Assessing technology needs for the elderly: finding the perfect match for home

Robots for Elderly Care: Review, Multi-Criteria Optimization Model and Qualitative Case Study

This paper focuses on three areas: the first is a review of current knowledge about social and service robots for elderly care. The second is an optimization conceptual model aimed at maximizing the efficiency of assigning robots to serve the elderly. The proposed multi-criteria optimization model is the first one proposed in the area of optimization for robot assignment for the elderly with robot utilization level and caregiver stress level. The third is the findings of studies on the needs, requirements, and adoption of technology in elderly care. We consider the use of robots as a part of the ENRICHME project for long-term interaction and monitoring of older persons with mild cognitive impairment, to optimize their independence. Additionally, we performed focus group discussions (FGD) to collect opinions about robot-related requirements of the elderly and their caregivers. Four FDGs of six persons were organized: two comprising older adults, and two of the other formal and informal caregivers, based on a detailed script. The statements of older participants and their caregivers were consistent in several areas. The analysis revealed user characteristics, robot-related issues, functionality, and barriers to overcome before the deployment of the robot. An introduction of the robot must be thoroughly planned, include comprehensive pre-training, and take the ethical and practical issues into account. The involvement of future users in the customization of the robot is essential.

UNRAQ-A Questionnaire for the Use of a Social Robot in Care for Older Persons. A Multi-Stakeholder Study and Psychometric Properties

(1) Background: while there exist validated measures to assess the needs of older people, there are comparatively few validated tools to assess needs and requirements for the use of robots. Henceforth, the aim of the study is to present and validate such a tool. (2) Methods: The study group included 720 subjects (mean age 52.0 ± 37.0, 541 females) who agreed to fill the Users' Needs, Requirements, and Abilities Questionnaire (UNRAQ). The validation part of the study included 125 persons. (3) Results: the acceptance of the robot was good in the whole group. The social functions were rated worse than assistive ones. A correlation was found between the scores of social and assistive functions. The respondents claimed that older adults were not prepared to interact with the robot and not very good at handling it, and were sceptical about their willingness to learn to operate the robot. The Cronbach alpha value for the whole questionnaire was 0.95 suggesting excellent internal consistency, and the ICC value of 0.88 represents excellent agreement; (4) Conclusions: We observed a good overall acceptance of the robot across the studied group. There is considerable demand for the use of a social robot in care for older people.

Challenges for Service Robots-Requirements of Elderly Adults with Cognitive Impairments

OBJECTIVE

We focused on identifying the requirements and needs of people suffering from Alzheimer disease and early dementia stages with relation to robotic assistants.

METHODS

Based on focus groups performed in two centers (Poland and Spain), we created surveys for medical staff, patients, and caregivers, including: functional requirements; human-robot interaction, the design of the robotic assistant and user acceptance aspects. Using Likert scale and analysis made on the basis of the frequency of survey responses, we identified users' needs as high, medium, and low priority.

RESULTS

We gathered 264 completed surveys (100 from medical staff, 81 from caregivers, and 83 from potential users). Most of the respondents, almost at the same level in each of the three groups, accept robotic assistants and their support in everyday life. High level priority functional requirements were related to reacting in emergency situations (calling for help, detecting/removing obstacles) and to reminding about medication intake, about boiling water, turning off the gas and lights (almost 60% of answers). With reference to human-robot interaction, high priority was given to voice operated system and the capability of robotic assistants to reply to simple questions.

CONCLUSION

Our results help in achieving better understanding of the needs of patients with cognitive impairments during home tasks in everyday life. This way of conducting the research, with considerations for the interests of three stakeholder groups in two autonomic centers with proven experience regarding the needs of our patient groups, highlights the importance of obtained results.

Care Coordination/Home-Telehealth for Veterans with Stroke and Their Caregivers: Addressing an Unmet Need

BACKGROUND

Stroke is a life-disrupting, costly event for many stroke patients and their families. An estimated 4.8 million stroke survivors are living in the community with some level of disability, and the incidence of stroke is expected to rise with correspondingly higher costs, both in dollars and other forms of burden for families of patients with stroke. Approximately 80,000 veterans have experienced a stroke, leaving approximately 40% with moderate residual impairments and 15%-30% with severe residual disability.

