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).