Opportunities for Technology to SupportIndependence and Assisted Living in OlderPeople and Other Vulnerable Groups

Written by: Dr Kevin Doughty, Consultant and Deputy Director of The Centre for Usable Home Technology (CUHTec)E: dr.k.doughty@btinternet.com

Commissioned by Wellness and Health Innovation, Scotland’s national initiative designed to support Scottish companies developing innovative products or services for the wellness and health sector. www.wellnesshealthinnovation.org

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1. MARKET OVERVIEW

Older people with disabilities used to be considered poortargets for the purchase of products and services to helpthem live independently because:

• they were perceived as being resistant tochange

• they struggled to deal with new devices andprocedures (e.g. programming the VCR)

• they represented a small sector with littlevoice and lower influence

• they were unlikely to live for many years,and

• they were considered to be financially badlyoff with little disposable income.

Such an approach is no longer the case; a typical olderand disabled person in the 21st century is rather differentto the stereotype implied above. The financial muscle thatthe over 50s can exercise, produces a great commercialopportunity for companies that can satisfy their variousneeds. Over-50s, in the UK, hold 80% of the nation’swealth, including 60% of all savings; they are responsiblefor 40% of all consumer demand. (1)

The main drivers for change:

a. Demographic shift – increasing lifespan and a fall inthe birth rate; according to the Office of NationalStatistics since 1931 the number of people aged 65and over has more than doubled, and this age grouphas exceeded the level of under 16s for the first time in2008 (2).

b. Living arrangements – The number of single personhouseholds in Scotland will increase from 34% of allhouseholds to 42% within a period of 20 years (4). This is consistent with a continuing reduction in SocialCapital (which includes involvement with family, neighbours, societies etc.). Therefore fewer people willhave someone to rely on to provide care and support.

(references on page 15)

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Opportunities for Technology to Support Independence and

Assisted Living in Older People and Other Vulnerable Groups

A WHI White Paper

The Independent and assistive livingmarket is set to grow exponentiallyin the next 30 years, this is largelydue to the demographic shift whichis said to be as big a challenge asGlobal warming!

Dr Kevin Doughty, Consultant and Deputy

Director of The Centre for Usable Home

Technology (CUHTec)

Dr Kevin Doughty is anexperienced consultant intelecare and is currentlyadvising CUHTec on thistopic as its Deputy Director.Originally a physicist andelectrical engineer by origin,Kevin became interested in medical electronics.

Via a research and then a lecturing career in sensortechnologies and telecommunications, he establishedhis own company Technology in Healthcare toenable direct and practical application of expertiseto the running of a residential care home. As formerDirector of Telehealth for Tunstall Group he nowworks with them to enable leading edge research to guide the design of telecare products.

E: dr.k.doughty@btinternet.com

c. Cost – the cost of providing care is increasing exponentially not only because of the increasing numbersof people requiring care and support, but also becauseexpectations are increasing, and the cost of new procedures and pharmacological interventions are alsoaccelerating. In the USA, the annual cost has reached$2.2 trillion, consuming 17% of GDP (6). Planned reformsare likely to increase the potential and penetration ofnew technologies including telehealthcare which alreadyhas a global marked of more than $6 billion (7).

d. Mature technology – the miniaturisation of electroniccircuit boards, the efficiency improvement in electronicactuators, and the use of embedded intelligence withindevices has enabled the design of more powerful assistive devices that are adaptable and wanted by a new generation of relatively wealthy healthcare consumers who are keen to exercise choice on theHigh Street.

e. Growth in long term conditions – Older peoplealready consume the lion’s share of NHS and socialwork budgets. They also are likely to suffer from one or more long term conditions (LTCs) and are responsiblefor more than 80% of current NHS spend.

In summary, PEOPLE ARE LIVING LONGER, and wantto STAY INDEPENDENT IN THEIR COMMUNITIES; this will drive an ever-expanding market for caredevices and systems.

2. RELEVANT TECHNOLOGIES

The term Assistive Technologies applies to any device orsystem that promotes independence (8). For assisted living applications, we should look at the two right-most intersecting circles on the right of the spectrum shown in Figure 2 and prepare to move away from the traditionaldisability focus of AT. These technology elements are asample only of what is and might become available.However, it may provide a useful context and starting point for the discussions below concerning opportunitiesfor small or medium sized companies. To clarify the meaning of some of the terms employed in this paper, we therefore offer some simplified definitions in the appendix.

