Low-Cost Non-Wearable Fall Detection System Implemented on a Single Board Computer for People in Need of Care.

This work aims at proposing an affordable, non-wearable system to detect falls of people in need of care. The proposal uses artificial vision based on deep learning techniques implemented on a Raspberry Pi4 4GB RAM with a High-Definition IR-CUT camera. The CNN architecture classifies detected people into five classes: fallen, crouching, sitting, standing, and lying down. When a fall is detected, the system sends an alert notification to mobile devices through the Telegram instant messaging platform. The system was evaluated considering real daily indoor activities under different conditions: outfit, lightning, and distance from camera. Results show a good trade-off between performance and cost of the system. Obtained performance metrics are: precision of 96.4%, specificity of 96.6%, accuracy of 94.8%, and sensitivity of 93.1%. Regarding privacy concerns, even though this system uses a camera, the video is not recorded or monitored by anyone, and pictures are only sent in case of fall detection. This work can contribute to reducing the fatal consequences of falls in people in need of care by providing them with prompt attention. Such a low-cost solution would be desirable, particularly in developing countries with limited or no medical alert systems and few resources.

[Experiences of uncertainty about the future, poverty risks, and precarious living situations in nursing homes]. / Erleben von Zukunftsunsicherheit, Armutsrisiken und prekären Lebenslagen im Pflegeheim.

The living situation of people in nursing homes, with a specific vulnerability to care-related impoverishment, is underresearched. This article deals with experiences of uncertainty, poverty and a precarious life situation of care home residents in later life. The data basis is supplied by an ethnographic study of ageing and living with chronic health conditions. A range of precarious living situations are outlined on the basis of real cases. Insights gleaned include: people with diverse sociobiographical backgrounds can be affected by insecurity, poverty and precarious life situations as a result of becoming dependent on help and the transition to care homes. Not knowing whether available funds will suffice to cover rising costs until the end of life is a common form of uncertainty about the future. The threat of poverty or becoming dependent on state benefits can exacerbate experiences of loss associated with institutional care, losing autonomy, opportunities for participation, and options for shaping one's life and can further destabilize the overall condition. This anguish remains largely invisible; structural problems are individualized.

[On the effectiveness of a new advisory service for parents of children in need of care: a controlled study]. / Zur Wirksamkeit eines neuen Beratungsangebots für Eltern pflegebedürftiger Kinder.

On the effectiveness of a new advisory service for parents of children in need of care: a controlled study Abstract: Background: Families with children in need of care are exposed to great stress. This results in risks that often lead to a poor living and care situation for families. To support them, an innovative regionally anchored support service is being developed by so-called Family Health Partners (FGP) as part of the NEST research project. Aim/Objective: The primary endpoint of the study is the quality of life of the families. Secondary outcomes are resilience factors and associated measures as well as access to care services. Methods: The effectiveness of the FGP will be tested in a controlled study with four measurement times (baseline, after 6, 12 and 18 months) between January 2022 and April 2024. A total of 204 families with children in need of care were recruited for an intervention and control group. Multilevel models are used to analyze the longitudinal data. Results: Between T0 and T1 there are statistically significant improvements in the intervention group, especially in daily and social stress in the family, in mental health and resilience. In addition, knowledge about general benefit rights as well as specific support and relief offers for caring parents has increased. Conclusions: The results of the first two measurement times indicate that a positive change in quality of life, resilience and health literacy can be achieved through the FGP.

[Use of support and relief services for parents of children in need of care: Results of the FamBer observational study]. / Inanspruchnahme von Unterstützungs- und Entlastungsdiensten für Eltern pflegebedürftiger Kinder.

