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The use of artificial intelligence in geriatrics is very promising and relevant, as the diagnosis of a geriatric patient is a complex, experience-based, and time-consuming process that involves a variety of questionnaires and subjective and inaccurate patient responses. This paper proposes the explainable artificial intelligence-based (XAI) clinical decision support system (CDSS) to assess nutrition-related factors (symptoms) and to determine the likelihood of geriatric patient health risks associated with four syndromes: malnutrition, oropharyngeal dysphagia, dehydration, and eating disorders in dementia. The proposed system’s prototype was tested under real conditions at the geriatric department of Lithuanian University of Health Sciences Kaunas Hospital. The subjects of this study were 83 geriatric patients with various health conditions. The assessments of the nutritional status and syndromes of the patients provided by the CDSS were compared with the diagnoses of the physicians obtained using standard assessment methods. The results show that proposed CDSS can efficiently diagnose nutrition-related geriatric syndromes with high accuracy: 87.95% for malnutrition, 87.95% for oropharyngeal dysphagia, 90.36% for eating disorders in dementia, and 86.75% for dehydration. The research confirms that the proposed XAI-based CDSS is an effective tool, able to assess nutrition-related health risk factors and their dependencies and, in some cases, makes even a more accurate decision than a less experienced physician.

Overall ranking Table 12 shows the rank each country was able to achieve in each of the ten categories. As can be seen from table 12, different countries excelled in different categories. 13 different countries (Belgium, Czech Republic, Finland, France, Ireland, Israel, Italy, Netherlands, Norway, Slovakia, Spain and the UK- both England and Scotland) came first in at least one of the 10 categories. Three countries however excelled and could score first place in three different categories: • Finland came first in care availability, care affordability and in the number of international conventions ratified. • Ireland came first in the treatment, dementia as a priority and employment right categories. • The United Kingdom (England) came first in the categories treatment, dementia friendliness and legal rights. In order to calculate the overall ranking of countries, we based the global score on a combined score of the ten different categories with each contributing m% to the overall score. This score is presented as a percentage of the over-all maximum score which countries could have achieved and leads to the following ranking as shown in figure 13. According to the overall ranking, Finland, the United Kingdom (England) and the Netherlands were the countries which had the most dementia-friendly policies in place, with Albania, Latvia and Bosnia and Herzegovina being the countries which need to make the most progress and reforms to improve the lives of people with dementia in their countries. When looking at the map of Europe (see map 5 below), we can see that there are significant differences across Europe with countries in Northern and Central Europe generally scoring much better than countries in Southern Europe.