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cost-effective care of these patients with multiple, complex conditions is a very
crucial problem [36, 40].
Elderly patients are admitted to the hospital, most of the times, unnecessarily
due to the complexity of decision-making about their health conditions (since the
clinical problems and needs of older patients are often substantially different from
those of younger patients) and they may be accompanied by cognitive or functional
deterioration. In addition to this, many older patients have multiple co-morbidities,
polypharmacy and further complex health and social care needs. Thus, they have
higher readmission rates. Many physicians and junior doctors are not specially
trained in geriatric medicine so they may have difficulty in assessing the patient's
condition as being of an intermediate risk or requiring just monitoring and observa-
tion [8, 9, 26].
Besides the various clinical tests and laboratory exams run in the ED and the
medical history taking, various questionnaires are used to assess patient status. For
example, risk factors known to have often-adverse health outcomes are used by the
questionnaire Identification of Seniors at Risk tool to detect impaired functional
status and depression at the evaluation [37].
It is significant to mention that in a sample of 50 randomly selected cases of
ED admissions patients 65 years or older, discrepancies were found between the
medical staff and expert nurses in 20 cases: where staff nurses had undertriaged 13
patients and overtriaged 7 patients [23].
Nowadays, the new technological advances, the utilization of ICT in the hospital
and all the new technology based diagnostic tests produce a huge amount of data
being available to make decisions. But under the tight time constraints, as is the
case of Emergency Department, only part of this data is utilized. On the other hand,
the limited number of medical professionals requires the efficient exploitation of
human resources to make the right decisions and leads to the need to develop au-
tomatic decision making systems, such as in the process of triage in the emergency
departments.
Generally speaking, Medical Decision Support Systems have a crucial role in
today's complex health systems, since it is required to combine the human clinical
experience acquired through hospital practice with widely accepted systematic an-
alytic approaches. Such hybrid methods that combine both of them are in favor of
medical professionals. One such approach is the soft-computing modeling method-
ology of Fuzzy Cognitive Maps, which is discussed in the next section.
The aims of this research is to present a Fuzzy Cognitive Map Medical Decision
Support System (FCM-MDSS) for supporting in the triaging of elderly patients ar-
riving in the emergency room for medical assistance while trying to minimize un-
necessary admission and/or over/undertriaging. A Fuzzy Cognitive Map MDSS
architecture is developed and described here based on existing medical protocols on
patient triaging, along with the consultation and support of emergency care nurses
and physicians.
