing these visits by earlier detection of worsening health conditions. OBJECTIVE: We aimed to implement a system that produces alerts when the machine learning algorithm identifies a short-term risk for an emergency department (ED) visit and examine health interventions delivered after these alerts and users' experience. This study highlights the feasibility of the general system and its performance in reducing ED visits. It also evaluates the accuracy of alerts' prediction. METHODS: An uncontrolled multicenter trial was conducted in community-dwelling older adults receiving assistance from home aides (HAs). We implemented an eHealth system that produces an alert for a high risk of ED visits. After each home visit, the HAs completed a questionnaire on participants' functional status, using a smartphone app, and the information was processed in real time by a previously developed machine learning algorithm that identifies patients at risk of an ED visit within 14 days. In case of risk, the eHealth system alerted a coordinating nurse who could then inform the family carer and the patient's nurses or general practitioner. The primary outcomes were the rate of ED visits and the number of deaths after alert-triggered health interventions (ATHIs) and users' experience with the eHealth system; the secondary outcome was the accuracy of the eHealth system in predicting ED visits. RESULTS: We included 206 patients (mean age 85, SD 8 years; 161/206, 78% women) who received aid from 109 HAs, and the mean follow-up period was 10 months. The HAs monitored 2656 visits, which resulted in 405 alerts. Two ED visits were recorded following 131 alerts with an ATHI (2/131, 1.5%), whereas 36 ED visits were recorded following 274 alerts that did not result in an ATHI (36/274, 13.4%), corresponding to an odds ratio of 0.10 (95% IC 0.02-0.43; P<.001). Five patients died during the study. All had alerts, 4 did not have an ATHI and were hospitalized, and 1 had an ATHI (P=.04). In terms of overall usability, the digital system was easy to use for 90% (98/109) of HAs, and response time was acceptable for 89% (98/109) of them. CONCLUSIONS: The eHealth system has been successfully implemented, was appreciated by users, and produced relevant alerts. ATHIs were associated with a lower rate of ED visits, suggesting that the eHealth system might be effective in lowering the number of ED visits in this population. TRIAL REGISTRATION: clinicaltrials.gov NCT05221697; https://clinicaltrials.gov/ct2/show/NCT05221697.

Effect of the Physical Environment on Health and Well-Being of Nursing Homes Residents: A Scoping Review.

OBJECTIVES: In what way the physical environment of nursing homes (NHs) influences the health and well-being of nursing residents is not well codified. The authors aimed to review scientifically based knowledge on this topic. DESIGN: A systematic scoping review of research into the effect that physical environment in nursing homes has on residents' health. SETTING AND PARTICIPANTS: Search for relevant English-language articles in PubMed and the Cochrane database before April 15, 2022. Article selection and data extraction were performed by 2 researchers. Studies were included if conducted on nursing home residents and if they examined associations between components of the physical environment and health outcomes. MEASURES: The review was performed in accordance with the PRISMA statement. RESULTS: Of 1347 articles retrieved, 59 met the inclusion criteria-40 observational, 1 survey, and 18 interventional studies, of which 5 were randomized controlled trials. Certain environmental features repeatedly show significant positive effect on resident's health, such as noise reduction, tuning of lighting, natural light, easy access to garden, dining environment, and resident-centered interior renovation. Nursing home size was not found to have a direct relationship to resident health and well-being, although it is related to more than only the physical environment (eg, social environment). CONCLUSIONS AND IMPLICATIONS: This review provides guidance in selective areas of the physical environment for the design of nursing homes, with potential benefits for the health and well-being of residents.

Lived experience, perceptions, and expectations of close relatives of nursing home residents and strengths-based nursing: a phenomenological approach.

Conflicts between residents' families and professionals are frequently described in nursing homes. This phenomenological study aims to describe and understand the experience, expectations and needs of residents' relatives. Forty-three interviews were conducted in six selected nursing homes. The main expectations voiced by the 43 relatives was that the nursing home respect the "humanity" of their loved one and improvements in communication between the family and staff. This study yielded original findings that are poorly described in the literature, namely the need for psychological assistance for relatives when loved ones enter a nursing home. Relatives wanted the administrative formalities to be separated in time from the time when their loved one entered the home. They wanted psychological support and training to better understand their loved one's illness. Finally, relatives strove to be a collaborative partnership with the staff team in the nursing home. These expectations fit the strengths-based philosophy. Training professionals, directors and leaders to apply this paradigm shift could improve the relationship between relatives and nursing home care.

[Lived experience, perceptions, and expectations of close relatives of nursing home residents and strength-based nursing, a phenomenological approach]. / Les soins fondés sur les forces : expérience vécue, perceptions et attentes des familles des résidents en Ehpad, une approche phénoménologique.

Dissensions between residents' families and professionals are frequently described in nursing homes. This phenomenological study aims to describe and understand experience, expectations and needs of residents' relatives. Forty-three interviews were conducted in the 6 selected nursing homes. The main expectations from the 43 relatives was the respect of "humanity" of their loved one by the nursing home and improving family-staff communication. This study yielded original findings that are poorly described in the literature, namely the need for psychological help for relatives when their love one enters the nursing home. Relatives wanted the administrative formalities to be separated in time from the moment of their loved one's admission. They wanted psychological support and training to better understand their loved one's illness. Finally, relatives aimed to be a collaborative partnership with the team in the nursing home. These expectations fit the Strengths-Based philosophy. Thus, training professionals, directors and leaders to apply this paradigm shift could improve the relationship between relatives and nursing home care.

Expectations and Needs of Families in Nursing Homes: An Integrative Review.

A better understanding of the expectations and needs of the families of nursing home residents is needed for a constructive and sustainable relationship of mutual trust. The objective of this study was to understand the expectations of families of nursing home residents described in the literature. A systematic integrative review of the literature was conducted. After a rigorous selection made by two researchers, independently, 53 articles were selected out of 1,094 results. The expectations of families are quality care, consideration complying with human dignity of the resident, collaboration, honesty, and mutual confidence that ties together families, staff, and physicians. This study reveals that families consider themselves as a strength for a resident's support services, in line with Gottlieb's strength-based approach. This approach offers promising implications for practice and for a new type of management in nursing homes based on strong values.