TELEHEALTHCARE SUPPORT SYSTEM FOR OLDER PERSONS

Transcription

1 THE REGIONAL IN-SITU SATELLITE TRAINING PROGRAM 2016, MALAYSIAN RESEARCH INSTITUTE ON AGING TELEHEALTHCARE SUPPORT SYSTEM FOR OLDER PERSONS Yeh-Liang Hsu Professor, Mechanical Engineering Department Director, Gerontechnology Research Center, Yuan Ze University Vice President, International Society for Gerontechnology 2016/08/14 1

2 嚙指心痛 FINGER BITING CAUSING HEARTACHE Zeng served his mother with all faithfulness. One day when he was out cutting wood among the mountains, there came a visitor to his house. His mother became perplexed and, after awaiting her son s return in vein, bit her finger. From the 24 stories of filial piety THE BEGINNING OF TELEHEALTH Zeng felt heartache all of a sudden and knew there was an emergency. He rushed back home with a burden of wood, and on arrival, knelt down to asked his mother what happened. His mother replied, Here is a visitor who needs you urgently. So I bit my finger to awake you to come back 2

3 IMPACT OF ICT TO MEDICAL CARE Telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve patients health status. (ATA, Telehealth is the delivery of health-related services and information via telecommunications technologies, including clinical and non-clinical uses. Telehealth delivery could be as simple as two health professionals discussing a case over the telephone, or as sophisticated as using videoconferencing between providers at facilities in two countries, or even as complex as robotic technology. [Wikipedia] The term e-health is more commonly used in Europe, which refers to healthcare practice which is supported by electronic processes (but not necessarily tele ), such as electronic health record, image processing, IC card, etc. 3

4 TELE-HOMECARE, HOME TELEHEALTH Definition: Tele-homecare can be defined as the use of information and communication technologies to enable effective delivery and management of health services at a patient s residence. [Office of Health and Information Highway, Canada, 1998] Users: Tele-homecare differs from tele-medicine in the sense that people who transmit and receive medical information are not medical doctors but the patients themselves and their families, nurses, care-givers, home-helpers and medical technical experts, etc. [Masatsugu, 2002] Goal: Home telehealth allows the patient the dignity of remaining in their own home for as long as possible and by providing care that is equal to or superior than approaches that rely solely on health providers coming into the home for scheduled visits. [ 4

5 PHILIPS LIFELINE SERVICE ( Lifeline is the first and most established Personal Emergency Response System (PERS). It was developed in 1974 by Lifeline System, Inc., which was acquired by Philips in 2006/01. Served more than 7 million people AutoAlert fall detection Standard Service starting at $29.95 or Lifeline with AutoAlert starting at $

6 TUNSTALL S LIFELINE ( 50 years in telecare and telehealth (started in UK, 1957), over 2.5 million users 6

7 TUNSTALL: ACTIVITIES OF DAILY LIVING MONITORING Activities of Daily Living (ADL) Monitoring: To provide an unobtrusive method of capturing a person s behaviour patterns so if a deviation from the norm occurs, it can be identified, the cause investigated and preventative action taken. 7

8 LONG TERM WELLNESS ONITORING Health Hero Network ( Health Buddy System Health Buddy Appliance : USD 99 Monthly Service Charge: USD

9 TELEHEALTHSOLUTIONS (AUSTRALIA) ( 9

10 MEDICOMPASS ( Connecting Patients, Care Professionals, and Health Plans PHR: Personal Health Record Our site is an online resource that allows you to store and track all of your health related data in a completely secure and private environment. Monitoring this information keeps you informed of your progress. You are also able to share information online with your healthcare team 10

11 TYPES OF HOME HEALTHCARE SERVICES (I) Personal Emergency Response System (PERS) Long term wellness monitoring Personal Health Record (PHR) Leading Industries: Hospitals Telecom companies Security companies Construction companies Home Health Care Provider : Lifeline service, Tunstall, Health Hero Network, MediComapss 11

12 EVALUATION OF HOME TELEHEALTH SYSTEMS Individual needs and perceived benefits A study by Teasdale and Roush [2001] used Lifeline to see if users felt more secure with the technology. All users reported a greater sense of security during their PERS use. Clinical outcome and save in medical expense Health Buddy is currently in use by over 12,000 patients and has proven its worth in clinical trials: reduced hospital admissions by 63%; reduced congested heart failure (CHF) hospitalizations by 72%; reduced CHF inpatient bed days from 8.6 to 1.7; increased medication compliance from 34% to 94%; reduced CHF costs/patient/year from $25.0K to $11.8K. What is missing? 12

