Smart home technology supporting people with dementiakt-equal.org.uk/uploads/Dementia2009/Suzanne.pdf · Smart home technology supporting people with dementia Suzanne Martin ... SENIOR

Smart home technology Smart home technology supporting people with dementiasupporting people with dementia

Suzanne MartinSuzanne MartinLecturer Occupational TherapyUniversity of Ulster at JordanstownLecturer Occupational TherapyUniversity of Ulster at JordanstownUniversity of Ulster at Jordanstown

Northern IrelandUniversity of Ulster at Jordanstown

Northern Ireland

OverviewOverview

RationaleClassificationsRationaleClassificationsClassificationsService applicationsE id f i l i

ClassificationsService applicationsE id f i l iEvidence for implementationEthicsEvidence for implementationEthics

RationaleRationale

2025 one million people in the UK will have dementia2025 one million people in the UK will have dementia

63% of people with late onset dementia live63% of people with late onset dementia live63% of people with late onset dementia live in private households (in the community) and 36 5% live in care homes (1)

63% of people with late onset dementia live in private households (in the community) and 36 5% live in care homes (1)and 36.5% live in care homes (1)and 36.5% live in care homes (1)

International influenceInternational influenceInternational influenceInternational influenceWorld Health organisationWorld Health organisationWorld Health organisationWorld Health organisationWorld Health organisationWorld Health organisationUnited NationsUnited NationsEuropean commissionEuropean commission

World Health organisationWorld Health organisationUnited NationsUnited NationsEuropean commissionEuropean commissionNational agendaNational agenda

Challenges of deliveringChallenges of delivering

National agendaNational agenda

Challenges of deliveringChallenges of deliveringChallenges of delivering Challenges of delivering Health and Social Care Health and Social Care to future populations to future populations

ith h iith h i

Challenges of delivering Challenges of delivering Health and Social Care Health and Social Care to future populations to future populations

ith h iith h iwith a changing with a changing demographic profiledemographic profilewith a changing with a changing demographic profiledemographic profile

Other factors influencing changeOther factors influencing change

ICT DevelopmentICT DevelopmentpDecreased Cost

Communications, Peripherals and Hardware

pDecreased Cost

Communications, Peripherals and HardwareIncreased Capability

Data Gathering and Analysis to Inform Health Cared i S bili

Increased CapabilityData Gathering and Analysis to Inform Health Care

d i S biliIncreased Device StabilityEnhanced Standardisation and Compatibility across Devices

Increased Device StabilityEnhanced Standardisation and Compatibility across Devicesacross Devicesacross Devices

Dementia has…Dementia has…

“ the potential to overwhelm health and social care services which are already ill “ the potential to overwhelm health and social care services which are already ill yequipped to respond to the challenge of

dementia” David Hunt Chief Executive Alzheimer’s

yequipped to respond to the challenge of

dementia” David Hunt Chief Executive Alzheimer’s fSociety

fSociety

Smart Home ClassificationSmart Home Classification

1. Homes with intelligent objects2 Homes with intelligent objects that1. Homes with intelligent objects2 Homes with intelligent objects that2. Homes with intelligent objects that

communicate 3 Connected homes

2. Homes with intelligent objects that communicate

3 Connected homes3. Connected homes4. Learning homes3. Connected homes4. Learning homes5. Attentive homes(Aldrich 2003)5. Attentive homes(Aldrich 2003)

Homes with intelligent objectsHomes with intelligent objectsHomes with intelligent objectsHomes with intelligent objectsCobolt talking alarm

Mybelle big button pictureSony universal remote control Mybelle big button picture

Homes with intelligent objects that Homes with intelligent objects that communicatecommunicate

SENIOR Pilot SICARE Light

SRS 100 SRS Lite

Connected homesConnected homesConnected homesConnected homes

Hillmount Close inHillmount Close inHillmount Close in BelfastHillmount Close in Belfast

Internal and external networks allowing interactive and remote control of systems as well as access

Internal and external networks allowing interactive and remote control of systems as well as access to services and information from within and beyond the hometo services and information from within and beyond the home

Learning homesLearning homesLearning homesLearning homes

Adaptive homeAdaptive homeAdaptive home ColoradoPatterns of activity in the homes

d d d h

Adaptive home ColoradoPatterns of activity in the homes

d d d hare recorded and the accumulated data are used to anticipate users needs and to control the environment

are recorded and the accumulated data are used to anticipate users needs and to control the environmentcontrol the environmentcontrol the environment

The Attentive HomeThe Attentive HomeThe Attentive HomeThe Attentive HomeThe aware home in C l dColorado

The activity and location yif people and Objects within the home is constantlyis constantlyRegistered and this information is used t t l t h l ito control technology in anticipation ofThe occupants needs.

