EMRAN Seminar June 2015 - Technology and Ageing

transcript

‘Technology & Ageing – Hero or Villain?’

@EMRAN_ageing #EM_Ageing

24 June 2015 – University of Nottingham

Professor Dan Clark – Head of Clinical Engineering, Nottingham University Hospitals

Sian Clark – Assistive Technology Innovation & Operational Manager, M&A CCG

Dr Michael Craven – Senior Research Fellow, MindTech Healthcare Technology Cooperative

Professor Stephen Morgan – Professor of Biomedical Engineering, University of Nottingham

Technology in Healthcare

Professor Dan ClarkClinical Engineering

The future: doom and gloom?

Dammit, Jim: I'm a doctor not a technologist!

Clinical Engineering

Our Purpose

maximise the potential of

medical technology for the benefits of

patients, carers and clinicians

whilst minimising the risks

Scope of Services

Technology in Healthcare

…it depends on the technology?

Innovation Research and InnovationCentre for Healthcare EquipmentAnd Technology Adoption (CHEATA)Contact: Beth Beeson

beth.beeson@nuh.nhs.uk

ApplicationEngineering & InstrumentationStandards & ConsultancyProficiency & TrainingContact: Ged Dean

gerard.dean@nuh.nhs.uk

ManagementMedical Equipment PlanningMedical Equipment ServicesMedical Equipment LibraryContact: Paul Hills

paul.hills@nuh.nhs.uk

General ContactProf Dan ClarkHead of Clinical Engineering QMC CampusTel. +44 (0)115 970 9131 (int. x 61131)daniel.clark@nuh.nhs.uk

Thank You

S I A N C L A R K – F L O P R O J E C T N O T T I N G H A M S H I R EA SS I S T I V E T E C H N O L O G Y I N N O VAT I O N A N D O P E R AT I O N A L M A N A G E R ( N AT T )

Real World Experiences of Technology and Older People (FLO project)

50% of people born

in 2007 will live to 103. More than 20 million aged over 60 by 2030

28% of total population aged over 60 by 2030

Barbara Beskind aged 91

“Embrace change and design for it”

simple & instinctive, helping patients to help themselves

Readings & answers

Opt-in/out,

prompts, questions, feedback,

advice,education

all my teams

patients mobile or

landline phone +Tell

Flo app

Alerts if needed

Closed loop

£ free to txt/call

So You can’t teach an old dog new tricks!........or can you?

Oldest patient

using Flo is x

Years of Age? Any

guesses?Patient 81 with COPD learns to text in 8 weeks

Over 2000 patients enrolled on Flo Age range (6 – 98

years since November 2012 across Nottinghamshire).

Mainstreamed service since April 2015 (no longer a

project).

Care Home Resident learns to manage Blood Pressure

MYTH BUSTING – OUR FLO PATIENT FEEDBACK

Recent evaluation nearly all respondents felt that using Flo was making a difference to their health

(96%), is helping them manage their own health better (82%) and reduces the frequency with which

they need to see their GP (83%). Also they report back that they find Flo convenient to use and do not

dislike lack of human contact. Flo does not take away clinician but increases monitoring and

support.

Isolation – ×Willingness to learn from both Clinicians and

Patients- √Carers need support - √Clear benefits to learn new skills - √Ease of use - large button phones- √

You can create Technology enabled care services….designed by and for older patients

Thank You for listening

Technology and dementia

Michael Craven 24th June 2015

MindTech HealthcareTechnology Co-operative

NIHR Healthcare Technology Co-operatives (HTCs)

Nottingham: Mental Health

Sheffield: Devices for Dignity

Cambridge: Brain Injury

Barts: Gastrointestinal Disease

Guys: Cardiovascular Disease

Leeds: Colorectal Therapies

Bradford: Wound Prevention & Treatment

Birmingham: Trauma Management

4 main clinical themes• Neurodevelopmental• Mood disorders• Dementia• Young people/paediatrics