PURPOSE

The purpose of this study was to identify postdischarge needs of veterans with stroke and their caregivers and to identify how to design a care coordination/home-telehealth (CC/HT) program to address these needs.

METHOD

Veterans and their caregivers (N = 22) were interviewed about their experiences with stroke, their postdischarge stroke recovery needs, and their experiences with the Veterans Administration's existing Care Coordination/Home-Telehealth (CC/HT) program. Data were analyzed using the process of grounded dimensional analysis.

RESULTS

Core concepts identified were (a) assessing and managing the residual effects of stroke, and (b) shifting roles and responsibilities.

CONCLUSION

The findings suggest that a comprehensive care coordination program that includes home telehealth could aid veterans and their caregivers in managing stroke recovery across the continuum of care at home and within the community. The results of the study can provide elements to be included in the CC/HT program.

Health information technologies in geriatrics and gerontology: a mixed systematic review

OBJECTIVE

To review, categorize, and synthesize findings from the literature about the application of health information technologies in geriatrics and gerontology (GGHIT).

MATERIALS AND METHODS

This mixed-method systematic review is based on a comprehensive search of Medline, Embase, PsychInfo and ABI/Inform Global. Study selection and coding were performed independently by two researchers and were followed by a narrative synthesis. To move beyond a simple description of the technologies, we employed and adapted the diffusion of innovation theory (DOI).

RESULTS

112 papers were included. Analysis revealed five main types of GGHIT: (1) telecare technologies (representing half of the studies); (2) electronic health records; (3) decision support systems; (4) web-based packages for patients and/or family caregivers; and (5) assistive information technologies. On aggregate, the most consistent finding proves to be the positive outcomes of GGHIT in terms of clinical processes. Although less frequently studied, positive impacts were found on patients' health, productivity, efficiency and costs, clinicians' satisfaction, patients' satisfaction and patients' empowerment.

DISCUSSION

Further efforts should focus on improving the characteristics of such technologies in terms of compatibility and simplicity. Implementation strategies also should be improved as trialability and observability are insufficient.

CONCLUSIONS

Our results will help organizations in making decisions regarding the choice, planning and diffusion of GGHIT implemented for the care of older adults.

Advocacy of home telehealth care among consumers with chronic conditions

AIMS AND OBJECTIVES

To describe use of home telehealth care as an alternative for chronic disease management from users' perspective.

BACKGROUND

As the population ages, telehealth is increasingly being used to tackle problems related to the fast growing ageing population. Home telehealth care therefore poses challenges and offers opportunities for patients and healthcare providers.

DESIGN

A qualitative approach was adopted with a purposeful sample of 20 patients residing in Taiwan.

METHOD

Patients who had received the service for three months and were willing to share their experiences were recruited. Data were collected by face-to-face interviews with semi-structured interview guideline (n = 8) and a focus group discussion (n = 12) in 2010. A qualitative content analysis was used.

RESULTS

Four key themes were identified: perceived support and security, enhanced disease self-management, concerned with using the devices and worries about the cost by patients. Most users favoured using the service to control their chronic conditions because of its convenience and accessibility, and their condition could be measured daily to enhance their sense of security. Users could determine and understand changes in their condition and improve medical regimen compliance, and they were empowered to revise their lifestyles for better disease self-management. However, users were concerned about the utility of the service, because they were unfamiliar with the operating procedures and doubted its quality. As the service is still in stage of pilot testing, users worried about possible cost and reimbursement policy changes in the future.

CONCLUSION

Most users perceived telehealth care was a convenient and useful model for healthcare-delivery. It increased the availability of health care and improved the self-care ability of patients.

RELEVANCE TO CLINICAL PRACTICE

To advocate for home telehealth care, nurses must play an active role in providing consumers with proper training and support for any problems when adopting the system to foster patients' willingness to use this service.