Use of support and relief services for parents of children in need of care: Results of the FamBer observational study Abstract: Background: Parents of children in need of care in Germany can fall back on a variety of relief and support services. So far, however, there has been a lack of systematic studies and quantitative data on the use of such offers at the individual level of parents and other legal guardians. Aim: The study on the compatibility of care and work for parents with a child in need of care (FamBer; funding: Federal Ministry for Family Affairs, Senior Citizens, Women and Youth, Germany) examines the knowledge of relief and support services, their use and the perceived benefits of these offers. Methods: 1070 parents answered a multidimensional online questionnaire in the cross-sectional study that was developed based on the Kindernetzwerk Study 2 from 2013 and the German socio-economic panel (SOEP). In addition to descriptive analyses, group comparisons were carried out using Chi2, Mann-Whitney U or Kruskal-Wallis H tests. Results: 43 to 58% of parents are aware of the respective legal options for taking time off work, but only very few families make use of them. The other support offers differ significantly in terms of the level of knowledge and utilization; these vary primarily with the education of the parents and the care needs of the child. They assessed the used services for consultation and advice as only little helpful. Conclusions: Due to the study design, we cannot rule out that the findings are also based on personal characteristics of the parents and their living conditions. Nevertheless, a large number of problems (e.g. a lack of information, low using, ineffectiveness of support services) can be identified that need to be overcome.

[Sexual abuse of care-dependent patients : Results of a nationwide cross-sectional study among general practitioners on responsibility and subjective confidence in dealing with suspected abuse]. / Sexueller Missbrauch Pflegebedürftiger : Ergebnisse einer bundesweiten Querschnittsstudie bei Hausärzten/-ärztinnen zu Verantwortung und subjektiven Sicherheit im Verdachtsfall.

BACKGROUND: Violence against people in need of care is a challenge for long-term care situations. Sexual violence in particular, is subject to strong taboos and has so far been little researched. Family physicians can play a role in preventing violence against people in need of care. OBJECTIVE: The objective of this study was to examine family physicians' attitudes to their responsibilities in cases of sexual abuse of patients in need of care. At the same time, we also examined subjective confidence in relation to the procedure in cases of suspected abuse and family physicians' interests in further training on this topic. MATERIAL AND METHODS: A cross-sectional study addressed to 1700 family physicians in Germany with a written survey between September and November 2016. Questionnaires from 302 physicians could be evaluated for the study. FINDINGS: Almost all respondents saw it as part of their responsibility as doctors to intervene in cases of sexual abuse of patients in need of care. There is great uncertainty about how to proceed in cases of suspected sexual abuse of patients in need of care. Respondents' main interest in further training related to the differential diagnosis of sexual abuse and the correct procedure in cases where abuse is suspected. CONCLUSION: Further training provision, particularly on the signs of sexual abuse of people in need of care, could contribute to increasing family physicians' confidence to act.

[Pain management in nursing care in outpatient older adults in need of care]. / Pflegerisches Schmerzmanagement bei ambulant versorgten Pflegebedürftigen.

Pain management in nursing care in outpatient older adults in need of care Abstract. Background: International data report a prevalence rate for chronic pain of up to 50 % in community dwelling older adults (> 65 years). A national study reported a prevalence rate of 68,5 % among outpatient adults (≥ 18 years). Nursing care has an important meaning in pain management. However, previous research on the quality of pain management in nursing care is insufficient. Aim: The aim of this study is to evaluate the appropriateness of pain management in nursing care in our target group. Method: The cross-sectional study is based on data from ACHE. The study comprises 219 patients. Information on subjective pain experience and pain management were obtained by face-to-face interviews and nursing documentation. Results: Our findings indicate considerable deficits in terms of pain management in nursing care. Results show a lack of systematic pain assessment as well as missing documentation of therapeutic aims and pain management in nursing care. Conclusions: The identified deficits might be the result of current framework conditions that separate nursing pain treatment in Volume V and Volume XI of the German Social Security Code services. Appropriateness in pain management in nursing care can only be ensured if framework conditions are optimized.

The effect of exercise intervention on frail elderly in need of care: half-day program in a senior day-care service facility specializing in functional training.