Technology Continuum Technology Continuum Environmental AutomatedSocial Alarms Environmental

Control SystemsAutomated

Home EnvironmentSocial Alarms

Assistive Technologies

S h d i ll ?S h d i ll ?S h d i ll ?S h d i ll ?So what does it all mean?So what does it all mean?So what does it all mean?So what does it all mean?Smart homeSmart homeSmart homeSmart home

Context aware homeContext aware homeContext aware homeContext aware homeTelehealthTelehealth

TelemedicineTelemedicine

TelehealthTelehealth

TelemedicineTelemedicinePredictive homePredictive home

Ubiquitous homeUbiquitous home

Predictive homePredictive home

Ubiquitous homeUbiquitous home

TelemedicineTelemedicine

TelecareTelecare

TelemedicineTelemedicine

TelecareTelecareqq

Ambient home environmentAmbient home environment

qq

Ambient home environmentAmbient home environment Preventative technologyPreventative technologyPreventative technologyPreventative technology

Social alarmsSocial alarmsSocial alarmsSocial alarms

Different things to differentDifferent things to differentDifferent things to differentDifferent things to differentDifferent things to different Different things to different peoplepeople

Different things to different Different things to different peoplepeople

TechnologistsTechnologistsTechnologistsTechnologistsTechnologistsTechnologistsCommercial providersCommercial providersS i idS i id

TechnologistsTechnologistsCommercial providersCommercial providersS i idS i idService providersService providersService usersService usersService providersService providersService usersService users

Technology Technology

Can contribute to support people with dementia in the communityCan contribute to support people with dementia in the community

Individual levelService levelIndividual levelService level

Impacts onPerson (and families) receiving supportSt ff d li i

Impacts onPerson (and families) receiving supportSt ff d li iStaff delivering careOrganisationsSociety

Staff delivering careOrganisationsSocietySociety Society

So what about the evidence?So what about the evidence?

Is it ethical?Is it ethical?

Technology from my perspectiveTechnology from my perspectiveTechnology from my perspective is considered…

Technology from my perspective is considered…

An interventionAn intervention Developing devices and servicesDeveloping devices and services

With a purposeWith a purpose Support people at home and their carersSupport people at home and their carers

With a consequenceWith a consequence Greater independence, changed service

d l

Greater independence, changed service

d lmodel…..model…..

Technology with community careTechnology with community care

RationalePolitical

RationalePolitical

Service Complexity and heterogeneityService Complexity and heterogeneity

SocioculturalCommercialSocioculturalCommercial

Service usersDevice typeService usersDevice type

TechnologicalTechnological

T h l th f l b i d t lTechnology therefore can no longer be viewed as neutralWhen used within services.

Ethics defined…Ethics defined…

Constructed norms of internal consistency regarding what is right and what is wrong. It Constructed norms of internal consistency regarding what is right and what is wrong. It g g g gis more than what is considered to be ‘good’ (4)

g g g gis more than what is considered to be ‘good’ (4)

Standards of right and wrong, good and bad. What we ought to do to fulfill our moral Standards of right and wrong, good and bad. What we ought to do to fulfill our moral duty (5)duty (5)

Tavani 2007 “ … defines ethics as the study of morality” which he states is a system of

Tavani 2007 “ … defines ethics as the study of morality” which he states is a system of y yrules for guiding human conduct and

l ti

y yrules for guiding human conduct and

l tiprinciples for evaluating those rules” (6)principles for evaluating those rules” (6)

World views paradigms andWorld views paradigms andWorld views, paradigms and perspectives

World views, paradigms and perspectives

What influences your perspective on the smoking ban?