Figure 2: The Intersecting Worlds of AT, Telecare andVirtual Presence

Following the various initiatives in the UK over the past few years, there are about thirty commercial companies operating in the wider UK electronic AT and telecare market segment.

3

Per

cent

age

wit

h o

ne o

r m

ore

LT

Cs

Age

Sources: General Household Survey 2005 and population census estimates 2004 for England* For those aged 65 or over an adjustment has been made using 2001 census data to account for those living in communal establishments

0

0-4

5-9

10-1

4

15-1

9

20-2

4

25-2

9

30-3

4

35-3

9

40-4

4

45-4

9

50-5

4

55-5

9

60-6

4

65-6

9*

70-7

4*

75-7

9*

80-8

4*

85+

*

10

30

40

50

60

70

80

Two LTCs Three or more LTCs

Assistive Technologies

Telecare

Increasing level of telecommunications

Virtual Presencewalking aids

smart homes

speaking communicator

reminder devices

door intercom

exoskeletons

finder devices

video doorbell

remote controls

health promotion

alarm sensors

activity monitors

proactive calling

movement analysers

actuators and valves

security devices

energy consumption monitor

video conference

granny-cams

virtual visitstelehospice holography

remote consultationvirtual health coach

remote door entry

remote cognitive therapieshug suits

internet shopping

chat-bots

carer quality management

vital signs measurements

gait analysis

prediction

environmental controller

pavement scooter

stair lift

hearing aids

bath hoist

level access shower

spectacles

page turners

grab rails

ramp

tap turner

and, most significantly, whether they live alone or with aninformal (i.e. family or friend) carer. In many situations, individuals or their families will wish to use individual budgets (15) or their own money to purchase AT or telecaredevices that will improve their Quality of Life or which willultimately reduce other care and support costs.

This private market is likely to expand quickly, especially if organisations develop retail models for their CommunityEquipment Stores. The personalisation of health and socialcare (16) is likely to result in the consumer being empoweredto exercise more control, and this could lead to more examples of users selecting technology. Their requirementscan be grouped under 3 main headings: personal well-being, practical concerns, and Quality of Life:

(a) Personal Well-being

Safety – older people are involved in more household accidents than any other group. These include slips, trips,fires, scalds, poisoning, electrocution and problems aroundthe home such as plumbing leaks, floods and spills. The risk of such accidents can be reduced by improvinglighting, offering reminders and providing automatic switch-offs to appliances so that they aren’t left on or used inappropriately. Alarm sensors provide reassurancebut for those who live alone, they need to be linked into atelecare system and to have a service to provide monitoringand, sometimes, a response. Design tends to be industrialrather than domestic, and they do not blend into the homeenvironment.

Figure 3: Banryu dragon – a smoke and intruder detector, and the Paro therapeutic seal

The opportunity is to make these sensors more aestheticallypleasing, perhaps by combining 2 or 3 devices into a singleproduct that fits with the community/home environment.Figure 3 shows two Japanese electronic pets that are used

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3. NEEDS OF OLDER AND VULNERABLEPEOPLE

The model of care in the UK has changed from one ofkeeping vulnerable people in long term hospitals, into oneof Community Care; ranging from family members and formal carers in existing dispersed housing through sheltered housing with wardens (and the equivalent in private retirement sector), to the new housing with caremodels, and ultimately to residential care homes and nursing homes. Assistive technology and telecare can play a role in each of these areas so it may be necessary to consider market segmentation.

In the UK, there are over 700,000 people aged over 50 insheltered housing schemes (and perhaps a similar numberin private retirement apartments) (13). They are generallysupported by a basic community alarm and a wardenwhose duties have changed significantly over the past 20years so that they do not have to be available and on-siteon a 24/7 basis. Floating support is now more likely, so atelecare service will enable rapid responses to be made toproblem situations detected by technology. Such changes,though necessary because of the European Working HoursDirective, are not popular with tenants so technology needsto become more user friendly whilst offering cost benefitsto the Registered Social Landlord or management service.

There are over 250,000 people currently living in residentialcare homes (14), and a similar number in nursing homes.Only a minority of these homes are today owned by localauthorities. Many are operated by small concerns thoughlarge groups such as Barchester Healthcare, Bupa CareHomes, Caring Homes, Four Seasons Healthcare, HallmarkHealthcare, Southern Cross and Sunrise Senior Living continue to buy up capacity. Monitoring systems with sensors, and more advanced nurse call systems will enablethem to improve the quality of care provision, minimising theeffects of and accidents and safeguarding members of staff.

