Background: The use of assistive technologies (ATs) to support older people has been fueled by the demographic change and technological progress in many countries. These devices are designed to assist seniors, enable independent living at home or in residential facilities, and improve quality of life by addressing age-related difficulties. Objective: We aimed to evaluate the effectiveness of ATs on relevant outcomes with a focus on frail older adults. Methods: A systematic literature review of randomized controlled trials evaluating ATs was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The Ovid Medline, PsycINFO, SocIndex, CINAHL (Cumulative Index to Nursing and Allied Health Literature), CENTRAL (Cochrane Central Register of Controlled Trials), and IEEEXplore databases were searched from January 1, 2009, to March 15, 2019. ATs were included when aiming to support the domains autonomy, communication, or safety of older people with a mean age ≥65 years. Trials performed within a laboratory setting were excluded. Studies were retrospectively categorized according to the physical frailty status of participants. Results: A total of 19 trials with a high level of heterogeneity were included in the analysis. Six device categories were identified: mobility, personal disease management, medication, mental support, hearing, and vision. Eight trials showed significant effectiveness in all or some of the primary outcome measures. Personal disease management devices seem to be the most effective, with four out of five studies showing significant improvement of disease-related outcomes. Frailty could only be assessed for seven trials. Studies including participants with significant or severe impairment showed no effectiveness. Conclusions: Different ATs show some promising results in well-functioning but not in frail older adults, suggesting that the evaluated ATs might not (yet) be suitable for this subgroup. The uncertainty of the effectiveness of ATs and the lack of high-quality research for many promising supportive devices were confirmed in this systematic review. Large studies, also including frail older adults, and clear standards are needed in the future to guide professionals, older users, and their relatives. Trial Registration: PROSPERO CRD42019130249; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=130249

Background: Technology can support healthy aging and empower older adults to live independently. However, technology adoption by older adults, particularly assistive technology (AT), is limited and little is known about the types of AT used among older adults. This study explored the use of key information and communication technologies (ICT) and AT among community-dwelling adults aged ≥ 65. Methods: A cross-sectional study was conducted among community-dwelling adults aged ≥ 65 in southern Germany using a paper-based questionnaire. The questionnaire included questions on the three domains sociodemographic aspects, health status, and technology use. Technology use was considered separately for key ICT (smartphone, computer/laptop, and tablet) and a range of 31 different AT. Data were analyzed using descriptive statistics, univariate analyses, and Bernoulli Naïve Bayes modelling. Results: The questionnaire was answered by 616 participants (response rate: 24.64%). ICT were used by 497 (80.68%) participants and were associated with lower age, higher level of education, living together with someone, availability of internet connection, higher interest in technology, and better health status (p < .05). No association was found with sex and size of the hometown. The most frequently owned AT were a landline phone, a body scale, and a blood pressure monitor. Several AT related to functionality, (instrumental) activities of daily living- (IADL), and morbidity were used more frequently among non-ICT users compared to ICT-users: senior mobile phone (19.33% vs. 3.22%), in-house emergency call (13.45% vs. 1.01%), hearing aid (26.89% vs. 16.7%), personal lift (7.56% vs. 1.61%), electronic stand-up aid (4.2% vs. 0%). Those with higher interest in technology reported higher levels of benefit from technology use. Conclusions: Despite the benefits older adults can gain from technology, its use remains low, especially among those with multimorbidity. Particularly newer, more innovative and (I)ADL-related AT appear underutilized. Considering the potential challenges in providing adequate care in the future, it may be crucial to support the use of these specific AT among older and frailer populations. To focus scientific and societal work, AT with a high impact on autonomy ((I)ADL/disease-related) should be distinguished from devices with a low impact on autonomy (household-/ comfort-related).