Duboy and Miley suggest we should make a distinction between microethics (linked

Duboy and Miley suggest we should make a distinction between microethics (linkeddistinction between microethics (linked

to individuals) and macroethics (linked

distinction between microethics (linked

to individuals) and macroethics (linked to social policy and organisational arrangements.to social policy and organisational arrangements.

Ethical theoriesEthical theoriesDentological theoriesDentological theoriesDentological theories

Interventions should be considered in relation to pre-existing duty based requirements within the given

i

Dentological theories Interventions should be considered in relation to pre-existing duty based requirements within the given

iscenario.Consequentialist theories

Suggest that reflecting on the consequences of the

scenario.Consequentialist theories

Suggest that reflecting on the consequences of theSuggest that reflecting on the consequences of the scenario should assist with decision making

Ethical egoism; an action is morally right if the overall consequences are favourable for the person carrying out the

Suggest that reflecting on the consequences of the scenario should assist with decision making

Ethical egoism; an action is morally right if the overall consequences are favourable for the person carrying out theconsequences are favourable for the person carrying out the actionEthical altruism considers the consequence for all except those carrying out the action

consequences are favourable for the person carrying out the actionEthical altruism considers the consequence for all except those carrying out the action

Principles established by thePrinciples established by thePrinciples established by the Astrid Project

Principles established by the Astrid Project

Autonomy: people should be able to decide whatthey want to happen or be done to themAutonomy: people should be able to decide whatthey want to happen or be done to themthey want to happen or be done to them.

Benificence: we should try to do good to the people we care for.

they want to happen or be done to them.

Benificence: we should try to do good to the people we care for.fNon-maleficence: we should try to avoid doing people harm

l h ld b d f l d ll

fNon-maleficence: we should try to avoid doing people harm

l h ld b d f l d llJustice: people should be treated fairly and equally.Justice: people should be treated fairly and equally.

Welcome to…Welcome to…

Your future and mineYour future and mine

So ethical issues could ariseSo ethical issues could arise

ControlIndependenceControlIndependenceIndependenceAutonomyS lf

IndependenceAutonomyS lfSelf governanceprivacySelf governanceprivacy

Developing an ethical frameworkDeveloping an ethical framework

Heterogeneity of provision requires framework to

Heterogeneity of provision requires framework toframework to acknowledge multi-agency partnerships

framework to acknowledge multi-agency partnerships g y p p(commercial providers etc)Ethi ll li k d

g y p p(commercial providers etc)Ethi ll li k dEthics generally linked to research and research governance

Ethics generally linked to research and research governancegg

Astrid project suggest 3 P ethicalAstrid project suggest 3 P ethicalAstrid project suggest 3 P ethical framework

Astrid project suggest 3 P ethical framework

Perspective - consider the views of all people involved in the proposed

Perspective - consider the views of all people involved in the proposed

Paradigms - as reference points Paradigms - as reference points involved in the proposed

action and the consequences of not taking the action.

involved in the proposed action and the consequences of not taking the action.

against which ethical issues can be clearer and the sol tion

against which ethical issues can be clearer and the sol tiontaking the action.

Principles;AutonomyB fi

taking the action.Principles;

AutonomyB fi

and the solution evaluated in terms of it appropriateness

and the solution evaluated in terms of it appropriatenessBeneficence

Non-maleficenceJustice

BeneficenceNon-maleficenceJustice

appropriateness(originally formulated by Tony Hope

1997)

appropriateness(originally formulated by Tony Hope

1997)

S l di th htS l di th htSome concluding thoughtsSome concluding thoughts

“ growing body of evidence that telecare services provide people with greater safety and security “ growing body of evidence that telecare services provide people with greater safety and security whilst maintaining independence for longer” (3)

Service innovations tend to report on consent to

whilst maintaining independence for longer” (3)

Service innovations tend to report on consent toService innovations tend to report on consent to participateService innovations tend to report on consent to participate

Opportunity to stimulate debate and innovate in this areaOpportunity to stimulate debate and innovate in this areathis area.this area.

