An AI/ML-Based Strategy for Disaster Response and Evacuation of Victims in Aged Care Facilities in the Hawkesbury-Nepean Valley: A Perspective

The Hawkesbury-Nepean Valley, Australia’s longest coastal catchment, is spanned by a river system of more than 470 km, that runs from Goulburn to Broken Bay, covering a total area of over 2.2 million hectares. This region has remained prone to flood events, with considerable mortalities, economic impacts and infrastructural losses occurring quite regularly. The topography, naturally variable climatic conditions and the ‘bathtub’ effect in the region are responsible for the frequent flood events. In response, the Government at the national/federal, state and local level has focused on the design of efficient flood risk management strategies with appropriate evacuation plans for vulnerable communities from hospitals, schools, childcare and aged care facilities during a flood event. Despite these overarching plans, specialized response and evacuation plans for aged care facilities are critical to reducing the loss incurred by flood events in the region. This is the focus of this present paper, which reviews the history of flood events and responses to them, before examining the utilization of artificial intelligence (AI) techniques during flood events to overcome the flood risks. An early flood warning system, based on AI/Machine Learning (ML) strategy is being suggested for a timely decision, enhanced disaster prediction, assessment and response necessary to overcome the flood risks associated with aged care facilities within the Hawkesbury-Nepean region. A framework entailing AI/ML methods for identifying the safest route to the destination using UAV and path planning has been proposed for timely disaster response and evacuation of the residents of aged care facilities.

Efficacy and Safety of Citalopram Compared to Atypical Antipsychotics on Agitation in patients with BPSD

Background: The psychomotor agitation of the behavioural and psychological symptoms of dementia (BPSD) is one of the common issues in aged care facilities, leading to the poor functional and medical consequences. Psychotropic interventions are the preferred choice of treatment, but which medication should be the prescribers first preference? This review aims to compare pharmacological interventions for psychomotor agitation, judging them according to their effectuality and justifiability profiles. This is to be achieved by retrieving information from Randomised Control Trials (RCTs) and systematic reviews. Objectives: This review evaluates evidence from RCTs, systematic reviews, and meta-analyses of BPSD patients who have taken agitation treatments. Assessing the efficacy of selective serotonin reuptake inhibitors (SSRI) and antipsychotic treatments when compared to each other for the purpose of improving agitation outcomes. Methods: This review includes RCT that compared one or more active ingredient medications with another medication or with a placebo, along with systematic reviews comparing citalopram (SSRI) with antipsychotics such as quetiapine, olanzapine, and risperidone. Studies were extracted by searching and accessing databases, such as PubMed, OVID, and Cochrane with restrictions of date from 2000 to 2021 and English language. Conclusion: There is still limited studies of SSRIs for the treatment of agitation in BPSD. SSRIs such as citalopram were associated with a reduction in symptoms of agitation, and lower risk of adverse effects compared to antipsychotics. Future studies are required to assess the long-term safety and efficacy of SSRI treatments for agitation in BPSD.

Video-telehealth to support clinical assessment and management of acutely unwell older people in Residential Aged Care: a pre-post intervention study

Background Older people living in Residential Aged Care (RAC) are at high risk of clinical deterioration. Telehealth has the potential to provide timely, patient-centred care where transfer to hospital can be a burden and avoided. The extent to which video telehealth is superior to other forms of telecommunication and its impact on management of acutely unwell residents in aged care facilities has not been explored previously. Methods In this study, video-telehealth consultation was added to an existing program, the Aged Care Emergency (ACE) program, aiming at further reducing Emergency Department (ED) visits and hospital admissions. This controlled pre-post study introduced video-telehealth consultation as an additional component to the ACE program for acutely unwell residents in RACs. Usual practice is for RACs and ACE to liaise via telephone. During the study, when the intervention RACs called the ED advanced practice nurse, video-telehealth supported clinical assessment and management. Five intervention RACs were compared with eight control RACs, all of whom refer to one community hospital in regional New South Wales, Australia. Fourteen months pre-video-telehealth was compared with 14 months post-video-telehealth using generalized linear mixed models for hospital admissions after an ED visit and ED visits. One thousand two hundred seventy-one ED visits occurred over the 28-month study period with 739 subsequent hospital admissions. Results There were no significant differences in hospital admission or ED visits after the introduction of video-telehealth; adjusted incident rate ratios (IRR) were 0.98 (confidence interval (CI) 0.55 to 1.77) and 0.89 (95% CI 0.53 to 1.47) respectively. Conclusions Video-telehealth did not show any incremental benefit when added to a structured hospital avoidance program with nursing telephone support. Trial registration The larger Aged Care Emergency evaluation is registered with ANZ Clinical Trials Registry, ACTRN12616000588493.

