A Framework for the Automatic Adaptation of User Interfaces

Ambient assisted living (AAL) is focused on providing assistance to people primarily in their natural environment. Over the past decade, the AAL domain has evolved at a fast pace in various directions. The stakeholders of AAL are not only limited to patients, but also include their relatives, social services, health workers, and care agencies. In fact, AAL aims at increasing the life quality of patients, their relatives and the health care providers with a holistic approach. This paper aims at providing a comprehensive overview of the AAL domain, presenting a systematic analysis of over 10 years of relevant literature focusing on the stakeholders’ needs, bridging the gap of existing reviews which focused on technologies. The findings of this review clearly show that until now the AAL domain neglects the view of the entire AAL ecosystem. Furthermore, the proposed solutions seem to be tailored more on the basis of the available existing technologies, rather than supporting the various stakeholders’ needs. Another major lack that this review is pointing out is a missing adequate evaluation of the various solutions. Finally, it seems that, as the domain of AAL is pretty new, it is still in its incubation phase. Thus, this review calls for moving the AAL domain to a more mature phase with respect to the research approaches.

Assisted Living Facilities: Benefits, Challenges, and the Importance of Culture

The objective of this scoping review is to examine and map knowledge of nursing provisions for self-determination while providing care to clients with cognitive impairment in residential aged care facilities. Maintaining the ability to have choices and to make decisions about daily activities is important for older adults. In residential aged care facilities, nurses' can be challenged to preserve clients' self-determination in favor of ritualistic care routines and a perceived duty to care. Moreover, nurses may perceive that their professional responsibilities to protect clients requires them to guard against decisions that are considered unwise or pose a risk to clients' health or safety. Insight into how nurses negotiate choice with clients with cognitive impairment who are living in a residential care facility will provide an in-depth understanding of the role self-determination plays in clients' lives. The scoping review will consider research and narrative reports on nursing provisions for self-determination in clients with cognitive impairment who are living in a residential aged care facility. The concepts of interest are self-determination and nursing provisions. Self-determination is defined as client choice and nursing provisions are the intentional reactions to clients' expressed choices. This scoping review will aim to locate published and unpublished literature employing a three-step search strategy. Only papers published in English from 1995 onward will be included. Data extracted from included papers will outline details on the participants, context, strategy, activity, and outcomes. Extracted data will be reported in a tabular form and presented narratively to address the review objective.

The Promise of Behavioral Activation to Treat Depression in Nursing Homes

One of the goals of Ambient Assisted Living (AAL) solutions is to extend the time that elderly people can live independently in their preferred environments by using ICT technologies for personal healthcare. However, in order to be optimal, remote monitoring services and health-related interventions should be strongly personalised to specific individuals’ requirements, preferences, abilities and motivations, which can vary among the elderly, and even dynamically evolve over time for the same person depending on changing user needs and context-dependent conditions. In this paper we present an End User Development (EUD) tool for the personalisation of context-dependent assistance by non-technical users in the AAL domain. In particular, we have considered applications for remotely monitoring and assisting elderly people at home through sending multimedia messages and reminders, as well as changing the state of various domestic appliances (e.g. lamps, heating system, TV) and devices available in the context surrounding the user. The design and development of the tailoring environment has been carried out in an iterative manner, informed by the feedback that was gathered through empirical evaluations done with older adults and caregivers.

To synthesize evidence regarding the spiritual needs and care of older adults living in residential care facilities from the perspectives of older adults and nurses or caregivers. Integrative review of literature. Literature search was conducted using CINAHL Plus with Full Text via EBSCO, Scopus, PubMed, PsychInfo, Web of Science, and ProQuest Social Science Databases from March to December 2017. This integrative review utilised the Whittemore and Knafl framework and PRISMA in the selection of eligible articles. Quality of the articles was evaluated using the Mixed Method Appraisal Tool. Seven articles were reviewed and analysed. There is limited evidence \and no agreed definition of spiritual needs and care of older adults living in residential care facilities. Spiritual needs of older adults in residential care facilities is a psycho-social, religious and existential construct. Spiritual care in residential care facilities is linked to information gathering, religious guidance, maintaining family connections, providing companionship, discussing end of life issues, and providing counseling. Older adults highly value the role of nurses and caregivers in fulfilling their spiritual needs and providing spiritual care. However, nurses and caregivers perceived arranging a referral to a religious advisor as the main aspect of spiritual care. Therefore, nurses', caregivers', and older adults' views on spiritual care differed to some extent. The practical aspects of spiritual needs assessment and spiritual care provision requires further investigation, which is essential to improve the effectiveness of service delivery in residential care facilities.