Or what about Moors law 2005Or what about Moors law 2005

“As technological revolutions increase their social impact, ethical problems increase.”

“As technological revolutions increase their social impact, ethical problems increase.”p , p

Realistically take into account that ethics is an ongoing and dynamic enterprise.

p , pRealistically take into account that ethics is an ongoing and dynamic enterprise.g g y pMultidisciplinary collaboration (Technologists/ethicists/social scientists)

g g y pMultidisciplinary collaboration (Technologists/ethicists/social scientists)Better ethical theoriesMore proactive and less reactiveBetter ethical theoriesMore proactive and less reactivepp

Tend to get!Tend to get!

Different terminologyEthicsDifferent terminologyEthicsEthics PrivacyC

Ethics PrivacyCConsent Security Consent Security Legal issuesLegal issues

It all makes sense to meIt all makes sense to meIt all makes sense to meIt all makes sense to meIt all makes sense to me….It all makes sense to me….It all makes sense to me….It all makes sense to me….

Electronic Assistive Technology inElectronic Assistive Technology in Health and Social Care

Supported Independent Living Via Tailored Integrated

Services & Technologiesg

Big white elephantsBig white elephants

Millennium DomeMillennium Dome

ReferencesReferences1. Dementia UK. A report to the Alzheimer’s Society on the prevalence and economic cost of dementia in the UK.

Produced by the Kings College London and the London School of Economic. Available at http://www.alzheimers.org.uk/News_and_Campaigns/Campaigning/PDF/Dementia_UK_Full_Report.pdf . Accessed on 01.04.07

2. Joint improvement team. Telecare programme. Available at http://www.jitscotland.org.uk/action-/th /t l /i d ht l A d 04 10 07

1. Dementia UK. A report to the Alzheimer’s Society on the prevalence and economic cost of dementia in the UK. Produced by the Kings College London and the London School of Economic. Available at http://www.alzheimers.org.uk/News_and_Campaigns/Campaigning/PDF/Dementia_UK_Full_Report.pdf . Accessed on 01.04.07

2. Joint improvement team. Telecare programme. Available at http://www.jitscotland.org.uk/action-/th /t l /i d ht l A d 04 10 07areas/themes/telecare/index.html . Accessed on 04.10.07

3. Joint improvement team. Telecare development programme guidance and application for funding. Available at http://www.jitscotland.org.uk/action-areas/themes/telecare/index.html. Accessed on 04.10.

4. Dubois and Miley (1996) cited in Beckett C, Maynard A. Values and Ethics in Social Work. London England: Sage Publications. 2005.A i i f i A il bl

areas/themes/telecare/index.html . Accessed on 04.10.073. Joint improvement team. Telecare development programme guidance and application for funding. Available at

http://www.jitscotland.org.uk/action-areas/themes/telecare/index.html. Accessed on 04.10.4. Dubois and Miley (1996) cited in Beckett C, Maynard A. Values and Ethics in Social Work.

London England: Sage Publications. 2005.A i i f i A il bl5. Association of community trustees. Available at http://www.acct.org/CenterEffectiveGovernance.asp?bid=82 accessed on 05.10.07

6. Tavani, H. 2007. Ethic and technology.2nd edition. Wiley and Sons. USA7. Hughes J. Baldwin C. Ethical issues in dementia care. London England: Jessica Kingsley

Publishers. 2006.

5. Association of community trustees. Available at http://www.acct.org/CenterEffectiveGovernance.asp?bid=82 accessed on 05.10.07

6. Tavani, H. 2007. Ethic and technology.2nd edition. Wiley and Sons. USA7. Hughes J. Baldwin C. Ethical issues in dementia care. London England: Jessica Kingsley

Publishers. 2006.8. BjØrneby S. Topo P. Holthe T. Technology, Ethics and Dementia: A guidebook on how to apply

technology in dementia care, The Norwegian Centre for Dementia Research, INFO-Bank, Norway, (1999)

8. BjØrneby S. Topo P. Holthe T. Technology, Ethics and Dementia: A guidebook on how to apply technology in dementia care, The Norwegian Centre for Dementia Research, INFO-Bank, Norway, (1999)