New Hope for Behavioural and Psychological Symptoms in Dementia (BPSD): A Narrative Review of Clinical Studies Conducted in the Symptomatic Treatments for Agitation and Psychosis Episodes in Alzheimer’s Disease/Dementia

Background: The psychomotor agitation of the BPSD is one of the common issues in aged care facilities, leading to the poor functional and medical consequences. Psychotropic interventions are the preferable choice of treatment. But which medication should be the prescribers first preference? This review aims to compare pharmacological interventions for psychomotor agitation, judging them according to their effectuality and justifiability profiles. This is to be achieved by retrieving information from RCTs and systematic reviews. Objectives: This review evaluates evidence from RCTs, systematic reviews, and meta-analyses of BPSD patients who had taken agitation treatments. Assessing the efficacy of antidepressants and antipsychotic treatments when compared to each other for the purpose of improving agitation outcomes. Methods: This narrative review includes RCTs and retrospective studies that were comparing one or more active ingredient medications with another or with a placebo, along with sys-tematic reviews comparing antidepressants with antipsychotics such as quetiapine, olanzapine, and risperidone. Studies extracted by searching accessing databases, such as PubMed, OVID, and Cochrane with restrictions of date from 2000 to 2021 and English language. Quality of evidence: The quality of systematic reviews was judged against AMSTAR score, and RCTs were judged according to CONSORT checklist for RCT protocols. Conclusion: There are still few studies of serotonin targeting treatment of agitation in BPSD. The SSRIs such as citalopram were associated with a reduction in symptoms of agitation, and lower risk of adverse effects compared to antipsychotics. This review also illustrates brexpiprazole as a target of multimodal neurotransmitters such as dopamine, serotonin, and norepinephrine; and dextromethorphan, OR dextromethorphan associated with bupropion or quinidine as a blockade of NMDA receptors. The outcome of this review suggests that further studies involving more dementia/Alzheimer’s participants should be conducted. Future studies are required also to assess the long-term safety and efficacy of SSRI, brexpiprazole, dextromethorphan treatments for agitation in BPSD.

The Work-Related Stress Experienced by Registered Nurses at Municipal Aged Care Facilities: A Qualitative Content Analysis

Background Stress can originate from many different unsatisfying work situations. Registered nurses working in municipal care have experience of work-related stress in different ways. Aim The purpose of this study was to describe the work-related stress experienced by registered nurses caring for older people at municipal aged care facilities. Methods Qualitative semi-structured interviews according to Polit and Beck were carried out in clinical work at six different municipal aged care facilities in Sweden. Twelve registered nurses participated in the study. Results The results outlined in one main central theme: Feelings of inadequacy and dissatisfaction contribute to work-related stress and three categories: Difficulty coping with work tasks, Insufficient support, Work-related stress affects private lives. Areas identified were lack of time, staff shortages, high number of patients, lack of communication and teamwork in the working group, showing that inadequacy and dissatisfaction can contribute to work-related stress. This can contribute to work-related stress, and it can be a result of problems in the organizational and social work environment. Conclusion This study showed the everyday experiences of registered nurses’ stress at work. The reasons that registered nurses experience a heavy workload were found to be similar in several municipal care facilities. Future interventions should consider the areas of stress found in this study in order to reduce the risk of further increasing the work-related stress experienced by registered nurses working in municipal aged care.