Despite a rapidly increasing number of new Housing withCare establishments, funded, in part, with grants from central government, most people will be cared for in theirown homes where the equipment that they will need willdepend on their particular requirements, the type of property

to support personal well-being. The former (17) protectsthe home and its resident from fires and from intruders,while the latter (18) allows its owner to be relaxed throughstroking it.

Comfort – extremes of hot and cold or dry and damp inthe home can aggravate many health conditions includingarthritis, asthma and diabetes. These can be managed byelectronic sensing devices with direct feedback to operatefans and heaters, plus instructions to advise them of anyactions that have been taken. Such functionality may bepossible within a smart home, but there is a market forsmaller more direct components that can offer the userchoice, and which will report problems directly to a remoteadviser in a monitoring centre.

Figure 4: The smart door camera and time-stampingarrangements

Security – Feeling secure is a basic human right. Existingsecurity systems involve door and window sensors andautomatic lighting. More intelligent approaches may involvethe use of remote monitoring and access control using videosurveillance or smart intercom systems. These have yet tobe optimised for use by older people who may have differentneeds to the rest of the population. Capturing visitor information including identity, purpose of call and verifyingthey are bona fide may be relevant and an opportunity fordevelopers of equipment extending some of the principlesemployed in products such as those shown in Figure 4 (20, 21).

(b) Practical Concerns

Mobility – many older and disabled people suffer fromconditions that limit their ability to move both inside and

outside their property. Pavement scooters and modernbuses enable more people with mobility problems to getout and about, and free bus passes remove some of thefinancial obstacles, but many visits are compromised byuneven ground, steps and stairs. Within the home, stair liftshave enabled people with such problems to continue tolive in properties where accommodation is on two floors;but such solutions are restricted to the individual’s ownproperty and are an expense resource to leave behindwhen the individual finally moves on. For example,Exoskeletons and joint enhancement motors are mobilityaids that could extend the role of stair lifts into the outsideworld. Applications for force enhancing devices exist forother joints (such as the wrist, the elbow and the ankle).There are opportunities to develop more aestheticallyappealing technologies than the ones shown in Figure 5(23-25) alongside the use of information technology to integrate transport and mobility options for older people,so that going out into the community becomes a viableand comfortable option.

Figure 5: Exoskeleton examples

Forgetfulness – current estimates suggest that there arealready over 65,000 people in Scotland suffering from acognitive impairment (26). By 2029 this number is likely tohave increased to over 108,000. Similar increases will beevident in other countries that have an ageing population.The vast majority will be supported at home but the mostadvanced cases, including those of people with no closerelatives, will be supported in specialist mental health units,care homes or housing with care facilities. In each case,there will be an enormous burden of care giving individuals

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reassurance, reminders and warnings of mistakes or dangers. Current telecare systems employ sensors todetect when a mistake has been made, enabling monitoringcentre staff to provide advice and to notify telecarers whereappropriate. These devices work well with detecting floods,people wandering out of the house at night and leaving gasdevices on without being lit. There remains a need and agreat opportunity to use technology to prevent problemsfrom occurring and in allowing people more freedomthrough understanding where they are at any time eitherinside or outside the home. A Scottish company has alreadyproduced an intelligent cooker monitoring device that automatically provides an automatic switch-off facility (27).Many other proposed devices will need to rely on individualscarrying or wearing some form of interface or tag (rfid oractive radio transponder) to predict their activity and locationwithin the home or GPS modules to allow them to betracked and kept safe outside the house. The challenge will be to find an acceptable way of fitting the devices onthe person, and of managing the batteries so that they can remain active for extended periods of time without recharging. Intelligent homes may include systems and displays (such as those shown in Figure 6) that areinstalled in kitchens and are able to predict activity andprovide advice on how to perform specific tasks (28, 29).

Figure 6: Activity reminder interfaces and displays forusers with cognitive impairment