[Purpose] This study investigated the long-term effect of a half-day exercise intervention program on health-related quality of life, life function, and physical function in frail elderly in need of care. The program was conducted at a senior day-care facility specializing in functional training. [Subjects and Methods] Subjects included 41 elderly in need of care who had visited the service facility for at least 1 year. Physical function and life function were evaluated at baseline, 6 months, and 12 months. Quality of life was evaluated with the Short Form-36 at baseline and 12 months. [Results] Improvements in balance, walking speed and endurance, complex performance abilities, self-efficacy during the activities, and the level and sphere of activity were observed at 6 months and maintained up to 12 months. Moreover, improvements in agility, activities of daily living, life function, and quality of life were also observed at 12 months. Improvements in muscle strength, walking ability, self-efficacy over an action, and activities of daily living were related to the improvement in quality of life. [Conclusion] The use of individualized exercise programs developed by physiotherapists led to improvements in activities of daily living and quality of life among elderly in need of care.

Associations of Mental Health Issues with Health Literacy and Vaccination Readiness against COVID-19 in Long-Term Care Facilities-A Cross-Sectional Analysis.

Vaccinations against COVID-19 are of the utmost importance in long-term care facilities. During the pandemic, mental health issues increased significantly. This cross-sectional analysis aimed to assess the associations of depression and anxiety with health literacy in people in need of care and the association of depression and burnout with vaccination readiness against COVID-19 in health care workers (HCWs). Within our cross-sectional study, people in need of care were assessed for symptoms of depression (PHQ-9), anxiety (GAD-7), and health literacy (HLS-EU-Q16). Among HCWs, we assessed symptoms of depression (PHQ-9) and burnout (MBI-HSS), as well as psychological antecedents of vaccination (5C) to measure vaccination readiness against COVID-19. A multivariate regression analysis was performed. Symptoms of a major depression were significantly associated with reduced health literacy (p = 0.010) in people in need of care. Among HCWs, symptoms of depression and burnout reduced vaccination readiness against COVID-19 significantly. In particular, collective responsibility was reduced in HCWs suffering from burnout symptoms (p = 0.001). People in need of care and their HCWs could benefit from intensified target group-specific vaccination counseling. Additionally, more attention should be paid to the protection of mental health in long-term care facilities.

[Care of older patients by community emergency paramedics : Comparison of community-dwellers and nursing home residents]. / Versorgung älterer Patienten durch Gemeindenotfallsanitäter : Vergleich der Einsätze im Pflegeheim und in der Häuslichkeit.

BACKGROUND: Emergency departments and emergency services are increasingly burdened by non-emergency patients. A substantial proportion of these is represented by older people. The project "community emergency paramedic" ("Gemeindenotfallsanitäter" [G-NFS]) was initiated to prevent unnecessary use of emergency services. OBJECTIVE: To identify specific utilizations of the G­NFS services by older people at home and in nursing homes. MATERIAL AND METHODS: Retrospective analysis of the assignment protocols from July 2019 through June 2020. Only data from patients aged ≥ 65 years were included. Data were grouped into whether patients lived on their own or in nursing homes. RESULTS: A total of 2358 protocols of older patients (mean age 80.8 years; 52.9% female) were evaluated and 55% of patients were treated on-site. The most frequently used measures by G­NFS were counselling (79.4%), aid in self-medication (16.7%) and administration of medication (23.2%). Of the G­NFS assignments 329 (14.0%) were carried out for nursing home residents. Measures related to urine catheter complications were more frequently performed in nursing home residents than in patients who lived at home (32.2% vs. 5.7%). Compared to other emergency cases, patients with catheter-related complications were most often treated at the scene (84.3% vs. 52.2%). CONCLUSION: The G­NFS enabled the majority of patients to be treated on-site, thus saving resources of emergency services and hospitals; however, the G­NFS also performed measures that were normally the responsibility of general practitioners. This possibly highlights structural deficits in the medical and nursing care of older people.

[Psychological care in German intensive care units : Results of a survey among the members of the German Interdisciplinary Association for Intensive Care and Emergency Medicine]. / Psychologische Versorgung auf deutschen Intensivstationen : Ergebnisse einer Umfrage unter den Mitgliedern der Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin.

