10‐09‐2017 1 Digital health and nutrition support services for the elderly. Mikkelsen, BE, Professor of Nutrition & Public Food systems, Aalborg University 10th International Forum of "Premium Healthcare“, 3rd Forum of Regional Collaborative Committee of International Medicine. "the Belt and Road initiative" China ‐Nordic Countries International Healthcare Summit. September 21‐22, 2017 Shanghai Abstract: Providing nutritional support to elderly and patients at nutritional risk is of high importance. Taking advantage of digital tools have shown promising results. This paper reports on the insights from the The eNutrition program run by Aalborg University, Aalborg University Hospital and Aalborg Municipality. The program aims at creating seamless interfaces between digital tools used for meal ordering and nutritional monitoring of food intake among elderly in transit between private home, nursing home and hospital. The presentation reports on validation and feasibility studies carried out in the program and uses the DIMS and Nutridia as cases. The DIMS is a Dietary Intake Monitoring System and the Nutridia is a mobile application for patients with reduced appetite. The presentation will finally touch upon emerging technologies including the Food & Go technology and the Cooking down Memory Lane application. It will finally discuss some of the requirements for seamless integration across different digital nutrition support technologies. The digital nutrition lab FoodScape Lab & Aalborg University Nutrition center Digitalisation & nutrition • Devices such as smartphones touch pads, etc. are increasingly used by consumers for self‐tracking of lifestyle and the number of research studies applying such devices is growing (see for example: Jia et al 2011; Moulos et al 2015). • New wearable devices that can objectively assess behaviours (Jia et al 2012, Jia et al 2013, Sun et al 2014) have been developed • Signals such as biosignals, GPS, mobile positioning, Wi‐Fi and Bluetooth are examples of signals and protocols that offer new potentials. Digitalisation & nutrition facts & figures DK/Nordics • Between 82% and 92% of the population use mobile ICT devices daily. • 89 % of Danish consumers own a mobile phone/smart phone • 88 % of Danes carry out digital self‐service • 88% of Danes do e‐Shopping • 22 % of internet users between 16 and 74 are skeptical about IT security • Penetration of wearables and according to Statista ‐ the sale of smart watches has risen by 141 percent in recent years* • 52 % of information workers across 17 countries report using + 3 three devices for work ** Statistics Denmark, http://www.dst.dk/da/Statistik/Publikationer/VisPub?cid=019373 * Statista, Nordics ** https://blogs.business.microsoft.com/en‐us/2016/02/16/employee‐devices‐bring‐added‐security‐concerns/ Two potentials in digitalisation •Monitoring •Assisting
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10‐09‐2017
1
Digital health and nutritionsupport services for the elderly.
Mikkelsen, BE, Professor of Nutrition & Public Food systems, Aalborg University
10th International Forum of "Premium Healthcare“, 3rd Forum of Regional Collaborative Committee of International Medicine. "the Belt and Road initiative" China ‐Nordic Countries International
Healthcare Summit. September 21‐22, 2017 Shanghai
Abstract: Providing nutritional support to elderly and patients at nutritional risk is of high importance. Taking advantage of digital tools have shown promising results. This paper reportson the insights from the The eNutrition program run by Aalborg University, Aalborg University Hospital and Aalborg Municipality. The program aims at creating seamless interfaces between digital tools used for meal ordering and nutritional monitoring of food intake among elderly in transit between private home, nursing home and hospital. The presentationreports on validation and feasibility studies carried out in the program and uses the DIMS and Nutridia as cases. The DIMS is a Dietary Intake Monitoring System and the Nutridia is a mobile application for patients with reduced appetite. The presentation will finally touch upon emerging technologies including the Food & Go technology and the Cooking downMemory Lane application. It will finally discuss some of the requirements for seamless integration across different digital nutrition support technologies.
The digital nutrition labFoodScape Lab & Aalborg University Nutrition center
Digitalisation & nutrition
• Devices such as smartphones touch pads, etc. are increasingly used by consumers for self‐tracking of lifestyle and the number of research studies applying such devices is growing (see for example: Jia et al 2011; Moulos et al 2015).
• New wearable devices that can objectively assess behaviours (Jia et al 2012, Jia et al 2013, Sun et al 2014) have been developed
• Signals such as biosignals, GPS, mobile positioning, Wi‐Fi and Bluetooth are examples of signals and protocols that offer new potentials.
Digitalisation & nutritionfacts & figures DK/Nordics• Between 82% and 92% of the population use mobile ICT devices daily.