Access to doctors, nurses and hospitals – older peoplemiss having their GP calling on them when they are unwell.They are the least likely people to use NHS 24 becausethey are used to being able to see and speak personally totheir doctors and nurses. Consequently, they want a way of receiving the personal attention that they are used to butwithout having to travel, especially when they are ill. These are ideal opportunities to provide remote vital signsmonitoring and remote consultations i.e. virtual healthcare.This will require a low-cost infrastructure (based on availabledigital telephone service) and a simple user-interface with a new range of sensors suited to the monitoring of parameters of relevance to the long term conditions thataffect more than half of all older people. Many of the sensors will be body worn and will measure vital signs.They may provide alarms if a parameter lies outside a saferange. Response to alarms may also be virtual and mightinclude teleconsultation with nurse advisers or the use ofthe TV to play recorded information clips. Continuous monitoring of activities of daily living, and real-time analysisof performance may be useful in detecting response tonew medications, therapies or other interventions. Remote vital signs monitoring holds out significant potential for the management of long term conditions(including obstructive pulmonary disease (COPD) andepilepsy). The potential for employing enhanced monitoringtechnologies to provide early warning of mental healthproblems and support for the patient will be welcomed.This may include on-line versions of cognitive behaviouraltherapy for depression. The introduction of BT’s 21stCentury Network may offer increased opportunities toemploy standard solutions.

Checking up on carers – personal care is free in Scotlandbut other forms of home help are charged as is all forms ofdomiciliary care (other than nursing care and reablement)throughout the UK. The consequence is that people whohave assets over about £20K must pay by the hour. The rates vary considerably between local authorities butare generally in the range £10 to £15 per hour, and arescheduled in care slots as small as 20 minutes. People areconcerned that carers may arrive late (or not at all) andleave early, short-changing the service users on the way.Furthermore, they may not perform the required tasks.

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Keeping healthy & active – a lifestyle that includes exercise and a balanced diet is a requirement for managingmany long term conditions whilst boosting quality of life.Technology can play a role in monitoring levels of activity,calories consumed and cardiopulmonary effort, and also inpromoting such exercise regimes through reminders andfeedback. New ways of taking exercise and of improving gaitand stamina are needed to ensure that people are coaxedback into a better lifestyle. Technology-supported healthcoaching techniques may also play an important role in supporting smoking cessation efforts and similar initiativesdesigned to keep people healthy. These may include interactive conversation maps (31) (such as the one for diabetes on the left of Figure 7) or worn devices which givedirect feedback (32) as a dashboard (see right of Figure 7 for example).

Figure 7: Interactive Approaches to Help PromoteHealthy Lifestyle

(c) Quality of Life

Social isolation/loneliness – the level of social capital(which incorporates the number of close relatives, visits byfriends, community support and membership of societies,churches etc) continues to fall across the UK, includingScotland. In a 1999 report for the Scottish Government(33), low levels of social capital are associated with higher mortality, a failure to participate in health promotion activities (such as flu inoculations) and, ultimately, high per capita spending on health and social care. This is particularly the case for those people who are lonely anddepressed. There are great opportunities to use technologyto help include these people in their communities, and tolink them with others with similar interests elsewhere in the country or even abroad. Government support for new initiatives is possible through the campaign to connectpeople through the digital switchover which begins with the South West Highlands and Islands in October 2010,extending to the rest of the country by June 2011. We should also consider the plight of informal carers (mainly family members) on whom a large number of people depend for support and personal care. There are660,000 informal carers in Scotland who are often sociallyexcluded. Telecommunications technology can offer them a means of keeping in touch with friends and former work colleagues without giving up their loving and important role.

Shopping & accessing services – increasing amounts ofretail purchases are performed on-line, in a manner whichexcludes the face-to-face contact on which many peoplethrived for their social interaction. Yet, teleshopping servicesthat deliver heavy items including groceries to the frontdoor are a boon to many people who are unable to visitsupermarkets. Home shopping websites could be mademore attractive and usable through better design and byproviding some of the opportunities for meeting andspeaking with people as they would in a real shoppingaisle. Many services are found most easily and then moredetails obtained using on-line search facilities. There is aneed for easier to use interfaces to allow older people to access the web.

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Receiving information & news – people are excludedfrom society and community participation perhaps becausethey aren’t informed about events that may be relevant tothem. They need access to information streams that arefed into their homes and presented to them appropriately.This would include generic advice regarding, for example,flooding alerts as well as specific information relevant totheir individual concerns such as the impact of the weatheron their particular conditions. Younger people have information delivered to them on a plethora of mobiledevices, which are upgraded at least every other year. The challenge is to find an equivalent ubiquitous deliveryvehicle which will appeal to older people irrespective oftheir dexterity, eyesight and hearing abilities. It will need tobe simple and low-cost, and of a form that it will pass thetest of time so that the model purchased in 2010 will stillwork and be useful 5 years later. Applications for a TVbased systems are described in Figure 8.