BACKGROUND: Psychological care should be provided in intensive care units (ICUs) because of the proven mental symptoms of patients and relatives. Even physicians and nurses can benefit from a corresponding care structure. Knowledge is lacking whether and how psychological care for patients and relatives as well as support for staff in German ICUs is implemented. For this reason, a survey was conducted among the members of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI) to gain an overview of the current structures and the need for psychological support. METHODS: The members of DIVI were invited to participate in a web-based survey. A total of 226 physicians and nurses took part in the survey. Analysis included statistics and group comparisons with Χ2 methods. RESULTS: In all care areas, psychological care of patients, relatives, and support for staff, respondents indicated a significant undersupply and expressed the need for improved care. A model which provides consular or team-integrated support based on the level of care is conceivable. DISCUSSION: The current state of psychological care in German ICUs does not cover the existing need. Consequently the development of concepts and the beginning of discussions on how appropriate psychological care can be implemented in the future is necessary.

Need for psychological support in intensive care : A survey among members of the German Society of Medical Intensive Care and Emergency Medicine.

A high incidence of care-relevant psychological problems in critical care medicine has been reported among patients, their families and professional care givers. International guidelines give appropriate recommendations for such care. What is unclear, however, is just how the care and support are provided in day-to-day practice and, in particular, which service providers are responsible for this support. The present care situation was studied in a web-based survey (38% response rate) among all members of the German Society of Medical Intensive Care and Emergency Medicine (DGIIN). Most respondents reported a moderate to substantial need for psychological support of patients in intensive care and a substantial to very substantial need in the case of their family members. The need for support in the case of staff showed a relatively broad scatter in the assessment. Providers of care are mainly the members of the intensive care team themselves, while clinical pastoral counsellors in particular are also involved and, to a lesser extent, counselling or liaison services specializing in psychotherapy.

[Influencing factors for nursing home admission in case of pre-existing need of care - a systematic review]. / Einflussfaktoren für einen Heimeintritt bei bestehender Pflegebedürftigkeit ­ eine systematische Übersichtsarbeit.

INTRODUCTION: Knowledge about predictors of nursing home placement is highly relevant. If they are known, targeted interventions such as counselling can help prevent or delay relocation to a nursing home. Above all, preventive and structural measures can target influenceable predictors. The aim of the review was to map predictors of nursing home admission and thus the permanent stay in inpatient long-term care for the target group of people with a pre-existing need for care. METHODS: A systematic literature search in the databases The Cochrane Library, PubMed, CINAHL, GeroLit and CareLit® was conducted in September 2017. Longitudinal studies with quantitative analyses were included. The methodological quality was assessed using the Newcastle-Ottawa Scale. RESULTS: 45 cohort studies were included. 21 studies examined study populations with need for care, in 24 studies the care status was unclear. A variety of predictors of nursing home admission with at least one-and-a-half times higher risk for both study populations could be identified, including higher age, dementia, underweight, higher age of caregiver, psychiatric symptoms, smoking status, ethnicity, challenging behaviour in people with dementia, higher number of hospitalizations and lower level of life satisfaction. DISCUSSION: All the predictors identified are relevant to people in need of care. No predictors for the study population with need of care could be identified that are particularly important in contrast to persons with an unclear care status. However, the quality of studies among people with care and support needs is limited compared to studies targeting people with unclear care status. CONCLUSIONS: Many factors seem to predict the admission to a nursing facility. For the first time, these factors are listed in this systematic review for the target group of people in need of care. Interventions or preventive measures based on known influenceable predictors can help prevent or delay nursing home admission.

A cohort study of the effects of multidisciplinary in-patient primary care in older adults.

