Context-Aware Alerting in Elderly Care Facilities: A Hybrid Framework Integrating LLM Reasoning with Rule-Based Logic

The rising demand for elderly care amid ongoing nursing shortages has highlighted the limitations of conventional alert systems, which frequently generate excessive alerts and contribute to alarm fatigue. The objective of this study is to develop a hybrid, context-aware nurse alerting framework for long-term care (LTC) facilities that minimizes redundant alarms, reduces alarm fatigue, and enhances patient safety and caregiving balance during multi-person care scenarios such as mealtimes. To do so, we aimed to intelligently suppress, delay, and validate alerts by integrating rule-based logic with Large Language Model (LLM)-driven semantic reasoning. We conducted an experimental study in a real-world LTC environment involving 28 elderly residents (6 high, 8 medium, and 14 low care levels) and four nurses across three rooms over seven days. The proposed system utilizes video-derived skeletal motion, care-level annotations, and dynamic nurse–elderly proximity for decision making. Statistical analyses were performed using F1 score, accuracy, false positive rate (FPR), and false negative rate (FNR) to evaluate performance improvements. Compared to the baseline where all nurses were notified (100% alarm load), the proposed method reduced average alarm load to 27.5%, achieving a 72.5% reduction, with suppression rates reaching 100% in some rooms for some nurses. Performance metrics further validate the system’s effectiveness: the macro F1 score improved from 0.18 (baseline) to 0.97, while accuracy rose from 0.21 (baseline) to 0.98. Compared to the baseline error rates (FPR 0.20, FNR 0.79), the proposed method achieved drastically lower values (FPR 0.005, FNR 0.023). Across both spatial (room-level) and temporal (day-level) validations, the proposed approach consistently outperformed baseline and purely rule-based methods. These findings demonstrate that the proposed approach effectively minimizes false alarms while maintaining strong operational efficiency. By integrating rule-based mechanisms with LLM-based contextual reasoning, the framework significantly enhances alert accuracy, mitigates alarm fatigue, and promotes safer, more sustainable, and human-centered care practices, making it suitable for practical deployment within real-world long-term care environments.