Figure 8: Home Hub for Information and Monitoring

3. TOPS TIPS FOR PRODUCTDEVELOPMENT

4.1 Smart sensors 4.1.1 Body worn devicesSensors to measure physiological parameters may need tobe implanted beneath the skin or worn against the skin inorder to optimise sensitivity. They may take the form of asticking plaster or some form of clothing (see Figure 9). In most cases, the challenges are in providing power fornormal use without the need for daily recharging throughan external source. Opportunities for scavenging powerfrom the movement of the body or of wireless power transmission need to be considered. There will be a marketfor both devices that simply transmit data to a receiver andthose with embedded intelligence that are capable of making a decision (e.g. raising an alarm) (34, 35).

Figure 9: Smart plasters and clothing

4.1.2 Medical emergenciesMany out-of-hours care requirements and A&E admissionsare due to dangerous situations that have not been recognised until a crisis is reached. Early detection of these situations could be achieved through sensors todetect problems of the type shown in Figure 10 In addition,devices to detect bowel blockage, urinary tract infections,and food poisoning would have applications beyond thetelecare and care of the elderly markets. They wouldenable timely interventions to be made by paramedics ornurses thus reducing the number of unplanned hospitaladmissions.

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Figure 10: Some medical alarm opportunities for telecare systems

4.1.3 Furniture sensorsMany of the sensors necessary to monitor lifestyle andactivities have their origins in security systems. They arefunctional but are more industrial than domestic in appearance. Miniature versions of movement sensors,sound sensors and occupancy sensors may be integratedinto the fabric of the home in the form of sensor pictureframes, mirrors, chairs and kitchen appliances. Joint working with manufacturers of beds, chairs and other items used by older or vulnerable people may be relevant.

4.1.4 Interoperable devicesDevices need to communicate with more than one receiverdepending on whether it is transmitting an alarm, a binarypiece of data, or a sequence of information with a requestfor a reply. Different frequencies and different communicationprotocols are currently employed depending on the appropriate application and the manufacturer of the system.Devices should be system agnostic and offered as modulesready for easy interfacing with any system. This movetowards interoperability will be accelerated when existingsocial alarm requirements are brought up-to-date and whenduplex communication overtakes the simplex approach forcritical care situations. Transceiver modules may be offeredfor OEM (Original Equipment Manufacturer) applications.

4.2 Digital assistants4.2.1 Smart rehab toolsAfter accident or illness, patients often have to relearn simple mobility tasks. Devices that measure parameterssuch as posture or gait and provide positive feedback will

have an important role to play in ensuring that people don’tbecome disabled. Robotic assistants can help people whohave suffered a stroke to exercise particular joint andmovements in order to speed up recovery (36). Universityresearch examples are shown in Figure 11 (37).

Figure 11: Telerehabilitation and programmable rehabilitation aids

4.2.2 Stair liftsLocal intelligence could monitor use of the stair lift andprovide information on performance to social workers oroccupational therapists. A dedicated user interface wouldprovide the patient with appropriate reminders and safetyinformation during their ride up or down the stairs. Thepotential for use of strap-on exoskeletons or motorised jointsshould increase as replacements for stair lifts should increase.

4.2.3 ToiletsIntelligent toilet systems can provide comfort and convenience through flexible support and the use of waterjets and hot air to provide cleaning and drying. There is anenormous market for a safe toilet that helps users to getonto and off the toilet seat – especially for use in the confined spaces which are typical of UK bathrooms in sheltered housing. The Japanese have extended the conceptinto that of a smart measurement device by including sensorsto detect sugar or blood in the urine. Figure 12 shows current examples of smart toilet design (38, 39).

Figure 12: Electronic toilets designed for older people

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4.2.4 Bathing aidsTwo carers are often required to prepare someone for abath or to support them in the shower. One of the carerseffectively offers physical support only, and obeys directinstructions from the second carer. A suitably flexible support stand could be used to replace the second carer,enabling the actual cost of delivering many personal careservices to be halved.

4.2.5 Dressing aidsMost people who need domiciliary care are unable to getthemselves out of bed and dressed without help. Electronicprofiling beds could be adapted to enable an individual tobecome more independent. Devices to help users put onor take off clothing are in demand.

4.3 Linked devices for smarter homes4.3.1 Water control unitFloods can be prevented by the closed loop control ofwater-flow. Water shut-off valves need to be controlled byflood detectors or by intelligent flow meters. These wouldprevent the loss of water through links and could also provide automated billing i.e. integrated solutions.