Globally, the population aged 65 years and over is increasing and with this growth comes a rising risk of chronic diseases that often require emergency care. Older adults living in Residential Aged Care Facilities (RACFs) have increased healthcare utilisation including visits to Emergency Departments (EDs). EDs are busy, noisy environments poorly suited to meeting the care needs of older adults. Older adults attending EDs often receive delayed and fragmented care, unnecessary procedures and tests and are at greater risk of iatrogenic complications. The Older Person’s Emergency Network Acute Outreach Service (OPEN AOS) based in Queensland, Australia, is a nurse-led, physician-supported model that provides ED substitution care to older adults living in RACFs. This paper outlines the OPEN AOS study protocol, which comprises three components and uses the integrated Practical, Robust, Implementation, and Sustainability Model (PRISM) and Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework to guide a comprehensive evaluation. The study comprises a pragmatic multi-methods design, consisting of three discrete yet related components. Component 1 is a retrospective, quasi-experimental design comparing outcomes for patients seen in the RACF by the OPEN AOS clinical team (intervention group) to standard ambulance attendance in the RACF resulting in transport to ED care (control group) between 1 July 2022 and 30 June 2023. Component 2 is a retrospective economic evaluation of the OPEN AOS model measuring the incremental cost per patient of OPEN AOS care compared to standard ambulance attendance resulting in transport to ED care. Component 3 adopts a prospective qualitative approach to explore and understand the contextual factors influencing implementation with the aim of informing effective delivery and supporting the potential scale and spread of the OPEN AOS model. The OPEN AOS model aims to deliver ED-substitution care in RACFs for older adults. This study will adopt a pragmatic approach to assess both outcomes and implementation processes, utilizing the integrated PRISM and RE-AIM frameworks for comprehensive evaluation. Findings will inform the design of similar models and guide health system decision-making for adopting approaches like the OPEN AOS model.

Improved dental services have increased the retention of natural teeth and prostheses, creating complex oral care needs among older adults. Care managers are key in overseeing residents' oral health; their perceptions can inform strategies to improve geriatric oral health in residential aged care facilities (RACFs). To explore care managers' perceptions of the oral healthcare experiences and needs of older adults in RACFs. A descriptive qualitative study, grounded in a constructivist paradigm, was conducted using the Socio-Ecological Model to guide data collection and analysis at individual, interpersonal, organisational, community and policy levels. Ten care managers were purposively sampled and interviewed online using a semi-structured guide. Data were analysed using reflexive thematic analysis following Braun and Clarke's framework. Participants (n = 10; age 28-59 years; mean age 41.7; 5 males, 5 females) were from urban and semi-urban areas of western India. Five themes were identified: (1) A Moral Duty to Care-Personal Beliefs and Emotional Drivers of Oral Health Practice; (2) Navigating Relational Complexities-Care Amidst Resistance, Trust and Support; (3) Systemic Gaps and Adaptive Practices in Resource-Limited Settings; (4) Disconnected Services and the Social Devaluation of Residents' Oral Health; and (5) Calls for Oral Health Care Delivery/Systemic Reforms-Embedding Oral Health in Aged Care Policy. Care managers perceived residents' oral health as often being deprioritized in RACFs due to competing general health demands. An interdisciplinary care team, including a dentist, stronger policy support, and targeted training for care managers and staff, was strongly recommended to improve older adults' oral health outcomes in residential settings.

Ambient assisted living (AAL) is a complex field, where different technologies are integrated to offer solutions for the benefit of different stakeholders. Several evaluation techniques are commonly applied that tackle specific aspects of AAL; however, holistic evaluation approaches are lacking when addressing the needs of both developers and end-users. Living labs have been often used as real-life test and experimentation environments for co-designing AAL technologies and validating them with relevant stakeholders. During the last five years, we have been evaluating AAL systems and services in the framework of various research projects. This paper presents the lessons learned in this experience and proposes a set of harmonized guidelines to conduct evaluations in living labs.

