Under-Mattress Temporal Sensing for Next-Day Agitation Risk Scoring in Dementia Wards

Agitation fluctuates over short time horizons in people living with dementia, yet continuous physiological information for anticipating next-day risk is limited. We assessed whether contactless under-mattress signals from the preceding night inform next-day agitation risk and whether preserving minute-level temporal structure improves performance over conventional nightly summaries. We analyzed 423 patient-nights from 65 subjects in a specialized hospital dementia unit using two under-mattress sensing systems. A unified four-paradigm benchmark compared nightly handcrafted summaries, three-period handcrafted features, full-night sequence modeling, and sliding-window multiple-instance learning. Source-specific preprocessing and five-fold patient-grouped cross-validation were used, with performance estimated from pooled out-of-fold predictions. Evaluation included discrimination, calibration, fixed-threshold metrics, and a comparison of period-signal attribution patterns across two temporal models. Full-night sequence modeling achieved the highest discrimination (AUROC, 0.692; AUPRC, 0.849) and balanced accuracy (0.658). Both minute-level pipelines had higher AUROC than nightly summaries, but differences from three-period handcrafted features were uncertain. Cross-model attribution prioritized activity, heart rate, and respiratory rate during the core overnight period. Calibration remained limited. The preceding night's signals supported modest next-day risk discrimination, with minute-level temporal modeling outperforming nightly summaries. Prospective calibration and external validation are needed before use in individual care decisions. This patient-grouped benchmark identifies contactless overnight sensing as a promising biomedical engineering direction for agitation-risk research in hospitalized dementia cohorts.