4.3.2 Lighting assistant with messagingPathways should be illuminated at night to prevent falls.Residents need a spoken interface to inform them of lightsthat are inside or outside the house. Outside lights couldbe linked with cameras to enable them to see visitors andto identify them before their arrival at the door. Systemscould also reduce wastage of electricity by automaticallyswitching off unnecessary lights.

4.3.3 Cooking assistantIntelligent monitoring of tasks is needed so that adviceand/or interventions can be offered when a sequence oftasks has been interrupted. Systems needs to link in withsmart cooking appliances of the type that will be availablethrough IP6. Knowledge of current tasks needs to beinferred from image analysis or by using tags built intokitchen appliances.

4.4 Virtual communication tools4.4.1 Linking servicesVideo and telephone conferencing between peoplematched through their interests, problems or personal circumstances facilitated through telecare monitoring centres can relieve loneliness. It is effectively a matchingarrangement that can operate at a distance enabling individuals or groups to be put into contact.

4.4.2 Low level communicationsRelatives who live at a distance from their lonely familymembers can share a sense of belonging using photographs and other reminder devices linked throughbroadband. A simple photograph touch arrangement isshown in Figure 13.

Figure 13: Continuous distant communication betweenfamily members

4.4.3 Virtual tour busUse of broadband, 3D technologies and surround sound canenable groups of people to overcome physical separationto share the experience of travel and new locations withouthaving to leave their homes. Virtual meetings may be facilitated (40) using optimised camera arrangements andcan simulate coach trips, football matches, community meetings and religious services.

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5. NEXT STEPS FOR SCOTTISH SMES

Scotland provides a natural test bed for many new productsin the independent living sector. In particular, by offeringfree personal care to all older people, it has establishedprinciples that necessarily lead to the support of care in the home environment. The use of technology alongsidetraditional forms of support then becomes a natural progression, enabling new and more innovative opportunitiesto be explored. A consequence of the home care strategyis that local authorities become powerful commissioners ofcare and support services. This simplifies the process ofexplaining the benefits of technology and enables the commissioners to include high levels of technology withintheir service specifications, thus eliminating any attempt torevert to more traditional approaches. This makes Scotlanda more attractive place to introduce innovation than therest of the UK and provides SMEs based in Scotland with agreat advantage over rivals in the rest of the UK. Althoughthe Scottish market may seem relatively small, all productsdeveloped may be immediately offered south of the border,and then in other countries (including Northern Europe andNorth America) where telecare services are being established.The economic benefits are not simply in the manufacture or supply of products, but extend to areas of training,maintenance and technical support.

The areas where Scottish companies are most likely to participate in the short term include those where there isalready considerable expertise available through government-led centres (such as the Scottish Centre forTelehealth in Aberdeen), professional development centres(such as the Iris Murdoch Centre) and academic researchinstitutes including partners in the MATCH project. Theseprovide cutting-edge research expertise which will beinvaluable in identifying gaps in the market and in offeringways of adding value to existing developments. It may berelevant that this level of expertise exists in areas that havebeen identified previously as being prime targets for development i.e. cognitive impairment, age-related loss of balance (i.e. increased risk of falls), chronic disease and long term conditions. They, and other universitydepartments, can also advise on human factors and interfaces of relevance to exploiting these markets and

of ensuring that new offerings take into account the heterogeneity of older people.

It may be appropriate to consider the sharing of this knowledge across Scotland through a Telecare and TelehealthSpecial Interest Group which could bring together academia,local authorities, the NHS, the voluntary sector, productdevelopers and facilitators. This would allow SMEs to haverapid access to informed opinion whilst also keeping themabreast on progress with interoperability, internet protocolsand radio standards. This would ensure that they couldplan for a timely introduction of 2nd or 3rd generation telecare products without their route to market being compromised by an inability to fit in with current models of telecare and smart housing.

SMEs intending to enter the telecare and assistivetechnology market need to:

• ensure that they understand the needs oftheir niche sector of the target market – thismeans extensive market research (or accessto specialist knowledge),

• know the limitations of existing products andplayers in this area,

• link with other organisations to tackle problems where specialist knowledge issparse,

• use support agencies to help plan how tointroduce the new product into the marketby overcoming the potential obstacles tomarket entry (such as formal approvals from regulatory bodies), and

• pilot the concept with focus groups and representative organisations before committing to large scale expenditure on production models.

