Using Preventive Gerontechnology Systems to Monitor Residents’ Behavior for Health Services During Emergencies Dr. Robert Roush, Baylor College of Medicine, Houston, TX Dr. Gloria Gutman, Simon Fraser University, Vancouver, BC 7 th World Conference of the International Society for Gerontechnology, Vancouver, BC May 28, 2010 This educational resource was developed, in part, with grants from the U.S. Health Resources and Services Administration – All rights reserved, 2010
Transcript
Using Preventive Gerontechnology Systems to Monitor Residents’
Behavior for Health Services During Emergencies
Dr. Robert Roush, Baylor College of Medicine, Houston, TX
Dr. Gloria Gutman, Simon Fraser University, Vancouver, BC
7th World Conference of the International Society for Gerontechnology, Vancouver, BC
May 28, 2010
This educational resource was developed, in part, with grants from the U.S. Health Resources and Services Administration – All rights reserved, 2010
September 11, 2001
Anthrax 2001
SARS 2003
Tsunami 2004
Bombings 2005
Hurricanes 2005
Avian Flu 2006
Swine Flu 2009
Earthquake & floods 2010
What’s next? ‘11
Is health care prepared? Are you?
Our Wonderful World Is Also a Dangerous Place
Global Aging
1.2 billion older people worldwide in 2025
70% will be in developing countries
1 million people turn 60 monthly worldwide now!
12,000 persons in the U.S. turn age 62 daily!
1st of 77 million U.S. boomers turn 65 in May 2011
Context and Perspective – GEPR
Older persons have altered levels of immune function
Higher risk of infectious illness and reduced response to antibiotics
Few health care workers have had adequate training in disaster planning
Even robust elders have a greater risk in natural disasters
We need all-hazards approach to geriatric emergency preparedness and response – GEPR
Technology can play an important role in mitigating effects of disasters
Need for disaster training Preparedness issues Diagnosing & treating older adults Bioterrorism and emerging infections Natural disasters, evacuation or shelter
in place Communications and technology Reverse alerts to PERS subscribers
Topics for This Program
Heat waves – France Extreme cold – England Floods – Manitoba and Nashville, TN Wild fires – Australia and California Tsunamis – S. Asia Earthquakes – Haiti Hurricanes – Katrina, Rita, Wilma, and Ike! Avian Influenza (H5N1), then Swine Flu (H1N1) Weaponized biological agents Your hometown Your family Your residents/patients
Need for Local Training in GEPR
<50% health care workers have had bioterrorism and emergency preparedness training, only 1 in 10 have had geriatrics-specific training
Health care workers, acute and LTC administrators, 1st responders & receivers, and ED staff need training in treatment and geroethics of triage, regardless of type of disaster – whether natural or human-caused
Need for National Training in GEPR
Need for International Training
GEPR – Geriatric Emergency Preparedness & Response issues are global …since 1995, heat waves, extreme cold, and floods in Europe plus earthquakes and weather-related disasters around the world have killed almost a million with over 2.5 billion people affected and costing $738 billion in US dollars .
Older people are always among those disproportionately affected.
The Public Health Agency of Canada’s Division of Aging and Seniors has started a global initiative on GEPR issues.
Canadian-led Initiatives in GEPR & PERS
1st meeting of International Work Group on Emergency Preparedness held in Washington, D.C., in 2005
Subsequent international conferences sponsored by the Public Health Agency of Canada/Division of Aging and Seniors held in Toronto, Winnipeg, Halifax, and Paris
Regular teleconferences of the IWG on EP
Research projects funded on GEPR tools used in LTC facilities and on use of PERS in disaster mitigation plans
Think “pre-event” preparedness Develop local relationships Education and training Communicate to our
patients/public– What is their risk?– What is being done to protect them?– How can I protect myself?– How can I protect my colleagues?– What else do we need to know?– Which technology can help?
RB McFee, 2004
Our Role in Emerging Threats
TodayThe Disaster Cycle
What is the threat? What are the vulnerabilities? What special geriatric preparedness issues
need to be addressed? What needs to be done? What can we do now?
