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.

COVID-19 risk perceptions and precautions among the elderly: A study of CALD adults in South Australia

Background: Coping with COVID-19 is a challenge for culturally and linguistically diverse (CALD) older adults. In Australia, little attention has been given to understanding associations between cultural contexts, health promotion, and socio-emotional and mental health challenges of older CALD adults during the COVID-19 pandemic. Therefore, we have collected data from older CALD adults to examine their COVID-19 risk perceptions and its association with their health precautions, behavioural dimensions and emergency preparation. Methods: A cross-sectional survey was conducted in South Australia. The CALD population aged 60 years and above were approached through 11 South Australian multicultural NGOs. Results: We provide the details of 155 older CALD South Australians’ demographics, risk perceptions, health precautions (problem-and-emotion-focused), behavioural dimensions and emergency preparation. The explanatory variables included demographic characteristics (age, gender, education and ethnicity); and risk perception (cognitive [likelihood of being affected] and affective dimension [fear and general concerns], and psychometric paradigm [severity, controllability, and personal impact]. The outcome measure variables were health precautions (problem-focused and emotion-focused), behavioral adaptions and emergency preparation. Conclusions: This dataset may help the researchers who investigate multicultural health or aged care in the pandemic and or who may have interest to link with other datasets and secondary use of this primary dataset in order to develop culturally tailored pandemic-related response plan. The data set is available from Harvard Dataverse.

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.

Strategies To Support Older Adults’ Mental Health During the Transition Into Residential Aged Care: A Qualitative Study of Multiple Stakeholder Perspectives

BackgroundThe move from home into residential care is one of the most stressful life experiences for older adults. ‘Relocation stress’ is a significant risk factor for anxiety and/or depression in aged care residents. Whether long-term or recently diagnosed, these mood disorders are associated with a decline in overall well-being, daily functioning and independence. The mental health needs of older adults are often poorly recognised and supported, including during the transition into residential care. Despite growing interest in how to facilitate this major life transition, few studies have taken the perspective of multiple stakeholders. The aim of this study was to explore resident, relative and staff experiences of the transition into residential aged care, and to identify strategies to support the mental health of older adults at this time. MethodsSemi-structured interviews were conducted with 35 aged care residents, relatives and staff, between January and April 2021. Participants were selected using purposive and convenience sampling. Interviews were audio recorded and transcribed verbatim. Data were analysed inductively and grouped into themes. ResultsResults were distilled into three main categories related to the overall transition experience, residents’ mental health needs and strategies to support residents’ mental health. A novel contribution of this study relates to the need to address a broad misunderstanding of the role of pastoral care and subsequent under-utilisation of a potentially valuable resource. ConclusionsBy describing transition experiences and the resources to support residents’ mental health, findings of this study provide practical, ‘real world’ suggestions for reducing relocation stress. New resources developed from the findings include guides, checklists and short question-and-answer films, in which current residents and staff describe strategies to support mental health and overall quality of life. Similar resources could be used to support transitions in other care settings.

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.

A Queueing-Based Model Performance Evaluation for Internet of People Supported by Fog Computing

Following the Internet of Things (IoT) and the Internet of Space (IoS), we are now approaching IoP (Internet of People), or the Internet of Individuals, with the integration of chips inside people that link to other chips and the Internet. Low latency is required in order to achieve great service quality in these ambient assisted living facilities. Failures, on the other hand, are not tolerated, and assessing the performance of such systems in a real-world setting is difficult. Analytical models may be used to examine these types of systems even in the early phases of design. The performance of aged care monitoring systems is evaluated using an M/M/c/K queuing network. The model enables resource capacity, communication, and service delays to be calibrated. The proposed model was shown to be capable of predicting the system’s MRT (mean response time) and calculating the quantity of resources required to satisfy certain user requirements. To analyze data from IoT solutions, the examined architecture incorporates cloud and fog resources. Different circumstances were analyzed as case studies, with four main characteristics taken into consideration. These case studies look into how cloud and fog resources differ. Simulations were also run to test various routing algorithms with the goal of improving performance metrics. As a result, our study can assist in the development of more sophisticated health monitoring systems without incurring additional costs.