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APPENDICES

APPENDIX 1 - TABLE OF DEFINITIONS

Assistive technologies – an umbrella term which is often separated into:

DEFINITIONS AND EXAMPLESStair lifts and level access showers which are adaptations to the property, andwhich therefore cannot be moved in a simple manner. UK companies dominate theworld supply and sale of stair lifts through organisations such as Stannah andChurchill.

Walking sticks and tap turners that are low cost and small enough to be carried onthe person. There are hundreds of small companies offering thousands of differentproducts, often marketing only through catalogue and other retail outlets. There arefew major brands to consider but moves towards a retail model may encouragegrowth in this sector.

Expensive tailored solutions that allow a disabled person to control their environment,or to communicate with others. The two biggest providers in the UK are Possumand RSL Steeper which control 95% of all UK sales.

Electronic devices that help to address the unmet needs of the individual, their carers, or society in promoting or supporting independence.

ASSISTIVE TECHNOLOGYFixed systems

Portable systems

Electronic devices and systems

Telecare

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Telecare – can be further split into 4 parts (or generations) (9) :

DEFINITIONS AND EXAMPLESAny sensor or device that doesn’t need to connect with an external telecommunicationsnetwork. This is effectively the devices that are described as telecare under the headingof Assistive Technologies above, and are particularly suited to supporting carers andto help people to overcome specific deficits including short-term memory problems.

Sensors and intelligent gateway units that detect alarm conditions and send codedmessages to a monitoring centre or to an individual telephone where appropriateaction can be initiated. The vendors are mainly the companies that produce the socialor community alarms that already support about 1.5 million people in the UK throughnearly 300 local, regional or national alarm receiving centres (10) . The market hasbeen stimulated over the past few years by telecare grants of £20 million in Scotland,£80 million (PTG) in England and £10 million in Wales. The UK market has been dominated by Yorkshire-based Tunstall which has over 70% of the market inScotland.

Sensors and data collection/storage units that forward data to remote servers wheretrends and exceptions can be displayed and shown to Occupational Therapists, GPs,community nurses and social workers using web technology. The medical versions of these systems (sometimes referred to as telehealth) monitor vital signs and also interact with patients by asking a number of questions relevant to a chronic disease.The Department of Health in England is spending £31 million over 3 years on a Whole System Demonstrator programme (11) in 3 counties to test the monitoringtechnologies on people at risk of hospital admission for heart failure, diabetes andchronic obstructive pulmonary disease (COPD). Another significant development inthe UK telehealth market was the decision by Northern Ireland’s Department of Healthand Social Services in spring 2008 to invest £46 million in technology to manage5000 people with chronic disease by 2011 (12) . There are more than 20 remote vitalsigns monitoring systems currently on sale in the UK.

Systems that include video and other high-bandwidth communications to enablepeople to be linked more effectively at a distance. This is a subset of Virtual Presencetechnologies. The market is immature and in need of some serious technologicalsolutions.

TELECARE SYSTEMStandalone devices (Generation 0)

Linked alarms (1st Generation)

Monitoring systems (2nd Generation)

Interactive systems (3rd Generation)

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Telecare – can be further split into 4 parts (or generations) (9) :

DEFINITIONS AND EXAMPLESSystems that aim to reduce the significance of geographic isolation by using highbandwidth telecommunications to bring people and situations together. The mainapplications use the television and a set-top box with a web-cam as the main components in order to deliver various teleconference possibilities. New systemswill utilise the increasing bandwidths available, and the use of switching technologiesto introduce 3D or shared experience possibilities. This will include tele-therapies –and the use of robotic assistants to deliver or monitor the delivery of physiotherapy,occupational therapy and psychological interventions for mental health problems.

Cellular phone technologies provide increasing levels of intelligence, memory andinterfaces to enable the handsets to be used as a mobile hub in many medicalmonitoring and alarm situations. The target audience is younger and, obviously,able to move around rather more than those likely to receive telecare.

This is the sharing of electronic records, an essential prerequisite for joined-up care,including ambulance services. The scale is so great that opportunities for SMEs tointroduce complete systems are very limited.

Over the next decade as microcontrollers and processors will be embedded into virtually every item of consumer electronics from the fridge through to the washingmachine and from the kettle through to the lights. These will all be provided withunique internet addresses thanks to IP6. This will allow smart systems to controlsecurity, energy efficiency, entertainment and assisted living functions provided thatthe systems are compatible and operate with each other i.e. they must talk to eachother using a common language and protocol. Interoperability is a requirement fortrue integration but may be achieved only through joint working on standards,which tends to be very slow to be accepted. In the meantime, smart homes willfocus on individual applications with the assisted living theme being popular fornew-build apartments for older people and for people with disabilities.

