Technology and Caregiving Technology and Caregiving Richard Schulz, Ph.D. Richard Schulz, Ph.D. University of Pittsburgh University of Pittsburgh Computer-Based Technology and Caregiving Computer-Based Technology and Caregiving for Older Adults, Spry National for Older Adults, Spry National Conference, October 3, 2003 Conference, October 3, 2003
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Technology and Caregiving Richard Schulz, Ph.D. University of Pittsburgh Computer-Based Technology and Caregiving for Older Adults, Spry National Conference,
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Technology and CaregivingTechnology and Caregiving
Richard Schulz, Ph.D.Richard Schulz, Ph.D.University of PittsburghUniversity of Pittsburgh
Computer-Based Technology and Caregiving for Computer-Based Technology and Caregiving for Older Adults, Spry National Conference, October Older Adults, Spry National Conference, October
How does it all fit together?How does it all fit together?
Some common themes—what Some common themes—what have we achieved, where do have we achieved, where do
we stand?we stand? The centrality of informationThe centrality of information A philosophy for the application of A philosophy for the application of
technology to health and well-beingtechnology to health and well-being Outcomes measurementOutcomes measurement Well-defined problems as starting Well-defined problems as starting
The Centrality of The Centrality of Information…Information…
Much of technology is focused on Much of technology is focused on Generating—sensory devices, telehealth Generating—sensory devices, telehealth
(Alwan)(Alwan) Collecting—Patient Safety Institute (Walker)Collecting—Patient Safety Institute (Walker) Organizing—Atlantic Regional Commission Organizing—Atlantic Regional Commission
(Schramm)(Schramm) Transmitting—Piers study (Aversano)Transmitting—Piers study (Aversano) Interpreting—(Aversano)Interpreting—(Aversano) Disseminating—(Schramm)Disseminating—(Schramm)
Philosophical approach…Philosophical approach…
Perlin—safety, quality, patient Perlin—safety, quality, patient centered, linkages and coordinationcentered, linkages and coordination
Cobb—importance of care coordinator—Cobb—importance of care coordinator—regulates information flow among patient, regulates information flow among patient, family, and health care providerfamily, and health care provider
Cantor—protecting privacy, who Cantor—protecting privacy, who control information about self and control information about self and othersothers
Irvine—tailoring and targetingIrvine—tailoring and targeting
Outcomes…Outcomes…
Survival (Aversano), Health (Lehman), Survival (Aversano), Health (Lehman), functioning…quality of life (VA)functioning…quality of life (VA)
Health care utilization (VA Examples, Health care utilization (VA Examples, Lehman)Lehman)
Cost analysis (Harrow, Whitten)Cost analysis (Harrow, Whitten) Patient/Provider satisfaction (Whitten)Patient/Provider satisfaction (Whitten) ““You see it, hear about it, want it “ You see it, hear about it, want it “
(Ackerman)(Ackerman)
Well-defined and Ill-defined Well-defined and Ill-defined problems…problems…
Older persons and “computers” (Cobb)Older persons and “computers” (Cobb) Utility trade-offsUtility trade-offs Next generation of older usersNext generation of older users
Provider Resistance-- (Whitten)Provider Resistance-- (Whitten) Learning curve problem (Whitten)Learning curve problem (Whitten) Changing definitions of Changing definitions of
Study designStudy design Sample size and compositionSample size and composition Statistical power and analytic methodsStatistical power and analytic methods Reliability and validity of key measuresReliability and validity of key measures Delivery assessmentDelivery assessment Role of technologyRole of technology Relative value/cost-effectivenessRelative value/cost-effectiveness
Conceptual issuesConceptual issues
How do you talk about technology across How do you talk about technology across studies, applications, studies, applications,
Develop taxonomy for characterizing Develop taxonomy for characterizing technology-based interventionstechnology-based interventions Whitten—type of information transmitted: data Whitten—type of information transmitted: data
only, video and audio, video/audio plus dataonly, video and audio, video/audio plus data
FunctionsFunctions and Features and FeaturesOn On demandemandd
Technology facilitates decisions/behaviorsWho is responsible for wrong decisions/actions?
Invasion of privacy “By entering this home you agree to be under surveillance”How much information do you want and how much are people willing to provide?