An intelligent videomonitoring system for fall detection at home: perceptions of elderly people

We explored the perception and receptivity of elderly people regarding the introduction of an intelligent videomonitoring system (IVS) at home. Using a mixed methods design, 25 elderly people with a history of falls completed a structured interview (two questionnaires). In the year preceding the interview, 72% of the participants fell as many as seven times. Open-ended questions (qualitative data) were used to supplement the quantitative data. A content analysis (qualitative data) and a descriptive analysis (quantitative data) were carried out. The participants were 84% favourable or partially favourable to technologies which ensured home security and 96% favourable or partially favourable to the IVS. About half (48%) said that they would use it. The other participants did not wish to use it unless they had been left to live alone or if their health condition worsened. Thus the living conditions of the elderly appear to influence their perception and receptivity regarding the acceptance and use of an IVS.

Using telehealth to educate Parkinson's disease patients about complicated medication regimens

Parkinson's disease (PD) primarily affects older adults, who manage their symptoms with complex medicine regimens. This mixed-methods study evaluated the usefulness and usability of follow-up telehealth medication counseling with a sample of community-based PD patients. Patients taking three or more medications for Parkinson's disease were randomly assigned to the teaching modalities of videophone or telephone. A self-care standardized medication educational session lasting 20 to 30 minutes was conducted, and patient and nurse usefulness of the intervention was evaluated by responses to a 15-question Likert scale and elicited comments. Patients' satisfaction with the intervention involved patterns of time, education, and technology. Videophone users were more satisfied with the equipment and counseling. Videophones were considered easy access to supportive, expert neuroscience nurses. Overall, videophone counseling sessions were significantly more useful than the telephone sessions (t[34] = 0.896, p = 0.004, 95% confidence interval = 1.90 to 3.12). Nurses found visualization via videophone significantly more useful for medication and self-management interactions.

Videoconferencing for a Veteran’s Pain Management Follow-Up Clinic

The under treatment of pain has been well documented. Contributing to this is the limited availability of pain management specialists in many geographic areas. The use of technology to provide care to underserved areas is gaining momentum. We chose to study whether stable patients and staff in chronic pain clinic were satified with the use of a videoconferencing format in care delivery. Our goals were to determine whether patients and staff could successfully operate the extant videoconferencing equipment, was the equipment dependably functional, was the use of a videoconferencing format an acceptable method of healthcare delivery for both patients and staff, whether patients and staff were satisfied with the process, and whether this was a cost-effective mode of care delivery. Thirty-six patients were enrolled over 29 months. Questionnaires were administered to staff and patients. Routine pain clinic patient assessment tools were administered. Results showed the use of videoconferencing for this group of patients is useable and satisfactory for both patients and staff, that the patients save time and money, and that for a system where videoconferencing equipment is already in use, it is also cost effective. Staff were able to identify new patient problems. Some patients would prefer to be seen in person but find that the savings in time and money override this preference. Hearing impaired patients have difficulty using this medium. Dependable equipment and phone connections are needed. A videoconferencing clinic format is a clinically acceptable and cost effective method for follow-up of stable patients with chronic pain.

Interventions for improving older patients' involvement in primary care episodes

BACKGROUND

There is a growing expectation among patients that they should be involved in the delivery of medical care. Accumulating evidence from empirical studies shows that patients of average age who are encouraged to participate more actively in treatment decisions have more favourable health outcomes, in terms of both physiological and functional status, than those who do not. Interventions to encourage more active participation may be focused on different stages, including: the use of health care; preparation for contact with a care provider; contact with the care provider; or feedback about care. However, it is unclear whether the benefits of these interventions apply to the elderly as well.

OBJECTIVES

To assess the effects of interventions in primary medical care that improve the involvement of older patients (>=65 years) in their health care.

SEARCH STRATEGY

We searched: the Cochrane Consumers and Communication Review Group Specialised Register (May 2003); the Cochrane Central Register of Controlled Trials (CENTRAL), The Cochrane Library issue 1, 2004; MEDLINE (Ovid) (1966 to June 2004); EMBASE (1988 to June 2004); PsycINFO (1872 to June 2004); DARE, The Cochrane Library issue 1, 2004; ERIC (1966 to June 2004); CINAHL (1982 to June 2004); Sociological Abstracts (1963 to June 2004); Dissertation Abstracts International (1861 to June 2004); and reference lists of articles.

SELECTION CRITERIA

Randomised controlled trials or quasi-randomised trials of interventions to improve the involvement of older patients (>= 65 years) in single consultations or episodes of primary medical care.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed trial quality and extracted data. Results are presented narratively as meta-analysis was not possible.

