A Protocol-Driven, Bedside Digital Conversational Agent to Support Nurse Teams and Mitigate Risks of Hospitalization in Older Adults: Case Control Pre-Post Study

Background Hospitalized older adults often experience isolation and disorientation while receiving care, placing them at risk for many inpatient complications, including loneliness, depression, delirium, and falls. Embodied conversational agents (ECAs) are technological entities that can interact with people through spoken conversation. Some ECAs are also relational agents, which build and maintain socioemotional relationships with people across multiple interactions. This study utilized a novel form of relational ECA, provided by Care Coach (care.coach, inc): an animated animal avatar on a tablet device, monitored and controlled by live health advocates. The ECA implemented algorithm-based clinical protocols for hospitalized older adults, such as reorienting patients to mitigate delirium risk, eliciting toileting needs to prevent falls, and engaging patients in social interaction to facilitate social engagement. Previous pilot studies of the Care Coach avatar have demonstrated the ECA’s usability and efficacy in home-dwelling older adults. Further study among hospitalized older adults in a larger experimental trial is needed to demonstrate its effectiveness. Objective The aim of the study was to examine the effect of a human-in-the-loop, protocol-driven relational ECA on loneliness, depression, delirium, and falls among diverse hospitalized older adults. Methods This was a clinical trial of 95 adults over the age of 65 years, hospitalized at an inner-city community hospital. Intervention participants received an avatar for the duration of their hospital stay; participants on a control unit received a daily 15-min visit from a nursing student. Measures of loneliness (3-item University of California, Los Angeles Loneliness Scale), depression (15-item Geriatric Depression Scale), and delirium (confusion assessment method) were administered upon study enrollment and before discharge. Results Participants who received the avatar during hospitalization had lower frequency of delirium at discharge (P<.001), reported fewer symptoms of loneliness (P=.01), and experienced fewer falls than control participants. There were no significant differences in self-reported depressive symptoms. Conclusions The study findings validate the use of human-in-the-loop, relational ECAs among diverse hospitalized older adults.

Download Full-text

A Protocol-Driven, Bedside Digital Conversational Agent to Support Nurse Teams and Mitigate Risks of Hospitalization in Older Adults: Case Control Pre-Post Study (Preprint)

10.2196/preprints.13440 ◽

2019 ◽

Author(s):

Nicholas Bott ◽

Sharon Wexler ◽

Lin Drury ◽

Chava Pollak ◽

Victor Wang ◽

...

Keyword(s):

Older Adults ◽

Los Angeles ◽

Social Engagement ◽

Depression Scale ◽

Control Unit ◽

Assessment Method ◽

Conversational Agents ◽

Pilot Studies ◽

Human In The Loop ◽

Hospitalized Older Adults

BACKGROUND Hospitalized older adults often experience isolation and disorientation while receiving care, placing them at risk for many inpatient complications, including loneliness, depression, delirium, and falls. Embodied conversational agents (ECAs) are technological entities that can interact with people through spoken conversation. Some ECAs are also relational agents, which build and maintain socioemotional relationships with people across multiple interactions. This study utilized a novel form of relational ECA, provided by Care Coach (care.coach, inc): an animated animal avatar on a tablet device, monitored and controlled by live health advocates. The ECA implemented algorithm-based clinical protocols for hospitalized older adults, such as reorienting patients to mitigate delirium risk, eliciting toileting needs to prevent falls, and engaging patients in social interaction to facilitate social engagement. Previous pilot studies of the Care Coach avatar have demonstrated the ECA’s usability and efficacy in home-dwelling older adults. Further study among hospitalized older adults in a larger experimental trial is needed to demonstrate its effectiveness. OBJECTIVE The aim of the study was to examine the effect of a human-in-the-loop, protocol-driven relational ECA on loneliness, depression, delirium, and falls among diverse hospitalized older adults. METHODS This was a clinical trial of 95 adults over the age of 65 years, hospitalized at an inner-city community hospital. Intervention participants received an avatar for the duration of their hospital stay; participants on a control unit received a daily 15-min visit from a nursing student. Measures of loneliness (3-item University of California, Los Angeles Loneliness Scale), depression (15-item Geriatric Depression Scale), and delirium (confusion assessment method) were administered upon study enrollment and before discharge. RESULTS Participants who received the avatar during hospitalization had lower frequency of delirium at discharge (<italic>P</italic><.001), reported fewer symptoms of loneliness (<italic>P</italic>=.01), and experienced fewer falls than control participants. There were no significant differences in self-reported depressive symptoms. CONCLUSIONS The study findings validate the use of human-in-the-loop, relational ECAs among diverse hospitalized older adults.