– conduct community risk assessments– train, train, train– empower seniors– take preventive actions – use communications and technology
What You Need to Know and Can Do Regarding All Hazards
Understanding, Diagnosing, and Treating Older Adults
Health: access to services; appropriate food, water, sanitation; psychosocial needs
Family and social: separation, dependents, changes in social structure, loss of status
Economic and legal: income, information, documentation
Source: HelpAge International. 2001. “Older People in Disasters and Humanitarian Disasters: Guidelines for Best Practice.” Available online as a pdf file: http://www.reliefweb.int/library/documents/HelpAge_olderpeople.pdf
Emerging Infections: SARS in Toronto
M. Gordon, 2006
Outbreak of SARS, early March 2003: 1st case diagnosed March 13, peaked mid-March; resurgence early May with peak in mid-May; ended mid-June
March 28th Baycrest received a directive (Code Orange) to take SARS prevention measures
>15,000 persons underwent voluntary quarantine in greater Toronto area
44 deaths,100 health care workers infected, 3 deaths
Preparedness Issues
Today
Mitigation – identifying threats and resources, taking preventive actions
Preparedness – planning, training + exercises
Response – acting decisively with Incident Command structure
Recovery – getting back to normal, feeling safe again, analyzing response mode for next event
Key: How many health professionals have been trained for disasters where you live?
The Four Pillars of GEPR
Natural vs. Human-caused Disasters
Similar concerns for frail elders whose lives are disrupted by hurricanes, floods, wild fires, power outages
Could experience interruption of home care services if damage is widespread and large numbers of people are affected – i.e., their informal caregivers
Even robust elders are affected more than younger people in
times of natural disasters
Same concerns for making people feel safe again
Evacuation vs. shelter-in-place decisionsSource: Fernandez, LS, et al., Prehosp Disast Med 2002;17(2):67-74
Roles and Responsibilities: Pre-event Public Health Emergency
Public Health Disease surveillance Respond to outbreaks
• Investigation• Control and
prevention Laboratory support Participate in planning
activities Training Assess for
communications technology
Hospitals & Health Care Workers Disease reporting Immediately notify public health
of unusual group expressions of illness or outbreaks
State laboratory utilization Participate in planning activities Exercise plans Training Know where frail elders live and
what their special needs are
D. Lakey, 2004
Roles and Responsibilities:During a Public Health Emergency
Hospitals & Health Care Workers Implement notification protocols Activate staff Implement response plans/guidelines Coordinate efforts with public health Provide care Coordinate health-related information
– public health officials– citizens– media outlets– check on communications with elders
D. Lakey, 2004
Roles and Responsibilities: Post-Event Public Health Emergency
Public Health, Hospitals & Health Care Workers
Evaluate response Review after-action reports Coordinate/implement changes to plans and procedures Implement recovery plans Determine if communications technology worked
D. Lakey, 2004
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1st step – knowing where our frail elders are before, during, and after disaster
2nd step – training frontline health care providers on how older people present differently
3rd step – teaching all-hazards approach on physical, mental, and psycho-social issues
4th step – ensuring that providers know about culturally and linguistically appropriate communication strategies and services
5th step – making sure health care providers and older persons are involved in planning for such practical considerations as evacuations, shelters, and receiving emergency alerts
Overview of American Society on Aging Article in Healthcare and Aging
Communications and Resources
Challenges to Aging in Place
Gerontechnology can be used to assess well-being
Expensive “smart homes” to inexpensive devices
Activities of Daily Living Reporting Systems
e-ADLRS gather data on elders’ routine home activities
Wireless motion and light sensors upload data
Establishes baseline, looks for marked changes
Clients sent reports via website, e-mail or phone
Possible problems checked out sooner
Receiving reverse alerts from PERS in emergencies
PERS Helps Elders….
Live safer and more independently in their homes longer by:
Alerting caregivers to emerging problems, thereby reducing risks of hospitalization
Providing “circle of safety” via e-ADLRS integrating PERS & motion sensor monitoring + bi-directional communications 24/7
Recognizing and better understanding resident/patient condition
Facilitating eldercare agencies to fill gaps in coverage and direct care where most needed
Reducing anxiety of and burden on family caregivers
Mitigating effects of disasters
Indications for Smart Home Technology
What are the leading medical indications – CVD, frequent faller, recent hospitalization?
What are the main social indications – living alone, no informal caregivers nearby, can’t afford in-home help?
What criteria should be used in writing an environmental Rx for e-ADLRS monitoring?
Is the SmartHT bundled with a reverse-alert PERS?
Smart Home Technology for Telecare
Sensors Only required information leaves home
Local Intelligenc
e
Why PERS, e-ADLRS & GEPR?
