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Due to the fastest growing senior population, age-related cognitive impairments, including Alzheimer's disease, are becoming among the most common diseases in the United States. Currently, prevention through delay is considered the best way to tackle Alzheimer's disease and related dementia, as there is no known cure for those diseases. Early detection is crucial, in that screening individuals with Mild Cognitive Impairment may delay its onset and progression. For my dissertation work, I investigate how computing technologies can help medical practitioners detect and monitor cognitive impairment due to dementia, and I develop a computerized sketch-based screening tool. In this dissertation, I present the design, implementation, and evaluation of the ClockMe System, a computerized Clock Drawing Test. The traditional Clock Drawing Test (CDT) is a rapid and reliable instrument for the early detection of cognitive dysfunction. Neurologists often notice missing or extra numbers in the clock drawings of people with cognitive impairments and use scoring criteria to make a diagnosis and treatment plan. The ClockMe System includes two different applications - (1) the ClockReader for the patients who take the Clock Drawing Test and (2) the ClockAnalyzer for clinicians who use the CDT results to make a diagnosis or to monitor patients. The contributions of this research are (1) the creation of a computerized screening tool to help clinicians identify cognitive impairment through a more accessible and quick-and-easy screening process; (2) the delivery of computer-collected novel behavioral data, which may offer new insights and a new understanding of a patient's cognition; (3) an in-depth understanding of different stakeholders and the identification of their common user needs and desires within a complicated healthcare workflow system; and (4) the triangulation of multiple data collection methods such as ethnographical observations, interviews, focus group meetings, and quantitative data from a user survey in a real-world deployment study.

Background: By the year 2030 the prognosis is that one fourth of the Swedish population will be 65 years or older. An age group that today stands for 40 percent of all the daily visits in the Swedish emergency departments. Nearly half of them are 80 years or older. The frail older adults are often low prioritized due to their diffuse symptoms whereby long waiting times and healthcare-related injuries may occur. As a complement to the standard prioritizing procedure, that triage stands for, some emergency departments have introduced screening tools for detecting those individuals that are older adults and frail. Unfortunately, the introduction of new guidelines, do not always imply that the implementation comes easy because there are factors that facilitate and inhibit their intended use. Aim: To illustrate factors that affect the nurses use of the screening tool Clinical Frailty Scale (CFS) which identifies frailty in elders during triage in the emergency department. Method: A descriptive quantitative cross-sectional study where data was collected through a web-based questionnaire. The data of the study was analyzed through descriptive and analytical statistics. Results: When it came to influencing factors regarding the use of CFS in the selected emergency department, CFS as a method with its practicalities constituted as facilitators, whilst the organizational and working cultural aspects constituted as barriers. The differences in the nurses' experience and education effected the perception of CFS in different ways. Conclusion: There is a need of a working culture where responsibility is shared between stakeholders to facilitate a guideline. Advanced nurse practitioners can have a crucial role in educating, motivating and creating space for discussion relating to organizational, theoretical and practical components of the process in identifying the frail older adults. / Bakgrund: Prognosen är att år 2030 kommer en fjärdedel av den svenska populationen vara 65 år eller äldre. Åldersgruppen utgör idag cirka 40 procent av alla besök på Sveriges akutmottagningar där nästan hälften av dem är 80 år eller äldre. De sköra äldre erhåller ofta låg prioritering på grund av sina diffusa symtom, där långa väntetider och vårdrelaterade skador kan uppstå som följd. Som komplement i den vanliga prioriteringsrutinen som triagering innebär har akutmottagningar infört screeningverktyg för att upptäcka de individer som är sköra äldre. Dessvärre innebär införandet av nya rutiner att de inte alltid lätt implementeras i verksamheten eftersom det finns faktorer som främjar och hindrar dess avsedda användning. Syfte: Att belysa faktorer som påverkar sjuksköterskors användning av screeningverktyget Clinical Frailty Scale (CFS) för att identifiera sköra äldre vid triagering på akutmottagningen. Metod: En kvantitativ tvärsnittsstudie där data samlades in genom en webbenkät. Studiens data analyserades deskriptivt samt med analytisk statistisk. Resultat: När det kom till faktorer som påverkade användningen av CFS på den valda akutmottagningen utgjorde CFS som metod med dess praktiska delar en främjande faktor, medan organisatoriska och arbetskulturella aspekter utgjorde hindrande faktorer. Skillnaderna i erfarenhet och utbildning hos sjuksköterskorna påverkade uppfattningen om CFS på olika sätt. Slutsats: Det behövs en arbetskultur med ett delat ansvar mellan organisation och medarbetare för att främja följsamheten till en rutin. Specialistsjuksköterskor kan ha en betydande roll i att utbilda, motivera och skapa forum för diskussion gällande organisatoriska, teoretiska och praktiska delar i processen av att identifiera sköra äldre.

Aus der Studie und den Ergebnissen können wertvolle Impulse abgeleitet werden. Es darf nicht aus den Augen verloren werden, dass junge Menschen mit traumatisierenden Erfahrungen spezifische Perspektiven (Kenny, Dooley, & Fitzgerald, 2016) und Bedenken in Bezug auf die Vertrauenswürdigkeit von KI (Grasser, 2020) haben können. Demzufolge ist wichtig, die subjektive Sicherheit sowie andere Einflussgrößen auf die Nutzung von KI und E-Health Angeboten zu kennen und in Betracht zu ziehen. Ferner zeigen Studien, dass E-Health Literacy (E-Health-Kompetenz) bei minderjährigen Geflüchteten eher gering ist (Bergmann, Nilsson, Dahlberg, Jaensson, & Wångdahl, 2021) und Forschung zur Erhöhung des Uptake von qualitativ hochwertigen Angeboten dringend benötigt wird. Die Integration der Zielgruppe kann jedoch nur dann gelingen, wenn die E-Health-Apps als wichtig erkannt werden und bei ihrer Umsetzung darauf geachtet wird, dass sie praktikabel sind. [Aus: Zusammenfassung]