Executive summaryObjective The objective of this systematic review was to report on the best available evidence relating to oral hygiene for adults with dementia in residential aged care facilities, including: documenting the prevalence and incidence, as well as the experiences and increments, of oral diseases and conditions the use of assessment tools by carers to evaluate oral health oral hygiene care strategies to prevent oral diseases and conditions the provision of dental treatment and the ongoing management of oral diseases and conditions. Inclusion criteria This review considered any randomised or non‐randomised controlled studies, cohort studies, case‐control studies, multiple time series studies, uncontrolled studies, descriptive studies and opinions of respected authorities (including theses and other publications) related to residents with dementia living in residential aged care facilities in Australia and overseas; community‐dwelling adults with dementia; and special needs adult populations (for preventive oral hygiene care strategies and interventions).The review considered studies and publications designed to: quantify the oral health status of older adults living in residential aged care facilities; quantify the oral health status of adults with dementia living in the community and in residential aged care facilities; evaluate tools used to assess the oral health of residents by staff and carers working in residential aged care facilities; evaluate preventive oral hygiene care strategies and interventions used in special needs adult populations (including adults with dementia); and evaluate oral health care training and oral hygiene care provision, staff and carers working in residential aged care facilities. Dental outcome measures of interest were those relating to the prevalence, incidence, experiences and increments of oral diseases and conditions including: denture problems, coronal and root caries, periodontal diseases (plaque accumulation, gingivitis, loss‐of‐attachment), oral mucosal conditions, xerostomia and salivary gland hypofunction, tooth loss, difficulty chewing, behavioural problems and pain/discomfort. Related characteristics and outcomes of interest included: medical conditions, medications, cognitive status, functional status, nutritional status and sociodemographics.Search strategy The aim of the search was to locate relevant English‐language studies and publications appearing between 1980 and 2002. The search utilised a two‐step approach, involving an initial search of electronic databases using combinations of key words followed by a second extensive search carried out using the identified key words. This was supplemented with a secondary search of the references cited in the identified studies. Electronic database searched were: Cinahl, Embase, Psycinfo, Medline and Current Contents.Methodological quality All selected studies were critically appraised by two reviewers prior to inclusion in the review.Results In regards to relevance, incidence, experiences, and increments of oral diseases and conditions, possible risk factors identified included: saliva dysfunction, polypharmacy, comorbid medical conditions, swallowing and dietary problems, increased functional dependence, need for assistance with oral hygiene care, and poor access and utilisation of dental care.Evidence on the use of assessment tools by carers to evaluate residents’ oral health showed that successful assessment of residents with and without dementia by nursing staff requires appropriate staff training by a dental professional. Coupled with appropriate training, an oral assessment screening tool designed for residents with dementia has been successfully used by nursing and care staff to identify residents requiring further review by dental professionals. Expert opinion in the field indicates that oral assessment screenings by a staff member and then by a dentist would ideally be undertaken upon admission to a facility, and regularly thereafter by staff and/or dentists as required.Clinicians and researchers suggested that oral hygiene care strategies to prevent oral diseases and conditions were found to be effective in preventing oral diseases, and thus are relevant for use in the resident with dementia.In regards to the provision of dental treatment and ongoing management of oral diseases and conditions, the use of adjunctive and preventive aids were found to be effective when introduced in conjunction with a staff training program:Expert opinion suggests that behaviour management techniques will increase the potential of performing oral hygiene care interventions.Conclusions This review suggests that the training of staff in the form of a comprehensive practically oriented program addressing areas such as oral diseases, oral screening assessment, and hands‐on demonstration of oral hygiene techniques and products is likely to have a positive impact on the management of oral hygiene care within residential aged care facilities. The review also identified that regular brushing with fluoride toothpaste, use of therapeutic fluoride products and application of therapeutic chlorhexidine gluconate products are validated by research as effective for the general population and some populations with special needs.