Download Full-text

Unmet needs of family caregivers of hospitalized older adults preparing for discharge home

Chronic Illness ◽

10.1177/1742395318789467 ◽

2018 ◽

Vol 16 (2) ◽

pp. 131-145 ◽

Cited By ~ 4

Author(s):

Jane McCusker ◽

Mark Yaffe ◽

Sylvie D Lambert ◽

Martin Cole ◽

Manon de Raad ◽

...

Keyword(s):

Older Adults ◽

Family Caregivers ◽

Medical Information ◽

Unmet Needs ◽

Depression Scale ◽

Principal Component ◽

Care Hospital ◽

Role Clarity ◽

High Burden ◽

Hospitalized Older Adults

Objectives To describe unmet needs of caregivers of hospitalized older adults during the transition from hospital back home, and identify subgroups with different needs. Methods Patients and family caregivers were recruited from an acute care hospital in Montreal, Canada. Measures included Instrumental Activities of Daily Living (IADL), Hospital Anxiety and Depression Scale (HADS), Zarit burden scale, and Family Inventory of Needs. Dimensions of unmet needs were explored with principal component analysis; regression tree models were used to identify subgroups with different unmet needs. Results A total of 146 patient-caregiver dyads were recruited. Three categories of caregiver unmet needs were identified: patient medical information; role clarity and support; and reassurance. Caregiver subgroups with highest unmet needs were those with high burden of care plus depressive symptoms ( n = 46) and those caring for patients with low IADL scores ( n = 10). Discussion Caregivers with high burden and depression are those with the greatest unmet needs during the care transition.

Download Full-text

HEARING IMPAIRMENT, DEPRESSION, AND THE ROLE OF SOCIAL ACTIVITY AMONG CHINESE OLDER ADULTS

Innovation in Aging ◽

10.1093/geroni/igz038.595 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S166-S167

Author(s):

Shu Xu ◽

Haowei Wang ◽

Caitlin Connelly

Keyword(s):

Older Adults ◽

Depressive Symptoms ◽

Hearing Impairment ◽

Social Engagement ◽

Depression Scale ◽

The United States ◽

Social Activities ◽

Chinese Older Adults ◽

Hearing Status ◽

The Relationship

Abstract Studies suggest that depression is closely linked to hearing impairment, which is highly prevalent among older adults in the United States. There is evidence that social engagement may be impacted by hearing impairment in older adults. However, there is relatively little research on these associations among Chinese older adults. This study examines the relationships between hearing impairment, social activities, and depressive symptoms among older adults in China. Using nationally representative data from the China Health and Retirement Longitudinal Study 2011, we conducted cross-sectional analysis on adults age 60 years and older (n=10,994). Depressive symptoms were assessed by the 10-item Center for Epidemiologic Studies Depression scale and we considered self-reported hearing status (if participants wear a hearing aid and how they would rate their hearing), and social activities (i.e., volunteering, dancing, attending courses, etc.). Models were controlled for age, gender, education, and other covariates. Descriptive analysis showed that 9% of older adults experienced hearing impairment. Multiple linear regression analyses revealed that hearing impairment was positively associated with depressive symptoms among older Chinese adults (β=1.32, p<.001). Social activities were found to partially mediate the relationship between hearing status and depressive symptoms. Respondents with hearing impairment were less likely to engage in social activities (OR=.78, p<.01) and those who did not participate in social activities reported more depressive symptoms (β=1.28, p<.001). These findings suggest that Chinese older adults experiencing hearing loss are at greater risk of depression and that social activities play an important role in the relationship between hearing status and depression.

Download Full-text

Pilot Testing of the UB-CAM Delirium Screening App

Innovation in Aging ◽

10.1093/geroni/igab046.3510 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 985-985

Author(s):

Ashley Kuzmik ◽

John Joseph Hannan ◽

Long Ngo ◽

Marie Boltz ◽

Priyanka Shrestha ◽

...