• 8 national centres addressing different areas of unmet need • Established 2013• Focussed on technological innovation, evaluation, adoption in NHS

Technology and dementiaContents• General issues• How can technology help?• General issues e.g. Quality of Life • Examples and categorisations

Brief note about MindTech’s projects• Connecting Assistive Solutions to Aspirations (CASA – Innovate UK

SBRI grant)• Knowledge-based User-adapted Person-centred Activity service

(KuPA – Norwegian Research Council grant)www.mindtech.org.uk

Dementia and technologyPoints to thing about:• Continuum between good design & technology for older people

(and society) in general and those with dementia• What is specific to dementia? • Not everyone with dementia is the same!• Pathway from mild cognitive impairment (MCI) to severe

dementia, so needs changes over time• ‘Working age dementia’ – younger cohort of people with different

histories of tech usage and often living with younger families• User acceptance and ethical perspectives of technology choices

How dementia interferes with daily life

• Memory – forget appointments, lose things• Language

– expressive – findings words, names– receptive – harder to understand what’s said

• Praxis – difficulty with daily tasks e.g. dressing• Thinking & judgement, e.g. planning• Alertness & motivation – can lead to apathy• Altered mood and behaviour

Areas of need

Particular areas / unmet needs where technology may help:

• encouraging daytime activity• maintaining hobbies, interests, exercise• company• continence• personal care• biofeedback including mood stateothers...

Quality of life issues

• Increased societal expectations for QoL - ‘living well with dementia’ • QoL not directly associated with cognitive function - though some

cognitive interventions do affect QoL • Depression most consistently associated with QoL – but often

neglected• Hope is an attitude most associated with QoL • Importance of quality of relationships with carers, staff attitudes,

family involvement• Avoidance of antipsychotic medication

Classifications of technology• 1st generation telecare: alarms, pull cords

• 2nd generation: memory aids, other forms of telecare

• 3rd generation: communication, smartphones, apps

• technology that people with dementia use themselves (by them) satnav, mobile phones

• that which is used with them electronic calendars, bulletin board, reminiscence therapy

• that is used on them sensors, alarms, hoists

after Gibson et al (2014) Dementia, doi: 10.1177/1471301214532643

Classifications cont.• Technologies specifically

designed for people with cognitive impairment

e.g medication reminder

• Everyday technologies which lend themselves well to people with cognitive difficulties

e.g. voice recorder

• Applications where the technology is the thing

e.g. iPads, robots

• Applications supported by technology, where the tech is invisible or in the background

e.g. sensors. Also includes services, including integration of health and other records

Memory technologies

• reminder messages • clocks and calendars • medication aids• locator devices (for ‘lost’ objects)• aids for reminiscence and leisure

Telecare technologies

• ‘Smart home’ sensors– Floods – Extreme temperature – Gas

• Location– Absence from bed/chair– Getting up in the night – Leaving the home

• Falls• Physiological sensors

Communication technologies• Video links• ‘Robots’• Phone/tablet apps• Home hubs

Company & petsParo the Seal http://www.parorobots.com/index.asp

• Molly http://www.brl.ac.uk/

Giraff http://www.remodem.eu/project/products-and-services/remote-support.aspx

• JustoCats http://www.blue-ocean-robotics.com

Altered worlds

• Hogeweyk (Netherlands)http://hogeweyk.dementiavillage.com/en/

• AVED (Applied Virtual Environment for Dementia Care) http://www.digitaldownunder.org/2014/10/building-a-virtual-world-for-dementia-care-article/

Entertainment & digital arts

1. Television and its potential– Post reminders– Personal DVDs, run favourite films etc.– Skype/video calling on Smart TV– Observable behaviour via camera in Smart TVCaveats:– May need simplified remote controls – Most people doze or watch blank screen (de Medeiros et

al, 2009)

Entertainment & digital arts 2

2. iPads and other hand-held devices– massive potential– younger PwD more likely to have familiarity– any App you can think of– good potential for creative arts but in practice usually

needs 1:1 supervision3. Personalised music

– e.g. Soundtrack to My Life (Music Works)

New applications for existing kit

• can we use sensors for early diagnosis or tracking change?– certain behaviours will change with incipient dementia, e.g.

using kitchen; going out; food choices– behaviour change could trigger suggestions e.g. about seeing GP– however, variability of day-to-day behaviour, lack of specificity– ??acceptability to older person, ethics

• use of intelligent lighting to support ADL– e.g. sequencing of lighting could guide tasks such as shaving,

cleaning teeth etc.