BackgroundIt has become very common for older adults to relocate to residential care facilities. Yet whether older adults adapt to life in a long-term care residential facility through perception, reflection, and conscious behavioral choices is a challenging social issue. Previous research has shown that adaptation is influenced by physical, mental, psychological, social systems, and other debris factors. However, existing knowledge is often based on unidirectional relationships between these factors and adaptation. Few studies have formally examined bivariate relationships between these factors, and the influence of adaptation between these factors internally remains unclear. Therefore, there is a need to examine the structural causality of adaptation in residential care facilities influenced by a combination of physical, emotional, social and psychological factors, life satisfaction, and social support.MethodsThe present cross-sectional study recruited older adults from three residential care facilities in Henan province, China, through convenience sampling. The Chinese Nursing Home Adjustment Scale (NHAS), Geriatric Depression Scale-15 (GDS-15) and Social Support Scale (SSRS), Satisfaction with Life Scale (SWLS), and Barthel Index were employed to measure the older adult’ adjustment level, depression level, social support, satisfaction with life, and self-care ability of the BMC, respectively. The relationships between depression, social support, self-care, satisfaction with life, and adaptation were analyzed and a structural equation model was developed.ResultsA total of 210 participants completed the questionnaire. The model demonstrated an acceptable fit of the data. The results showed that the difference between life satisfaction and depression on the level of adaptation was 60 and 23%, respectively. Social support and life satisfaction had a positive direct effect on the level of adaptation, both showing a positive correlation with the level of adaptation. Depression, on the other hand, have a direct effect on the level of adaptation and showed a negative correlation with the level of adaptation. Self-care ability indirectly influenced adaptation mediated by social support.ConclusionSocial support has a positive impact on both life satisfaction and depression, which in turn promotes adaptation. As a major source of social support, family members and nursing home staff in residential care facilities can enhance social support for older people through improved interaction, which can have a meaningful and positive impact on levels of adjustment. The model demonstrates the strengthening and weakening of social support, self-care, life satisfaction, and depression levels, which can help inform the development of relevant care health strategies for older people to promote levels of adjustment and improve quality of life.

BackgroundWith an increasingly ageing population in Australia, more older adults who are frail are living in residential aged care facilities (RACFs). The aim of this study was to detail the type, scope, and funding of physiotherapy utilised in Australian RACFs.MethodsRegistered physiotherapists (n = 219, 72% female, mean age (SD) = 38.6 (12.9) years) working in Australian RACFs participated in a nationwide, cross-sectional online survey. The survey was developed iteratively through a review of the literature and clinical guidelines, consensus of final survey items by an expert panel of five senior physiotherapists and aged care managers. Survey questions related to the characteristics of the physiotherapists (e.g., age, gender, employment status), characteristics of the RACFs (e.g., state, remoteness, sector), the type and scope of physiotherapy provided by respondents, and the availability of equipment and certain spaces (e.g., gyms) in the RACFs that respondents worked in. Survey responses were analysed and presented descriptively. Correlation using Spearman’s rho (ρ) and the associated 95% confidence intervals (CI) were used to determine whether the availability of equipment or space at the RACF was associated with the time dedicated to performing non-Aged Care Funding Instrument (ACFI) tasks.ResultsCommon reasons for physiotherapy referral were chronic pain management as per the ACFI framework (89.7%), falls (69.2%), and reduced mobility (35.9%). Rehabilitation or short-term restorative care was provided in only 22.2% of the facilities. The ACFI funded 91.4% of all participants, which limited physiotherapists to low-value chronic pain management including massage and electrical stimulation. Respondents spent 64.5% of their time on ACFI tasks, which equated to 19 h per week. More time was spent on non-ACFI tasks particularly when resistance bands (ρ = 0.28, 95%CI 0.14–0.41) and a dedicated therapy space or gym (ρ = 0.19, 95%CI 0.04–0.33) were available.ConclusionsThe expertise of physiotherapists is currently being under-utilised in Australian RACFs, which may be related to the availability of public funding, equipment, and space for therapy. Therefore, public health policy should address the urgent need for high-value, evidence-based physiotherapy that supports the reablement and independence of older adults living in RACFs.

