Assistive technology focus on Health & Environment Helianthe S.M. Kort, PhD Full professor Demand Driven care, Utrecht University of Applied Sciences

Assistive technology focus on Health & Environment

Helianthe S.M. Kort, PhDFull professor Demand Driven care, Utrecht University of Applied Sciences / Hogeschool Utrecht Full professor Building healthy environments for future users, Eindhoven University of Technology / TU/e

August 2014

Overview

n Trends in healthcare

n Active ageing

n Research framework

n eHealth

n Selfmanagement and personalized health

AAATE

n "to stimulate the advancement of assistive technology for the benefit of people with disabilities, including elderly people"

n The AAATE is the interdisciplinary pan-European association devoted to all aspects of assistive technology, such as use, research, development, manufacture, supply, provision and policy.

Research Center For Innovations in Healthcare

n Care for older people and family caren Lifestyle and Healthn Demand Driven Care

n Speech Therapyn Dissemination of Pharmaceutical innovations

Mission KC IVZ

n the ability of professionals trained at the Faculty of Health Sciences to act critically and reflectively within professional practice;

n process existing and new knowledge in such a way that this is applicable in the care sector;

n produce knowledge in response to concrete questions from the field.

Trends in Care

n Ageing of the populationn Growth in 55-plus

n Hazing of the populationn Potential working force decreases

n Increase of chronic diseases

n Limitations in care supply (professional and family)

n Ageing in Place

Increasing care demand

n Older adults deteriorating healthn Diseases increases

n Dementia, COPD, Diabetes mellitus, n Mental disorders

n Limitation in ADLn Domestic workn Mobilityn Personal Care

Availability of professional carers

n The need for professional care givers increases every year, by 2% on average.

n More than one out of ten people of the professional population work in the care- and welfare sector.n of which 78% are women working part time.

n Approximately 22% of the work force should be employed in the care- and welfare sector by the year 2025.

Telecare

Care after hospital admissionAdmission length ↓Re-admission ↓Therapy compliance ↑

Care and supportTravelling time Satisfied customersSatisfied employees

Smart Homes (AAL)Comfort and safety

Information and Entertainment

Services (alarm / telehelp)

World population ageing

Effects due to ageing

n Shrinking workforcen Old age dependency ratio (Grijze druk) = TP 60 plus

/ TP 15 – 60n TP = Total population

n Financial implications of pension and care policy

Rapid ageing in developing countries

Trends

n Vergrijzing verdeeld 2010 CPB

Trends

n Vergrijzing verdeeld 2010 CPB

World profile of ageing 2013

Availability of family care in NL

Meaning of ageing

n Oma op stap

n What about your age?

Assistive Technology

n ALT; eALT; eHealth; Telecare

n WHO:n With the aid of these technologies, people with

a loss in functioning are better able to live independently and participate in their societies.

Active ageing concept1990 WHO

n Active ageing is the process of optimizing opportunities for

n Healthn Participationn Security

n In order to enhance quality of life as people age

n Need base Rights base

Possible intervention moments

Determinants of active ageing

Gerontechnology

n Gerontechnology is an interdisciplinary academic and professional field combining gerontology and technologyn Assistive technology and inclusive design for

innovative and independent living and social participation of older adults in good health, comfort and safety

n Gerontechnolgy concerns matching technological environment to health, housing, mobility, communication, leisure and work for older people

25Herman Bouma. GT Basics and Impact Matrix. May 22, 2006

Gerontechnology Impact matrix

Life Domain

Health &Self-esteem

Housing &Daily living

Mobility &Transport

Communication & Governance

Work &Leisure

GoalEnhancement& Satisfaction

TelemedicineInternet

Wireless / remote (e.g.phone)

GPS navigationInfo publ.transp

Mobile phoneInternet

Digital. cameraInternet

Prevention &Engagement

Healthy dietHome trainer

Smart ventil.Safety illumin.