Keyword(s):

Older Adults ◽

Rating Scale ◽

Pragmatic Trial ◽

Confusion Assessment Method ◽

Assessment Method ◽

Clinical Dementia Rating ◽

Systematic Screening ◽

Pilot Testing ◽

Computer Scientists ◽

Hospitalized Older Adults

Abstract Systematic screening improves delirium detection among hospitalized older adults. This poster describes the development and pilot testing of an iOS-based app that incorporates the Ultra-Brief Confusion Assessment Method (UB-CAM), a two-step, delirium detection protocol that combines the UB-2 (2-item screener) and 3D-CAM. Previous work tested a RedCAP-based UB-CAM app in 527 patients with 399 physicians, nurses, and certified nursing assistants (CNAs) showing it can be successfully completed by all three disciplines in 97% of eligible patients in 80 seconds on average with over 85% accuracy relative to a gold standard. To improve accessibility to the clinical setting, our research team now collaborated with a computer scientist to develop and refine an iOS-based UB-CAM app for the iPhone and iPad through iterative “laboratory” testing. The app was piloted by non-clinician, research testers in hospitalized older adults (age x̄ =83, SD= 8.0) with dementia (Clinical Dementia Rating Scale x̄ =1.1, SD= .30); 64% were assessed to be delirium positive. The app demonstrated preliminary efficiency (90 seconds on average), high acceptability (100% satisfaction of users), and reliability (100% inter-rater). This project underscores the need for close collaboration between researchers, clinicians, and computer scientists with iterative testing of bedside-facing apps prior to testing with patients. Next steps include testing effectiveness in a pragmatic trial with clinician users (physicians, nurses, CNAs), integrating the UB-CAM app into the routine hospital care of all older patients. Having rapid, accurate bedside delirium detection has the potential to transform care.

Download Full-text

Depresión, ansiedad, función cognitiva y dependencia funcional en adultos mayores hospitalizados

Enfermería Global ◽

10.6018/eglobal.422641 ◽

2021 ◽

Vol 20 (1) ◽

pp. 267-284

Author(s):

Tirso Duran-Badillo ◽

Víctor Alfonso Benítez - Rodríguez ◽

Ma de la Luz Martínez - Aguilar ◽

Gustavo Gutiérrez-Sánchez ◽

Jorge Luis Herrera-Herrera ◽

...

Keyword(s):

Older Adults ◽

Cognitive Function ◽

Depression Scale ◽

Cross Sectional Study ◽

Anxiety And Depression ◽

Cross Sectional ◽

Cognitive Evaluation ◽

Evaluation Test ◽

Hospitalized Older Adults ◽

The Relationship

Objetivo: Determinar la relación entre la depresión, ansiedad y función cognitiva con la dependencia en adultos mayores.Material y Método: Estudio descriptivo y correlacional de corte transversal en 98 adultos mayores hospitalizados. Se aplicó la Escala Hospitalaria de Ansiedad y Depresión, el test de evaluación cognitiva de Montreal e Índice de Barthel.Resultados: La edad, el género, la depresión, la ansiedad y la función cognitiva explican el 33% de la dependencia funcional. Las variables que influyen sobre la dependencia en las actividades básicas de la vida diaria fueron el género (p=.000), la depresión (p=.002) y la función cognitiva (p=.002).Conclusiones: En la valoración de la funcionalidad del adulto mayor hospitalizado es importante considerar el género, la depresión y la función cognitiva. Objective: Determine the relationship between depression, anxiety, and cognitive function with dependency in older adults.Materials and Method: Descriptive and correlational cross-sectional study conducted on 98 hospitalized older adults. The Hospital Anxiety and Depression Scale, the Montreal Cognitive Evaluation Test, and the Barthel Index were applied. Results: Age, gender, depression, anxiety, and cognitive function explain 33% of functional dependency. The variables that influence dependence to carry out basic activities in daily life were gender (p = .000), depression (p = .002), and cognitive function (p =.002).Conclusions: In assessing the functionality of hospitalized older adults, gender, depression, and cognitive function are important to consider. Resumo:Objetivo: determinar a relação entre depressão, ansiedade e função cognitiva com dependência em idosos.Material e Método: Estudo transversal descritivo e correlato em 98 idosos hospitalizados. Foi aplicada a Escala de Ansiedade e Depressão Hospitalar, o Teste de Avaliação Cognitiva de Montreal e o Índice de Barthel.Resultados: Idade, sexo, depressão, ansiedade e função cognitiva explicam 33% da dependência funcional. As variáveis que influenciam a dependência das atividades básicas da vida cotidiana foram sexo (p.000), depressão (p.002) e função cognitiva (p.002).Conclusões: Ao avaliar a funcionalidade do idoso hospitalizado é importante considerar gênero, depressão e função cognitiva.