PURPOSE: To evaluate short and long-term effects of a multifactorial and multidisciplinary in-patient municipality intervention including training of activities of daily living, cardiovascular exercise, resistance training and social activities on quality-of-life, need-of-care, and physical function in older adults at risk of further functional decline. METHOD: A cohort study including data collected rigorously during 3.5 years at an in-patient municipality rehabilitation center in Aalborg, Denmark. Patients received a multifactorial and multidisciplinary intervention. Outcomes were quality-of-life (EQ5D), weekly need-of-care hours, and test of physical functioning (sit-to-stand, 6-min walking test, tandem balance). RESULTS: Data was collected from 532 patients (63.3% women). The median [5; 95 percentiles] age was 79 [55; 92] years with a length-of-stay of 21 [8; 55] days. The mean (95% CI) EQ5D index score showed a clinically relevant improvement from admission 0.46 (0.44; 0.48) to discharge 0.69 (0.67; 0.71) and there was no decline 6-month postdischarge 0.67 (0.64; 0.70). The weekly need-of-care decreased significantly by 7.2 (6.6, 7.9) h from a mean of 9.8 h before admission to 2.6 h 6-month postdischarge. Sit-to-stand improved from 6.3 (6.0; 6.7) to 9.3 (8.9; 9.6) repetitions, 6-min walking test from 147 (138; 156) to 217 (207; 227) m, and tandem balance from 20.7 (19.8; 21.6) to 25.2 (24.8; 26.2) s. CONCLUSION: Our results were remarkable and highlight that a well-structured multifactorial and interdisciplinary intervention with a clear aim and inclusion criteria related to functional decline may lead to long-term clinically relevant improvements in functionally declining older adults. Future studies should, however, explore similar interventions in comparable populations preferably in randomized controlled designs.

Effect of social networks and well-being on acute care needs.

The effect of social surroundings has been noted as an important component of the well-being of elderly people. A strong social network and strong and steady relationships are necessary for coping when illness or functional limitations occur in later life. Vulnerability can affect well-being and functioning particularly when sudden life changes occur. The objective of this study was to analyse how the determinants of social well-being affect individual acute care needs when sudden life changes occur. Empirical evidence was collected using a cross-sectional mail survey in Finland in January 2011 among individuals aged 55-79 years. The age-stratified random sample covered 3000 individuals, and the eventual response rate was 56% (1680). Complete responses were received from 1282 respondents (42.7%). The study focuses on the compactness of social networks, social disability, the stability of social relationships and the fear of loneliness as well as how these factors influence acute care needs. The measurement was based on a latent factor structure, and the key concepts were measured using two ordinal items. The results of the structural model suggest that the need for care is directly affected by social disability and the fear of loneliness. In addition, social disability is a determinant of the fear of loneliness and therefore plays an important role if sudden life changes occur. The compactness of social networks decreases social disability and partly diminishes the fear of loneliness and therefore has an indirect effect on the need for care. The stability of social relationships was influenced by the social networks and disability, but was an insignificant predictor of care needs. To conclude, social networks and well-being can decrease care needs, and supportive actions should be targeted to avoid loneliness and social isolation so that the informal network could be applied as an aspect of care-giving when acute life changes occur.

Incidence of certified need of care in the long-term care insurance system and its risk factors in the elderly of Japanese population-based cohorts: the ROAD study.

AIM: To examine the incidence of certified need of care in the national long-term care insurance (LTCI) system, and to determine its risk factors in the elderly of Japanese population-based cohorts of the Research on Osteoarthritis/Osteoporosis Against Disability (ROAD) study. METHODS: Of the 3040 participants in the baseline examination of the ROAD study, we enrolled 1773 (699 men, 1074 women) aged 65 years or older who were not certified as in need of care level elderly at baseline. Participants were followed for incident certification of need of care in the LTCI system. Associated factors in the baseline examination with occurrence were determined by multivariate Cox proportional hazards regression analysis. Muscle dysfunction was defined in accordance with the European Working Group on Sarcopenia in Older People algorithm for screening sarcopenia. RESULTS: A total of 54 men and 115 women were certified as in need of care level elderly during the average 4.0-year follow up. The incidence was 2.0 and 2.5 per 100 person-years in men and women, respectively. Identified risk factors were region, age, body mass index <18.5 or ≥ 27.5 kg/m(2), grip strength, knee extension torque, usual gait speed, chair stand time and muscle dysfunction. CONCLUSIONS: Both underweight and obesity, as well as low muscle strength and physical ability, are risk factors for certification of need of care. Considering muscle dysfunction is a risk factor for occurrence, screened individuals are recommended to receive early intervention programs regardless of muscle volume.