• 89 % of Danish consumers own a mobile phone/smart phone• 88 % of Danes carry out digital self‐service• 88% of Danes do e‐Shopping• 22 % of internet users between 16 and 74 are skeptical about IT security
• Penetration of wearables and according to Statista ‐ the sale of smart watches has risen by 141 percent in recent years*
• 52 % of information workers across 17 countries report using + 3 three devices for work**
Nutritional monitoring – howAccording to the NRS*2002
• Screen all at admission
•Make actions and follow up plans for the 30‐40% at risk
•Monitor daily
•Keep records•Allow for retrospective evaluation
*Nutritional Risk Screening tool Gemming, et al., Eur J Clin Nutr (2013) 67, 1095‐1099: Arab et al., Eur J Clin Nutr, 2011, 65(10):1156‐1162,
So, how does it work? While the company chalks it up to “magic”, we’re assuming they’ve got a handful of people (be it through Amazon’s Mechanical Turk, or a room full of dudes promised free Internet in exchange for calorie counting) breaking down the meal in your picture item by item. Snap a shot of a chicken salad? They punch in some chicken, some lettuce, maybe some dressing — and bam, they’ve got a rough estimate.Is it a precise science? Hardly. Even in the screenshot above, you can see that there are some pretty wild variations. A “Small handful of cashews”, for example, comes back as being anywhere from 150 to 614 calories. Still, having some idea of what you’re taking in is still far better than not having any idea at all.You can find MealSnap on the App Store for $2.99 right here [iTunes link].
SenseCam & Meal Snap
Source: Faustaina Hwang: Measuring Food Intake of Older Adults at Home Presentation to Training Course on ICT Assisted Methods for Measuring Diet & Behaviour in Complex Foodscapes, Aalborg University, 24 August 2015
NANA: Novel Assessment of Nutrition and Ageing
eButton: A Wearable Computer for Evaluation of Diet, Physical Activityand Lifestyle. Wenyan Jia, Presentation to Training Course on ICT Assisted Methods for Measuring Diet & Behaviour in Complex Foodscapes, Aalborg University, 24 August 2015
eButton
Video camera: looking at food and PAGPS: positioning the individual3‐axis accelerometer – estimating motion 3‐axis gyroscope: measuring body orientationUV sensor – distinguishing indoor/outdoorBarometer: determining body position/floor level
New imaging technologies for foodidentification
Other systems• ASA24 – Automated Self Administered 24hdr
• TADA: Technical Assisted DietaryAssessment
•Diet Data Recorder System (DDRS)•Smart Plate•Smart Fork•TelSpec
New technology in dietary assessment: A review of digital methods in improving food record accuracy, Stumbo, P, Proceedings of The Nutrition Society 02/2013; 72(1):70‐6
http://www.tadaproject.org/
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From DIMS1.0 to 1.5
Ofei, K. T., Holst, M., Rasmussen, H. H. & Mikkelsen, BE Effect of meal portion size choice on plate waste generation among patients’ with different nutritional status – An investigation using Dietary Intake Monitoring System (DIMS). Appetite, 2015
DIMS ver 2.0on the go design
Can the DIMS approach be learnt?Training course at Fudan, Shanghai, 2016
Is the DIMS robust in practice?The Herlev stress test
Input modeOutput mode
DIMS ver. 2.5
Weight Energy Protein Carboneqv
Price
grammes kcal Grammes Grammes DKK
Pre‐serve
Post‐serve
Intake
Waste
Is the DIMS saving time?The Aalborg feasbility study
•Reduces the time spent on NM from 15 to 4 minuttes
•Patients at nutritional risk produced increased amounts of plate waste, with less energy & protein intake when compared to patients not at nutritional risk.
• It can be used in co‐creation mode improvingaccuracy
Ofei, K. T., Holst, M., Rasmussen, H. H. & Mikkelsen, BE Effect of meal portion size choice on plate waste generation among patients’ with different nutritional status –An investigation using Dietary Intake Monitoring System (DIMS). Appetite, 2015
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Is the DIMS accurate?Validation Study 1: Herlev HospitalIntervention:
• Front End Nutrition & Meal support
• Meal hosting
Results:
• No significance pre‐ og post test• DIMS functions well with a trained operator
• Meal hosting requires training
Ofei, K.T¹, Andersen, T² and Mikkelsen, B.E³. Measuring effect of Changes in Meal Service at hospital using digital technology – case insights from the Dietary Intake Monitoring System study
Acknowledgement: catering manager Michael Allerup Nielsen
Is the DIMS accurate?Validation 2: Odense University Hospital• Hypothesis• High correlation between DIMS data and standard weighed method
• Results:• Correlation: DIMS total energy/standard total energy (r= 0.990 and p value = 0.01)
• Correlation: DIMS total protein/standard total protein (r= 0.974 and p‐value=0.01)
Acknowledgements: Dr. Rudolf Albert Scheller, GeriatricDept G, Odense
Ofie. KO, ul Ain, Q, Sceheller, R & Mikkelsen, BE: Validation of a novel image‐weighed technique for monitoring food intake and estimation of portion size in hospital settings. Submission Public Health Nutrtition. Sept 2017
NSR 2002 risk screeningNSR 2002 risk screening
DankostMenuplanning
DankostMenuplanning
MasterCaterMenuplanningMasterCaterMenuplanning
Food’n Go Meal BookingFood’n Go Meal Booking
* Der benyttes LCA food og LT/DTU Man regneark samtSimaPro simulering (menuplans‐ og opskriftssimulering* Der benyttes LCA food og LT/DTU Man regneark samtSimaPro simulering (menuplans‐ og opskriftssimulering