Congregant care communities are where the density of elders at risk is far higher than among community dwelling elders
24/7 emergency response and motion-by- locus monitoring systems help mitigate risks of elders harmed in disasters when systems have bi-directional communications capability
Mitigation requires interoperability between caregivers, both at a distance and those on site
Funded Study on PERS in GEPR
DAS contracted with Sandra P. Hirst, RN, PhD, GNC(C), Director, Brenda Strafford Centre for Excellence in Gerontological Nursing, University of Calgary, for a 3-phase environmental scan to determine the state of PERS services used to mitigate harm to elders in disasters
1. Literature scan on general uses of technology in personal and large scale emergency settings to understand key technical and non- technical considerations and hence criteria for study’s assessment
2. Detailed survey of North American PERS providers, to understand product capabilities and variations in technologies, target clients, and patterns of communication
3. Contacted PERS providers to obtain company assessments of the actual and potential benefits of their systems in disaster settings
Assumptions of Study on PERS & GEPR
PERS system support in disasters settings would have these minimum capabilities:
Be able to reach all the targeted individuals Allow broadcast of specific messages to a targeted set of individuals Permit local authorities to provide messages for distribution
Putative benefits of PERS systems for disaster situations were these:
PERS have databases of client information, including medical information and chains of contacts for both caregivers or family and the entire caregiver network
PERS technology designed to accommodate older adults with special needs, e.g., large buttons, lights or audio accessories for those with hearing impairment
PERS technology is accessible to and accepted by older adults and communications/systems infrastructure is in place.
Results of Study on PERS & GEPR
SWOT analysis of 28 PERS companies revealed:
PERS communications systems are not generally designed for mass broadcast
PERS on-person alert devices are usually not designed for incoming notices
Geographic coverage is fragmented: a region may be covered by multiple PERS providers, resulting in even greater difficulty for local a authority to distribute messages
No existing channels for local authorities to communicate with PERS providers
Recommendations for PERS use in Disasters
Demographics Assess percentage of seniors using PERS to solicit response in personal medical emergencies and coverage of providers Plan for next generation of seniors or their caregivers who will be looking for PERS with such enhanced capabilities as wide-area coverage, global positioning Technical aspects How can current technologies such as GPS, and cellular voice & data services be packaged into simple, effective devices easily usable by seniors with a variety of age-related limitations? What data flows will be needed between PERS and other agencies so PERS can participate as fully as possible in an overall disaster management setting?
Non-technical aspects What information security, privacy, and regulation considerations are needed for private companies to play key roles in overall disaster management?
Center for Aging Services Technologies – CAST
CAST Members with Reverse Alert Capability
CAST director Majd Alwan, PhD, in a personal communication on May 14, 2010, stipulated that, to his knowledge, only two PERS companies have reverse alert capability <[email protected]>.
Touchtown’s e-Notify system was recently used to warn residents
of Holley Creek Retirement Community near Denver, CO, to take
appropriate action as they were in the path of a tornado.
Wellcore’s bi-directional communication capability converts text messages to voice, forwarding them to residents regarding up-coming events. While not used yet for disaster messages, the “on the go” feature uses GPS with compatible mobile phones to locate residents should they leave the facility for any reason. http://www.wellcore.com
Touchtown’s e-Notify System
Touchtown Command Center Showing Location of Unit Acknowledging “OK”
WHO Report, A Safer Future: Global Public Health Security in the 21st Century
http://who.int/whr/2007/en/index.html
Online Resources 2
Decision-making Criteria for Evacuation of Nursing Homes – http://www.fhca.org/emerprep/
evacsurvey.pdf
GAO Report on Evacuation of Hospitals and Nursing Homes Due to Hurricanes– http://www.gao.gov/
new.items/d06790t.pdf
Older people in disasters and humanitarian crises: Guidelines for Best Practice – http://www.helpage.org/
Resources/Manuals
Online Resources 3
Public Health Agency of Canada Pandemic Flu Plan http://www.phac-aspc.gc.ca/ep-mu/index.html U.S. Department of Health and Human Services: Disasters and Emergencies
http://www.hhs.gov/emergency
U.S. Centers for Disease Control and Prevention - Pandemic and Avian Flu www.pandemicflu.gov/
U.S. Agency for Healthcare Research and Quality: Disaster Response Tools and Resources
http://www.ahrq.gov/path/katrina.htm
U.S. Federal Emergency Management Agency – Metropolitan Management Resource Centers http://www.mmrs.fema.gov/
Baylor College of Medicine & American Medical Association – “Best Practices for Managing Elderly Disaster Victims”
http://www.bcm.edu/pdf/bestpractices.pdf
Online Resources 4
Summary
Healthcare workers must have mitigation training for all disasters, natural & human-caused HCWs need to have training for each vulnerable population – the young, the old, the disabled
HCWs need to remember that we’re always in the pre-event mode of the next disaster
GEPR planning & frequent exercises required
Need reverse alert capability via PERS
Smart Homes of the Future: Aging Trekkie Welcomes R2D2
