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
Clinical Engineering
Scope of Services
Clinical Engineering
Scope of Services
Clinical Engineering
Scope of Services
Technology in Healthcare
OR
…it depends on the technology?
Innovation Research and InnovationCentre for Healthcare EquipmentAnd Technology Adoption (CHEATA)Contact: Beth Beeson
ApplicationEngineering & InstrumentationStandards & ConsultancyProficiency & TrainingContact: Ged Dean
ManagementMedical Equipment PlanningMedical Equipment ServicesMedical Equipment LibraryContact: Paul Hills
General ContactProf Dan ClarkHead of Clinical Engineering QMC CampusTel. +44 (0)115 970 9131 (int. x 61131)[email protected]
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
18
Readings & answers
Opt-in/out,
prompts, questions, feedback,
advice,education
all my teams
web
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
EMRAN
Technology and dementia
Michael Craven 24th June 2015
MindTech HealthcareTechnology Co-operative
EMRAN
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
MindTech HealthcareTechnology Co-operative
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
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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
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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
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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
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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...
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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
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Classifications of technology• 1st generation telecare: alarms, pull cords
• 2nd generation: memory aids, other forms of telecare
• 3rd generation: communication, smartphones, apps
OR
• 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
or
• Everyday technologies which lend themselves well to people with cognitive difficulties
e.g. voice recorder
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• Applications where the technology is the thing
e.g. iPads, robots
or
• 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
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Memory technologies
• reminder messages • clocks and calendars • medication aids• locator devices (for ‘lost’ objects)• aids for reminiscence and leisure
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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
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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/
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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)
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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)
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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.
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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
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• 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
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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.
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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
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Thankswww.mindtech.org.uk
Michael Craven 24th June 2015
MindTech HealthcareTechnology Co-operative
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
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
1
2
3
4
5
Acc
eler
atio
n (g
)
Time (s)
Resultant Acceleration data
(F)
(A)
(B)
(C)
(D)
(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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