The Role of Social Work in Residential Aged Care Facilities: Evaluation of a Pilot Program in Australia

In some international settings, social workers are employed within aged care settings. However, in Australia, social workers rarely work in residential aged care facilities. In an innovative program, an Australian health network employed a social worker in an aged residential care facility from 2010 to 2011. In this research we examine and evaluate this program. Qualitative semi-structured interviews with nine key stakeholders and data extraction from medical records were conducted. Data from medical records and interview transcripts were coded and themes extracted using thematic analysis. Thematic analysis identified five key themes reflecting the roles performed by the social worker. These were: (1) The importance of having an independent third party, (2) The provision of emotional support to residents, carers and families during the transition period, (3) The importance of role clarity, (4) The provision of family-centered care, and (5) Social work responses to potential difficulties which were preventative rather than reactive. The move into residential aged care can be an overwhelming, and in some cases, traumatic transition for residents and families. Results identified that timely and expert social work intervention can improve the transition process through the provision of counselling to effectively manage grief, loss, and psychosocial issues.

An Evaluation of Texture Modified Diets Compliant with the International Dysphagia Diet Standardisation Initiative in Aged-Care Facilities Using the Consolidated Framework for Implementation Research

Background: Texture modified diets (TMDs) are commonly prescribed for older adults with swallowing difficulties to improve swallowing safety. The International Dysphagia Diet Standardization Initiative (IDDSI) provides a framework for terminology, definitions and testing of TMDs. This observational mixed-method study used the Consolidated Framework for Implementation Research (CFIR) to establish the barriers and enablers to IDDSI adoption in aged-care facilities (ACFs).Methods: Five New Zealand ACFs who had adopted IDDSI >12 months previously were recruited. Evaluation tools were developed based on CFIR constructs, integrating data from i) mealtime observations; ii) manager interviews and iii) staff (nursing, carers and kitchen) self-administrated surveys. Results: All facility and kitchen managers were IDDSI-aware and had access to online resources. Three sites had changed to commercially compliant products post-IDDSI adoption, which had cost implications. Awareness of IDDSI amongst staff ranged from 5-79% and <50% of staff surveyed felt sufficiently trained. Awareness was greater in large sites and where IDDSI was mandated by head office. Managers had not mandated auditing and they felt this had led to reduced perceived importance. Managers felt staff required more training and staff wanted more training, believing it would improve food safety and quality of care. Lack of a dedicated project leader and no speech pathologist onsite were perceived barriers. Collaboration between healthcare assistants, kitchen staff and allied health assisted implementation. Conclusion: ACF staff were aware of IDDSI but staff awareness was low. Using the CFIR, site-specific and generic barriers and enablers were identified to improve future implementation effectiveness. Managers and staff want access to regular training. Multidisciplinary collaboration and improving communication are essential. ACFs should consider TMD auditing regularly. Successful implementation of IDDSI allows improvement of quality of care and patient safety but requires a systematic, site-specific implementation plan.

The Impact of a Dementia-Friendly Garden Design on People With Dementia in a Residential Aged Care Facility: A Case Study

Background: There is a paucity of evidence on the efficacy of garden design based on dementia-friendly environment (DFE) characteristics on the level of agitation, apathy, and engagement of people with dementia in residential aged care facilities (RACFs). Objective: To investigate the effect of a garden improved according to DFE characteristics on agitation, apathy, and engagement of people with dementia in one RACF. Methods: A case study design with a mixed-method approach was used. Results: There was no significant improvement in the level of participants’ agitation following visits to the improved garden, χ2(2) = 5.167, p = .076. A high level of engagement was found in participants during the intervention (Week 1-1, p < .01; Week 1-2, p < .01; Week 2, p < .01; Week 3, p < .05; and Week 4, p < .05) when compared to before intervention (Week 0). A higher level of apathy was found in participants at Week 0 when compared to during the intervention (Week 1-1, p < .05; Week 1-2, p < .01; Week 2, p < .05; Week 3, p < .01; and Week 4, p < .01). Five themes emerged from participant interviews: the presence of sensory-provoking elements in the garden, meaningful engagement in the garden, accessibility of the garden, garden impacts, and garden experiences that demonstrated the effectiveness of the garden. Conclusions: The garden promoted engagement and decreased apathy of people with dementia living in the RACF with the researcher’s partial facilitation of the intervention sessions. The qualitative findings indicated the effectiveness of the garden in reducing agitation.