Download Full-text

Discrepancy between food offered and consumed during hospitalization in older adult patients

Proceedings of The Nutrition Society ◽

10.1017/s0029665120004267 ◽

2020 ◽

Vol 79 (OCE2) ◽

Author(s):

Ligia J. Dominguez ◽

Francesco Milazzo ◽

Angela Parisi ◽

Mario Barbagallo

Keyword(s):

Quality Of Life ◽

Older Adults ◽

Cognitive Performance ◽

Physical Performance ◽

Early Recognition ◽

Depression Scale ◽

Care Quality ◽

Hospitalized Patients ◽

Hospitalized Older Adults

AbstractMalnutrition is one of the most frequent geriatric syndromes and a key contributor to frailty. Ageing is commonly associated with modifications in eating habits with changes in appetite and food intake. Malnutrition is not only a sign of illness, but its presence increases morbidity, hospital stay, institutionalization, poor quality of life, in-hospital complications, expenses, and mortality. Hospitalized patients have increased calorie requirements to overcome the increased energy expenditure due to acute disease. We aimed to evaluate the actual consumption of the food offered to a sample of hospitalized older adults. Sixty hospitalized patients (women/men = 23/37) were recruited sequentially. After participants signed an informed consent, we evaluated their mean actual intake of macronutrients (carbohydrates, proteins, and fats) at lunch during three consecutive days, calculated with a nutrition analysis software from the weighted food (first course, second course, side dishes) measured before and after consumption. Other parameters assessed included self-sufficiency by the capacity to perform basic and instrumental activities of daily living (ADL, IADL), cognitive performance with Mini Mental State Evaluation (MMSE), Geriatric Depression Scale (GDS), physical performance with the Short Physical Performance Battery (SPPB) and handgrip dynamometry, EAT-10 test for the assessment of swallowing capacity, and anthropometric parameters. Mean ± SD of the main parameters assessed were as follows: age 77.8 ± 9.3 years, BMI 27.1 ± 8.7 Kg/m2, ADL 3.8 ± 2.0, IADL 4.1 ± 2.8 (indicative of compromise self-efficacy), MMSE 21.8 ± 5.9, SSPB 5.3 ± 3.1, handgrip dynamometry 16.5 ± 7.8 Kg (indicative of mild to moderate cognitive and physical impairment). The mean intake of macronutrients for the 3-day assessment was 65.7 ± 20.6% of carbohydrates, 74.3 ± 30.4% of proteins, and 47.4 ± 38.1% of fats of the total amount offered at lunch. Older patients tended to have lower intakes of carbohydrates, proteins, and fats, while participants with higher SPPB had higher intakes of carbohydrates and proteins. The results of the present study show that hospitalized older adults, with compromised autonomy, physical and cognitive performance, had lower consumption compared to what is offered to them in the hospital despite their elevated nutritional needs due to the acute illness leading to hospitalization. Undernutrition and weight-loss are key factors associated with increased mortality and morbidity. Therefore, it is crucial to set appropriate nutritional interventions in hospitalized patients, particularly those with disability and cognitive decline. Early recognition and treatment of malnutrition are essential preventive measures to improve the quality of care, quality of life, and decrease mortality risk in hospitalized older adults.

Download Full-text

Perceived Voice Disorders in Older Adults and Impact on Social Interactions

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2020_persp-20-00059 ◽

2021 ◽

pp. 1-8

Author(s):

Connie K. Porcaro ◽

Clare Singer ◽

Boris Djokic ◽

Ali A. Danesh ◽

Ruth Tappen ◽

...

Keyword(s):

Older Adults ◽

Social Interactions ◽

Social Engagement ◽

Leisure Activities ◽

Treatment Strategies ◽

Voice Disorders ◽

Community Dwelling ◽

Vocal Performance ◽

Older Individuals ◽

Cross Sectional

Purpose Many aging individuals, even those who are healthy, report voice changes that can impact their ability to communicate as they once did. While this is commonly reported, most do not seek evaluation or management for this issue. The purpose of this study was to investigate the prevalence and differences in voice disorders in older adults, along with the effect of fatigue on their social interactions. Method This is a cross-sectional investigation of a community-dwelling sample of individuals aged 60 years or older. Participants completed the Questionnaire on Vocal Performance, the Social Engagement Index subset “Engagement in Social or Leisure Activities,” and the Fatigue Severity Scale. Results Results indicated 32.5% of the 332 participants reported symptoms of voice problems with no difference found between male and female respondents. A slight increase in report of voice problems was noted with each year of age. Participants who self-reported voice problems indicated less interaction in social activities involving communication than those who did not. Finally, as severity of self-reported voice problems increased, an increase was reported by the same individuals for signs of fatigue. Conclusions Voice problems and resulting decreased social interaction are commonly experienced by older individuals. Voice symptoms in older adults have been found to benefit from evidence-based treatment strategies. It is critical to provide education to encourage older individuals to seek appropriate evaluation and management for voice issues through a speech-language pathologist or medical professional.

Download Full-text