Choice & autonomy

• spectrum of choice• at one end: can make own choice; go to shop or buy

online; ask family & friends• at the other, severe dementia: any tech will be

chosen and provided for you• dementia journey takes us from one end to the

other; therefore, intermediate scenarios exist, where more help, advice, suggestions or initiative from others is needed

• traditionally, focus is on care needs:– ADL, physiological needs, safety– often driven by issues of perceived risk– carer and professional perspectives outweigh those of

person with dementia – aspirations (self actualisation)

are also needs• therefore need to set our goals higher than mere containment• choice & autonomy!!

Aspirations and needs

The market: improving access• huge ‘assistive technology’ industry already (£150m ??)• lots of devices on market, with little or no evaluation• tends to be product-led, not needs-led, i.e. dominated by

devices – this ought to change• how to ensure uptake of appropriate technology and equity of

access• web based resources, e.g. www.atdementia.org.uk/• attention to funding solutions, e.g. subscription, equity

release etc.

Conclusions• Aim above the immediate horizons

– aspirations, not just basic needs• Lots of products, it’s how they get used that matters • Research needs to look at acceptability and benefits for pwd• Moving from product-led to service-led economy

– by analogy with home broadband, mobile phones etc.– it’s the service not the device

• For dementia: choice, autonomy, design, inclusion & participation are really important!

• Use co-design and involve real people

Thankswww.mindtech.org.uk

Michael Craven 24th June 2015

TiPoFFTechnology in the Prevention of Falls and Fractures

Stephen P Morgan

S Korposh, S Sun, BR Hayes-Gill, S McMaster, D He, L Liu, C Teo

D Clark, R Morris, T Masud (NUH)

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Falls are the dominant cause of injuries among older people and account for approximately one-third of fatal injuries … Falls can often lead to long-term physical disability (e.g. loss of mobility), severe dependency and reduction in quality of life*

UK national cost is ~£2.33 billion per year and in the US it is ~$30 billion.

Can technology play a role in fall prevention and detection in hospitals and home?

*EIP-AHA Action Group A2 – Fall prevention Action Plan 2012-2015 ec.europa.eu/research/innovation-union/

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Quite a lot of work on fall detection using wearable devices and video cameras

Some work at Nottingham on healthy young volunteers

Video tracking, recognising movement and shape of person

PLAY VIDEO 1

file:///C:/Users/eezspm/Desktop/emran/Falling.swf

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Easy to recognise standing, sitting, lying – just measure aspect ratio of rectangle drawn around person

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Measuring rate of change of aspect ratio can help distinguish falls and normal activity(these are extreme cases though!)

Cameras in hospital wards and at home may be obtrusiveCould wearable sensors detecting motion and heart rate play a role?Motion to detect fall and activity in daily lifeHeart rate to predict a fall in the medium term

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a) Walking b) standing still c & e) change sit d) sitting f) fall g) lying h&i) change lying

5 10 15 20 25 30 35 40 45 500

Time (s)

Resultant Acceleration data

(E)(G)

(H) (I)

• Tight fitting strap may not be comfortable in daily life

• More comfortable to place sensors in clothing

• Integrate plastic optical fibres into textiles during knitting process

• Can measure pressure under the foot (gait & activity)

Photonic textiles

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• implement in hospital wards in NUH

• Test in home environment

• (funding dependent)

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Video cameras – potential privacy issues?

Wearable sensors – will tight fitting straps be worn?

Textiles – better?

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