Introduction: Post-operative delirium (POD) is a common complication in older patients, with an incidence of 14–56%. To implement preventative procedures, it is necessary to identify patients at risk for POD. In the present study, we aimed to develop a machine learning (ML) model for POD prediction in older patients, in close cooperation with the PAWEL (patient safety, cost-effectiveness and quality of life in elective surgery) project. Methods: The model was trained on the PAWEL study’s dataset of 878 patients (no intervention, age ≥ 70, 209 with POD). Presence of POD was determined by the Confusion Assessment Method and a chart review. We selected 15 features based on domain knowledge, ethical considerations and a recursive feature elimination. A logistic regression and a linear support vector machine (SVM) were trained, and evaluated using receiver operator characteristics (ROC). Results: The selected features were American Society of Anesthesiologists score, multimorbidity, cut-to-suture time, estimated glomerular filtration rate, polypharmacy, use of cardio-pulmonary bypass, the Montreal cognitive assessment subscores ‘memory’, ‘orientation’ and ‘verbal fluency’, pre-existing dementia, clinical frailty scale, age, recent falls, post-operative isolation and pre-operative benzodiazepines. The linear SVM performed best, with an ROC area under the curve of 0.82 [95% CI 0.78–0.85] in the training set, 0.81 [95% CI 0.71–0.88] in the test set and 0.76 [95% CI 0.71–0.79] in a cross-centre validation. Conclusion: We present a clinically useful and explainable ML model for POD prediction. The model will be deployed in the Supporting SURgery with GEriatric Co-Management and AI project.

Background: The Maritime Labour Convention, 2006 (MLC2006) entered into force in August 2013 and is a milestone for better working and living conditions (WLC) for seafarers. As of March 2020, 96 countries have ratified the MLC2006, covering more than 90% of the world’s shipping fleet. A system of port state control (PSC) allows ratifying countries to inspect any foreign ship arriving in their ports for compliance with the convention. It is intended as a second safety measure for the identification of substandard ships that sail all over the world. Nine regional agreements, so-called Memoranda of Understanding (MoU), have been signed to coordinate and standardize PSC inspections and to increase efficiency by sharing inspections and information. This paper uses public PSC statistics to evaluate the impact of the MLC2006. Methods: A preliminary analysis using registered tonnage and MLC2006 ratification was conducted and seven MoU were selected for the analysis. The annual reports of these MoU have been viewed in September 2019. Numbers on annual inspections, deficiencies and detentions and in particular data for deficiencies related to living and working conditions and certificates and documents, have been extracted and analyzed for the years 2010 to 2017. Results: Across the eight-year period analyzed, inspection numbers remained stable among all MoU authorities. Deficiencies overall and deficiencies related to WLC declined, indicating an improvement in conditions overall and an increased focus on seafarers’ conditions on board. After the MLC2006 entered into force, three MoU reported WLC-ratios above 14%, while the numbers didn’t rise above 10% in the other four authorities. Deficiencies related to certificates and documents did not rise significantly between 2010 and 2017. Two European MoU showed the highest ratios for deficiencies in both categories analyzed. Conclusion: The analysis confirmed that an increasing attention is being paid to the inspection of working and living conditions, especially in European countries. However, a clear positive impact of the MLC2006 could not be determined from the PSC statistics in this analysis. A large variation still exists among the MoU, a fact that demands increased efforts for harmonization of PSC procedures.