Car automationTraffic info

Video Links Focussedlighting

Compensation& Assistance

Passivealarms

Smart IADL Rollator/walker Battery wheelchair

Hearing Aids Power toolsRobot pet

Care support& Organisation

Smart intakeControl-PDA

Electronic keys

Powered lifting Care NetworksVideo links

Robots

Challenges

n The double burden of Disease (acute -> chronic)n Increased Risk of Disabilityn Providing Care for Ageing Populationsn The Feminization of Ageingn Ethics and Inequitiesn The Economics of an Ageing populationn Forging a new paradigm (passive -> active older

people)

Approach prevention and reduction

n Prevention and effective treatmentsn Age-friendly, safe environmentsn Reduce avoidable hearing impairmentn Reduce and eliminate blindnessn Provide approitae eye care servicesn Barrier-free livingn Quality of life

Approach reduction of risks

n Physical activityn Healthy eatingn Oral healthn Psychological factorsn Medications (access to safe medications)n Adherence

ICF

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Health and self managementn WHO : Health is a state of complete physical,

mental and social well-being and not merely the absence of disease or infirmity.

The correct bibliographic citation for the definition is:

Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.

n The Definition has not been amended since 1948.

A new approach:n “health, as the ability to adapt and to self

manage” is to identify and characterise it for the three domains of health: physical, mental, and social. The following examples attempt to illustrate this.

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Self management

n Management of or by oneself; the taking of responsibility for one’s own behavior and well-being:

n The individual capacity to deal with symptoms, treatment, physical and mental consequences. Life style changes due to the life with a chronic disorder.

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Telehome care and Self management

n Special attention for frail people: n Persons with dementia, n Older oldest (85+), n With complex problems, n With a low SESn Those with a low literacy in language / health n In a terminal phase.

n With low self management skills

Telehomecare in the Netherland

n Health conditions:

n Dementia (19 projects)

n COPD (11 projects)

n Diabetes (11 projects)

Kort e.a., Telehomecare in the Netherlands: value-based analysis for full implementation, in: A.P. Glascock, Kutzik, D.M. (Eds.), Essential lessons for the success of telehomecare: why it's not plug and play 30, 145-160, IOS Press, Amsterdam, 2012.

Telehomecare in Nederland

Telehomecare

VCAMeHealthTmedother

eHealth

eHealth or Telehealthn Exchange of data between patient and

professionals for diagnosis or management of the health condition

n Encompasses electronic health records, AAL, smart systems, telecare, telemedicine, ALT

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Possible Barriers

n Telehomecare: support of AiP or quality of life. n No consideration with requirements to building

construction, building systems ,..n Not all stakeholders are involved and not all of

the needs of these stakeholders are met in the design and implementation

n The execution of the projects seems to exist merely out of an analysis of the technological applications only

H.S.M. Kort, J. Van Hoof, Telehomecare in The Netherlands: Barriers to Implementation, International Journal of Ambient Computing and Intelligence 4 (2012), 64-73.

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Possible Barriers

n Accessibility of computersn Availability of support n Technology generationsn Technicaln Structure of the Healthcare systemn Legaln Education n User Acceptance

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Possible Barriers

n The paradigm of telehomecare implies an innovation in the provision of care.

n Hardly any knowledge exchange about telehomecare services between producers /enterprises and care professionals

Challenges

TELEHOMECARE

Professionals Client

Users factors

Technology

Cost

Challenges

TELEHOMECARE

Professionals

Client

User factors

Technology

Cost

Studies

n WSD (UK)

n NRW (GE)

n PETZ (NL / USA)

Whole Systems DemonstratesTelehealth in de UK

n Largest RCT in the worldn Telehealth and telecaren Aim is to provide benefit for 3 million lives

n The programme will provide a clear evidence base to support important investment decisions and show how technology supports people to live independently, take control and be responsible for their own health and care.

n N = 3230 people with a long term condition (HF / COPD)