Variability in access and usability—enhance health disparities
Technology can undermine functioning, adaptive capacity by providing too much support
Feasibility and usability Training needs Factors that limit access Adaptability to individual
needs
Evaluating TechnologyEvaluating Technology
The pocketbook vote as The pocketbook vote as outcomeoutcome
Conflicting Stake HoldersConflicting Stake HoldersOlder personOlder personFamily memberFamily memberHealth care providerHealth care providerInsurerInsurer
The information processing problemThe information processing problem Capacity to generate vast amounts Capacity to generate vast amounts of information—poses profound data of information—poses profound data reduction interpretation challenges reduction interpretation challenges (the software problem)(the software problem)
Too much, Too much, ambiguous/inconsistent, and ambiguous/inconsistent, and unreliable informationunreliable informationRegulating information flowRegulating information flowData reduction needs will vary for Data reduction needs will vary for different userdifferent user
Potential for bad decisions, anxiety, Potential for bad decisions, anxiety, distress, guilt, or alternatively, a false distress, guilt, or alternatively, a false sense securitysense security
EndEnd
Caregiver InterventionsCaregiver Interventions
Education on disease and Education on disease and available resourcesavailable resources
Training in problem solving; Training in problem solving; behavior and emotion behavior and emotion managementmanagement
Counseling, case Counseling, case managementmanagement
Instrumental and emotional Instrumental and emotional supportsupport
Care Recipient: Disability, Problem Behaviors, Physical and
Social Environment
Appraisal of demands and adaptive capacities
Perceived Stress
Emotional/ Behavioral Response
Morbidity/Mortality
Stress-Health Process Intervention ComponentsIntervention Components
Pharmacologic Treatment,Environmental Changes
Social Support
Self Care, Preventive Health Practices
Communication
Skills Training
Education
Multi-component interventions and their impact on the stress-health process
Key Questions:Key Questions:
1. What types of technology have been What types of technology have been used in caregiving interventions and how used in caregiving interventions and how effective have they been?effective have they been?
2. What are the limitations of the existing 2. What are the limitations of the existing research in this area?research in this area?
3. What are the future opportunities for 3. What are the future opportunities for applications of technology to caregiving?applications of technology to caregiving?
Review MethodologyReview Methodology
Data base searches—Feb. to Aug., 2002Data base searches—Feb. to Aug., 2002 Medline 2966-2002Medline 2966-2002 PsychINFO 1967-2002PsychINFO 1967-2002 CancerLITCancerLIT 1975-20021975-2002 CinAHL 1982-2002CinAHL 1982-2002 Evidence-based databases 1991-2002Evidence-based databases 1991-2002
Cochran Controlled Trials Register, Cochrane Cochran Controlled Trials Register, Cochrane Database of Systematic Reviews, Database of Database of Systematic Reviews, Database of Abstracts of Reviews of EffectivenessAbstracts of Reviews of Effectiveness
Targeted journals: Journal of Telemedicine and Targeted journals: Journal of Telemedicine and Telecare, Telematics and InformaticsTelecare, Telematics and Informatics
outcomesoutcomes Used technology to deliver intervention to older Used technology to deliver intervention to older
caregiver and/or older adult/patient coping with caregiver and/or older adult/patient coping with chronic physical illness or aging-related issueschronic physical illness or aging-related issues
Exclusion CriteriaExclusion Criteria Used technology as adjunct to non-tech. interventionUsed technology as adjunct to non-tech. intervention Focused solely on personal assistive devicesFocused solely on personal assistive devices Technology incidental to intervention, not Technology incidental to intervention, not
differentiated by treatmentdifferentiated by treatment Focused on older residents in long-term care Focused on older residents in long-term care
facilitiesfacilities
Yield and CharacteristicsYield and Characteristics
26 papers found reporting results of 26 papers found reporting results of 22 non-overlapping studies22 non-overlapping studies
TelephoneTelephone 50%50% InternetInternet 14%14% Video/audio/computerVideo/audio/computer 9% 9% Various combinations including Various combinations including
infrared sensinginfrared sensing
Proximal goals of Proximal goals of interventionsinterventions
0
10
20
30
40
50
60
70
Knowledge SocialSupport
Access toExperts
DecisionSupport
Assessm./ Monitor.
AffectManagem.
Respite
Percent
Primary outcomes of studiesPrimary outcomes of studies
Improve physical or psychosocial Improve physical or psychosocial healthhealth Burden, depression, emotional and Burden, depression, emotional and
relationship strain, activity restrictionrelationship strain, activity restriction Usability and satisfactionUsability and satisfaction
Development of assessment Development of assessment methods/toolsmethods/tools
Current ApplicationsCurrent Applications
Low-level adaptations of common Low-level adaptations of common objects, such as tableware and objects, such as tableware and furniturefurniture
Social support, technical Social support, technical assistance, and respite provided assistance, and respite provided via telephone, videotape, and via telephone, videotape, and computerscomputers
Sophisticated monitoring of Sophisticated monitoring of activity, location, and physical activity, location, and physical status through telemetric status through telemetric approachesapproaches
Caregiving and technology—Caregiving and technology—Unique featuresUnique features
Information on demand – quickly, across long distances, and tailored to needs of individuals and groups
Increased access to health and social service professionals
Access to multiple delivery modes (e.g., visual and auditory)
Option of sender and/or receiver anonymity, facilitating the delivery of sensitive information