MAIN RESULTS

We identified three studies involving 433 patients. Overall, the quality of studies was not high, and there was moderate to high risk of bias. Interventions of a pre-visit booklet and a pre-visit session (either combined or pre-visit session alone) led to more questioning behaviour and more self-reported active behaviour in the intervention group (3 studies). One study (booklet and pre-visit session) showed no difference in consultation length and time engaged in talk between the intervention and control groups. The booklet and pre-visit session in one study was associated with more satisfaction with interpersonal aspects of care for the intervention group although no difference in overall satisfaction between intervention and control. There was no long-term follow up to see if effects were sustained. No studies measured outcomes relating to the use of health care, health status and wellbeing, or health behaviour.

AUTHORS' CONCLUSIONS

Overall this review shows some positive effects of specific methods to improve the involvement of older people in primary care episodes. Because the evidence is limited, however, we can not recommend the use of the reviewed interventions in daily practice. There should be a balance between respecting patients' autonomy and stimulating their active participation in health care. Face-to-face coaching sessions, whether or not complemented with written materials, may be the way forward. As this is impractical for the whole population, it could be worthwhile to identify a subgroup of older patients who might benefit the most from enhanced involvement, ie. those who want to be involved, but lack the necessary skills. This group could be coached either individually or, more practically, in group sessions.

Use of a Telehealth Device to Deliver a Symptom Management Intervention to Cardiac Surgical Patients

A variety of approaches can provide cardiac patients with needed follow-up care. However, with the explosion of telehealth capabilities, clinicians are more ready to explore other methods to integrate the use of telehealth devices into the delivery of effective nursing interventions. This article summarizes the development of a symptom management intervention for coronary artery bypass graft patients using the Health Buddy to deliver a nursing intervention in the early recovery period after hospital discharge. Considerations used to design the symptom management intervention and selection of this telehealth modality are discussed. This overview can help clinicians and researchers gain perspective on how to evaluate telehealth modalities to aid in the delivery of interventions for cardiac and other clinical populations.

Impact of a telehealth intervention to augment home health care on functional and recovery outcomes of elderly patients undergoing coronary artery bypass grafting

OBJECTIVE

This pilot study examined the effect of a home communication intervention (HCI) to augment home health care (HHC) on functioning and recovery outcomes of elderly patients undergoing coronary artery bypass graft.

DESIGN

A randomized, experimental two-group (N = 50) repeated-measures design was used. Both HCI and control subjects received HHC, and the HCI group also received the 12-week HCI delivered by a telehealth device, the Health Buddy (Health Hero Network). The Medical Outcome Study Short Form-36 measured physiologic and psychosocial functioning at baseline, 6 weeks, and 3 months after surgery. Follow-up subject interviews ascertained self-report of postoperative problems and health care use.

SAMPLE

Subjects had an average age of 75.3 years and included males (56%) and females (44%).

RESULTS

By using repeated-measures analyses of covariance, covariating for the total number of HHC visits, HCI subjects, compared with the HHC group only, had a significantly higher adjusted mean general health functioning score (F = 8.41 [1, 36], P < .01). There were significant time effects on physical, role-physical, and mental health functioning, indicating that both groups improved over time. The groups reported similar postoperative problems; however, the control group had more emergency department visits than the HCI group.

CONCLUSIONS

Findings demonstrate the potential benefit of using an HCI to further augment outcomes of high-risk patients undergoing coronary artery bypass graft surgery referred to HHC after hospitalization.

Skill sets for the home telehealth practitioner: a recipe for success

Successful implementation of home telehealth programs require unique skills and personality traits of professionals driving the program. Understanding these traits and skills, and how they predict performance will help staff recognize superior applicants when recruiting individuals for such positions. An extensive literature review ties research published on human factors, what they are, the role they play in performance, and how this may translate into a successful telehealth program. We compared case examples of some successful home telehealth programs. Furthermore, a summary of problems approached and resolved by the home telehealth professionals illustrated decision making and action steps taken that correlated to research published on human factors. Further research is needed to validate the tools used by other fields of study to select and identify successful individuals.