Development of Deep Learning Models for AI-Enhanced Telemedicine in Nursing Home Care

<b>Background/Objectives:</b> Acute health events in institutionalized older adults often lead to avoidable hospital referrals, requiring rapid, accurate remote decision-making. Telemedicine has become a key tool to improve assessment and care continuity in nursing homes. This study aimed to evaluate outcomes associated with telemedicine-supported management of acute events in residential care facilities for older adults and to develop a deep learning model to classify episodes and predict hospital referrals. <b>Methods:</b> A quasi-experimental study analyzed 5202 acute events managed via a 24/7 telemedicine system in Vitalia nursing homes (January-October 2024). The dataset included demographics, comorbidities, vital signs, event characteristics, and outcomes. Data preprocessing involved imputation, normalization, encoding, and dimensionality reduction via Truncated SVD (200 components). Given the imbalance in referral outcomes (~10%), several resampling techniques (SMOTE, SMOTEENN, SMOTETomek) were applied. A deep feedforward neural network (256-128-64 units with Batch Normalization, LeakyReLU, Dropout, AdamW) was trained using stratified splits (70/10/20) and optimized via cross-validation. <b>Results:</b> Telemedicine enabled the resolution of approximately 90% of acute events within the residential setting, reducing reliance on emergency services. The deep learning model outperformed traditional algorithms, achieving its best performance with SMOTEENN preprocessing (AUC = 0.91, accuracy = 0.88). The proposed model achieved higher overall performance than baseline classifiers, providing a more balanced precision-specificity trade-off for hospital referral prediction, with an F1-score of 0.63. <b>Conclusions:</b> Telemedicine-enabled acute care, strengthened by a robust deep learning classifier, offers a reliable strategy to enhance triage accuracy, reduce unnecessary transfers, and optimize clinical decision-making in nursing homes. These findings support the integration of AI-assisted telemedicine systems into long-term care workflows.