Background: The Maritime Labour Convention 2006 (MLC2006) entered into force in 2013 and is the first comprehensive set of standards for better living and working conditions covering aspects such as wages, contracts, food, medical care and social security. Currently, the Convention covers more than 90% of the world’s shipping fleet. The aim of the study was to investigate the impact of the MLC2006 on the living and working conditions of seafarers and to test and adjust the methods for future use through a pilot study. This article presents the seafarers’ perceived impact of MLC2006. Materials and methods: A mixed-method research approach was used (February to April 2018). The quantitative data of 55 seafarers were analysed using descriptive statistics. Qualitative data obtained through a focus group interview and thematic content analysis was applied. Results: Remarkably, one third of the respondents pointed out a complete lack of improvement, while 43.6% stated that the MLC2006 had improved their working and living conditions “somewhat” and only 7.3% “to a great extend”. The focus group participants agreed that the MLC2006 did not improve working conditions but mostly increased paperwork. Other issues of concern were the safety on board including safety training, long working hours connected to low manning, food and social difficulties. Conclusions: For Danish seafarers, the MLC2006 did not have a significant impact, as most standards were in place before. It must be further investigated what the MLC2006 achieved for other flag states, especially in the light of its 5-year anniversary. Both methods yielded valuable data. Focus groups are an ideal setting to study the views of seafarers. Background: The Maritime Labour Convention 2006 (MLC2006) entered into force in 2013 and is the first comprehensive set of standards for better living and working conditions covering aspects such as wages, contracts, food, medical care and social security. Currently, the Convention covers more than 90% of the world’s shipping fleet. The aim of the study was to investigate the impact of the MLC2006 on the living and working conditions of seafarers and to test and adjust the methods for future use through a pilot study. This article presents the seafarers’ perceived impact of MLC2006. Materials and methods: A mixed-method research approach was used (February to April 2018). The quantitative data of 55 seafarers were analysed using descriptive statistics. Qualitative data obtained through a focus group interview and thematic content analysis was applied. Results: Remarkably, one third of the respondents pointed out a complete lack of improvement, while 43.6% stated that the MLC2006 had improved their working and living conditions “somewhat” and only 7.3% “to a great extend”. The focus group participants agreed that the MLC2006 did not improve working conditions but mostly increased paperwork. Other issues of concern were the safety on board including safety training, long working hours connected to low manning, food and social difficulties. Conclusions: For Danish seafarers, the MLC2006 did not have a significant impact, as most standards were in place before. It must be further investigated what the MLC2006 achieved for other flag states, especially in the light of its 5-year anniversary. Both methods yielded valuable data. Focus groups are an ideal setting to study the views of seafarers.

Background: Geriatric comanagement has been shown to improve outcomes of older surgical inpatients. Furthermore, the choice of discharge location, that is, continuity of care, can have a fundamental impact on convalescence. These challenges and demands have led to the SURGE-Ahead project that aims to develop a clinical decision support system (CDSS) for geriatric comanagement in surgical clinics including a decision support for the best continuity of care option, supported by artificial intelligence (AI) algorithms. Objective: This qualitative study aims to explore the current challenges and demands in surgical geriatric patient care. Based on these challenges, the study explores the attitude of interviewees toward the introduction of an AI-supported CDSS (AI-CDSS) in geriatric patient care in surgery, focusing on technical and general wishes about an AI-CDSS, as well as ethical considerations. Methods: In this study, 15 personal interviews with physicians, nurses, physiotherapists, and social workers, employed in surgical departments at a university hospital in Southern Germany, were conducted in April 2022. Interviews were conducted in person, transcribed, and coded by 2 researchers (AU, LB) using content and thematic analysis. During the analysis, quotes were sorted into the main categories of geriatric patient care, use of an AI-CDSS, and ethical considerations by 2 authors (AU, LB). The main themes of the interviews were subsequently described in a narrative synthesis, citing key quotes. Results: In total, 399 quotes were extracted and categorized from the interviews. Most quotes could be assigned to the primary code challenges in geriatric patient care (111 quotes), with the most frequent subcode being medical challenges (45 quotes). More quotes were assigned to the primary code chances of an AI-CDSS (37 quotes), with its most frequent subcode being holistic patient overview (16 quotes), then to the primary code limits of an AI-CDSS (26 quotes). Regarding the primary code technical wishes (37 quotes), most quotes could be assigned to the subcode intuitive usability (15 quotes), followed by mobile availability and easy access (11 quotes). Regarding the main category ethical aspects of an AI-CDSS, most quotes could be assigned to the subcode critical position toward trust in an AI-CDSS (9 quotes), followed by the subcodes respecting the patient’s will and individual situation (8 quotes) and responsibility remaining in the hands of humans (7 quotes). Conclusions: Support regarding medical geriatric challenges and responsible handling of AI-based recommendations, as well as necessity for a holistic approach focused on usability, were the most important topics of health care professionals in surgery regarding development of an AI-CDSS for geriatric care. These findings, together with the wish to preserve the patient-caregiver relationship, will help set the focus for the ongoing development of AI-supported CDSS.