WSD

n Benefit analysis of costs and outcomes (QALY) & costs (N = 965)

n Qualified Adjusted Life Year gained in Telehealth group = usual care group

n Total cost in Telehealth group is slightly higher, but non significantly than usual care groupn Similar costsn Cost effectiveness is depended with the

willingness to pay for generated health outcomes

WSD: Cost effectiveness & QALY

Henderson e.a. BMJ 2013; 346 – f1035 doi: 10.1136/bmj.f1035

Assuming an 80% reduction in equipment costs at a willingness to pay for the service = (£ 30.K per QALY (€ 35.K), telehealth was 34% cost effective

NRW

n Health survey in North Rhine-Westphalian in 2009 (to identify health needs, initiate policies, and evaluate effects on population health)

n Regular yearly survey n Awareness; willingness to use; reasons for

usen N = 1993 ( 23% low SES; 36% has a chronic

disease part 50 -69 years old)n Y 18 – 93

NRW: Willingness to use Telemonitoring

n Willingness to use telemonitoring seems to be high in the general population of Germany

n decreases with age and targets groups with individuals with Cardiovascular diseases

n Health status is an important factor that influences the willingness to use

NWR: Disadvantages using Telemonitoring

n Bürmann e.a., 2013, Telemedicine and e-Health

NRW

n Possible explanation for a lower willingness to use telemonitoring then men could be cause by computer illiteracy with women

n Older women particular should be assisted and educated regarding use of telemedical devices at home.

n Fear to lose social contact (No GP visits)n Better understand how telemonitoring can

help them to control their health status

PETZ

n Predictors to use eHealth by professionals and older adults

n Ageing adults 65 plus with a long term condition

n E-Panel N= 218 (183 completed the survey)n Selection at a market for social care (hard

copy)n Professionals from home care (N= 500, 207

respondedn Selection by team managersn N = 207

n Survey and observations

Unified Theory of acceptance and use of Technology Venkatesh et.al, 2003

PETZ: Professionals willingness to use

n Thijs Van Houwelingen, Ansam Barakat, Angelo Antonietti, Helianthe Kort

n Using the Unified Theory of Acceptance and Use of Technology to Explore Predictors for the Use of Telehomecare by Care Professionals Pages1223 - 1228

n DOI10.3233/978-1-61499-304-9-1223, 2013

PETZ: Professionals

n Perceived usefulness for the care to my client (ß = .429, P< 0.001)

n Effort Expectancy (ß = .106, P=0.001)

n Social influences(ß = .212, P=0.011)

n Cost expectancy (clients willingness to pay) (ß = .234, P=0.003)

n Experience with eHealth having positive attitude (intention) (p< 0.001)

PETZ: Ageing adults (E panel)

n Predictorsn Motivation for self-

caren Usability

Angelo Antonietti, Ansam Barakat, Thijs Van Houwelingen, Helianthe KortRemote Telecare in an Aging Dutch Sample: Critical Factors Predicting Their Intention to UsePages 1229 – 1234 DOI 10.3233/978-1-61499-304-9-1229, 2013

Pyramid of Technology

Koert van Mensvoort, Pyramid of Technology, How Technology Becomes Nature in Seven Steps, Eindhoven University Lectures 2013

1. Envisoned: Technology is thought up

2. Operational: working prototype exists

3. Applied: Accessible and affordable

4. Accepted: part of your daily life

5. Vital: prety hard to live without

6. Invisible: Intuitive and authentic

7. Naturalized: Indistinguisable from nature

lab fase

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eHealth

eHealth in COPD Care

New eHealth possibilities

n Decubitus preventie

Paddle

n Paddle

n Reference:n Raf Ramakers, Johannes Schöning, Kris Luyten. Paddle: Highly Deformable Mobile Devices with Physical Controls. In

Proceedings of the SIGCHI Conference on Human Factors in Computing Systems (CHI '14) (to appear).

Contact: [email protected]@bwk.tue.nl