This scoping review aimed to map the existing literature about nursing provisions for self-determination in residents with cognitive impairments living in residential aged care facilities. Freedom to decide for oneself and express preferences about daily care is important for all older adults. When older adults transition to residential aged care facilities, they may experience barriers to self-determination due to routine care practices and staff attitudes about autonomy. This is particularly true for residents living with cognitive impairments. Residents with cognitive impairments are often prevented from making choices that nursing staff perceive to be unwise or harmful, as nurses uphold their professional duties to protect and care. This can result in the denial of preferences and the right to self-determination. Mapping the ways nurses balance their duty to protect with residents' rights to self-determine provides insight into nurses' roles and residents' experiences of care. Research and narrative articles about nursing provisions for self-determination in residents with cognitive impairments living in residential aged care facilities were included in this review. The main concepts explored were nurses' provisions and residents' self-determination. Self-determination included residents' preferences and expressions of choice, while nurses' intentional reactions to residents' preferences were considered nurses' provisions. The review included qualitative and quantitative studies as well as text and opinion papers. Only studies and papers published in English from 1992 onwards were included. The databases searched were CINAHL (EBSCO), MEDLINE (Ovid), Embase (Elsevier), and ERIC (EBSCO). The search for unpublished papers included ProQuest Nursing and Allied Health Database, ProQuest Dissertations and Theses, and Google (with advanced search strategies). The reference lists of included articles were searched for additional studies not captured by the search strategy. Data were extracted using a standardized tool created by the authors and included details on study design, strategies to promote, and conditions that deny residents' self-determination. Charting tables were developed to record and analyze data related to the review questions. The final set of 17 articles were published from 1995 to 2018. The literature was analyzed in relation to the review's four questions to map the boundaries of the nurse's role in providing for residents' self-determination. Nurses' roles as investigators, advocates, protectors, and assessors emerged as critical to providing for self-determination. Literature about this topic has tended to describe nursing provisions for self-determination in people with cognitive impairments in terms of an ethical dilemma between the resident's right to act autonomously and their right to protection as a vulnerable population. In mapping the literature, this scoping review demonstrates a more complex process at work in providing for self-determination in the context of cognitive impairment and highlights a need for deeper reflexivity around nurses' understandings of personhood and autonomy. Further research should focus on determining if nurses' perceptions of residents' experience with self-determination are accurate. The complexity of self-determination in the context of cognitive impairment and nurses' advocacy role highlights the need for ongoing support and education for staff working in residential aged care facilities.

Ambient Assisted Living (AAL) systems are designed to provide unobtrusive and user-friendly support in daily life and can be used for monitoring frail people based on various types of sensors, including wearables and cameras. Although cameras can be perceived as intrusive in terms of privacy, low-cost RGB-D devices (i.e., Kinect V2) that extract skeletal data can partially overcome these limits. In addition, deep learning-based algorithms, such as Recurrent Neural Networks (RNNs), can be trained on skeletal tracking data to automatically identify different human postures in the AAL domain. In this study, we investigate the performance of two RNN models (2BLSTM and 3BGRU) in identifying daily living postures and potentially dangerous situations in a home monitoring system, based on 3D skeletal data acquired with Kinect V2. We tested the RNN models with two different feature sets: one consisting of eight human-crafted kinematic features selected by a genetic algorithm, and another consisting of 52 ego-centric 3D coordinates of each considered skeleton joint, plus the subject's distance from the Kinect V2. To improve the generalization ability of the 3BGRU model, we also applied a data augmentation method to balance the training dataset. With this last solution we reached an accuracy of 88%, the best we achieved so far.

World population aging requires finding solutions to improve independent living options. Ambient Assisted Living (AAL) is making step forward developing services supporting the elderly, but the implementation of predictive environments is still far away. Besides, the emerging Digital Twin (DT) concept has begun to shape the first cognitive environments that integrate users into assessments, improving efficiency, prevention, and prediction of likely events through real-time AI computing. This paper provides a prototype of a Cognitive Building framework based on DT models that develop high-level knowledge to achieve real-time Scenario Awareness and offer appropriate AAL services once anomalous scenarios are detected.