TELECARE SYSTEMVirtual Presence

Mobile Care (m-care)

e-care

Smart Homes

15

APPENDIX 2 – SCOTLAND SPECIFIC INFORMATION

Scottish Landscape

The Scottish Centre for Telemedicine in Aberdeen is likely to become a valuable source ofexpertise for promoting new solutions which may be extended to provide high qualityimage transfer between secondary and tertiary care facilities.

The replacement value of care provided by informal carers has increased by over 50% in 5 years and is currently estimated to be in the order of £8 billion per annum. There are660,000 informal carers in Scotland who are often socially excluded because of their caring responsibilities and by a lack of respite options (3).

WHO data for 1997 (5) shows that Scotland had higher mortality rates due to heart disease,vascular disease, and the majority of common cancers than Japan, the USA, Spain andEngland and Wales. It is therefore an ideal test-bed to attempt innovative approaches toprevention, treatment and general health promotion.

The early uptake of alarm sensors in West Lothian and in North and South Lanarkshire,helped to make Scotland the focus for trials of new devices.

Scottish House Condition Surveys show that the proportion of dwellings with condensationor dampness, or failing the Scottish Housing Quality Standard, has fallen, the most recentfigures for 2005-06 show that 60% of social housing and 69% of private sector housingfalls short of the Scottish Housing Quality Standard with nearly half (47%) of dwellings havesome urgent disrepair (19). Despite initiatives such as the Scottish Warm Deal, which offershome insulation grants for those aged 60 or over, many older people who may havereduced peripheral sensitivity and an inability to adjust for extreme conditions, will be at risk.

The Scottish Executive is trying to create a feeling of safety by tackling both crime and thefear of crime in communities by building strong, safe, inclusive communities as a foundationfor the Social Justice agenda. Reducing the fear of crime among older people is a milestonein this policy and involves support for such strategies including the use of AT and similardevices.

In Scotland, a discretionary improvement grant of up to £20,000 is available to providebasic amenities while a 50% of the total approved is available as of right for making ahouse suitable for the accommodation, welfare or employment of a disabled person wholives there (22). Such grants may not need to be confined to building work; more innovativesolutions using AT may become relevant as new systems appear.

The Audit Scotland report shows that the NHS spent at least £98.5m on COPD (ChronicObstructive Pulmonary Disease) (30). This is an underestimate of the total cost due to alack of information about social work costs, services provided by the voluntary sector andfamilies, and full prescribing costs. Epilepsy cost a minimum of £38m in the same year.

Geography – Large proportion of rural area

Informal Care

Long Term Illnesses

History of Alarm systems in social care

Living Conditions

Security for Vulnerable people

Scottish Housing

NHS Expenditure

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Abstract of the United States 1997, Table 1339 (pg. 17).6 www.nchc.org/facts/cost.shtml 7 www.telecareaware.com/index.php/what-is-telecare.html8 www.fastuk.org/about/definitionofat.php 9 Doughty K, Cameron K & Garner P; “Three Generations of Telecare of the Elderly”, Journal of Telemedicine and Telecare; Vol. 2, pp. 71-80 (1996)10 Fisk MJ; “Social Alarms to Telecare”; Policy Press, Bristol (2003)11 The UK Domiciliary Care Market Development © MBD 200912 Ovum, The emergent UK telehealth market: beyond the hype 05 February 2009 Tola Sargeant13 www.bapen.org.uk/pdfs/press_releases/press_43.pdf 14 www.carehomesguide.com/ 15 www.direct.gov.uk/en/DisabledPeople/FinancialSupport/DG_10016128 16 www.dh.gov.uk/en/SocialCare/Socialcarereform/Personalisation/Individualbudgets/index.htm 17 www.robotster.org/archives/200702/18 www.mip.sdu.dk/press/gr/paro1.jpg19 scotland.shelter.org.uk/housing_issues/research_and_statistics/key_statistics/the_facts_about_scotlands_housing 20 www.onestop-locks.com/acatalog/Security_Cameras.html21 www.visibell.co.uk/visibell3_jpegs.htm22 www.scotland.gov.uk/Publications/2003/09/18303/27476 23 www.medgadget.com/archives/2008/01/gardeners_exoskeleton.html24 www.bing.com/images/search?q=exoskeleton+suit&FORM=BIFD#focal=d7fa5b58517d26cea413b159a33d6b9b&furl=http%3A%2F%2F

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