13 NEED MAY NOT NECESSARILY TURNS INTO MOTIVATION Older adults may have strong need for walking sticks, walkers, wheelchairs etc., but have very little motivation of using them What is the internal motivation of the older adults for using the technologies? Enjoyment as a source of life, more fun than functions! How if the vital sign measurements of the older adults are transmitted to children, family members, rather than to hospitals, or some home health care provider? 13

14 IOT STRUCTURE FOR WHIZCONNECT Wi-Fi 3G/4G MQTT Broker Cloud Server Wi-Fi IoT Processor Bluetooth Android App Care, interaction, connection in addition to health monitoring HBP and Glucose Measurement

15 WHIZCONNECT NOTIFICATION, APP AND FACEBOOK OPEN GRAPH

16 BEYOND TRANSMITTING VITAL SIGNS Assess wandering behaviors of dementia patients at Tainan Dementia Nursing Home 16

17 WANDERING BEHAVIORS OF DEMENTIA PATIENTS: MS MODEL A video-based observational methodology was used to assess the travel behaviors of 40 nursing home residents, 24 of whom were identified by nursing staff as wanderers. Travel was monitored continuously for 30 days, resulting in the recording of over 5,000 unassisted travel events. Four basic travel patterns were observed: direct travel (86.8%), lapping (11.6%), random travel (.9%), and pacing (.7%). Travel efficiency (percentage of direct travel) was significantly related to cognitive status (r = 56), with inefficient travel most prevalent in severely demented participants. Martino-Saltzman, D., Blasch, B. B., Morris, R. D., & McNeal, L. W. (1991). Travel behavior of nursing home residents perceived as wanderers and nonwanderers. The Gerontologist, 31(5),

18 FRACTAL D FOR DESCRIBING MOVEMENT PATHS OF WANDERERS (I) Movement paths tracked by RFID for 14 residents in a nursing home, 6 with dementia, 8 without dementia. Fractal dimension (Fractal D) was used to measure of complexity of movement path (directed vs. irregular or apparently aimless locomotion) Kearns, W. D., Nams, V. O., & Fozard, J. L. (2010). Tortuosity in movement paths is related to cognitive impairment. Methods Inf Med, 49(6),

19 FRACTAL D FOR DESCRIBING MOVEMENT PATHS OF WANDERERS (II) Fractal D ranges from 1 when the movement path is perfectly straight, to a values of 2 when the movement path is random. Fractal D was significantly and negatively correlated with cognitive status as measured by the Mini Mental State Examination administered to each participant at the study s end. Kearns, W. D., Nams, V. O., & Fozard, J. L. (2010). Tortuosity in movement paths is related to cognitive impairment. Methods Inf Med, 49(6),

20 HOW TO CALCULATE FRACTAL DIMENSION The total length of coastline of England depends on the scale used for measurement. When the scale approaches zero, the total length approaches infinity. Fractal dimension D = logn logε N stands for the number of new sticks, ε for scaling factor Fractal D for coastline of England D = log 49 9 log = 1.22 Fractal D for a straight line: 1 Mandelbrot, B. B. (1967). How long is the coast of Britain. Science, 156(3775),

21 FRACTAL D FROM MOVEMENT PATH MEASURED BY WHIZCARPET 21

22 WANDERING BEHAVIORS CAPTURED BY WHIZCARPET Fractal D: Fractal D: Direct travel Pacing travel Fractal D: Fractal D: Lapping travel Random travel 22

23 14 DAY RECORD AT TAINAN DEMENTIA NURSING HOME Residents A, B are wanders, residents C, D are not. indexes D1 D2 D3 D4 D5 D6 D7 A Average Fractal D Fractal D > Fractal D < B Average Fractal D Fractal D > Fractal D < C Average Fractal D Fractal D > Fractal D < D Average Fractal D Fractal D > Fractal D < D8 D9 D10 D11 D12 D13 D14 Ave Fractal D > 1.4: A 36.1%, B 29.8%, C 16.5%, D 5% 23

24 Yuan Ze University Future opportunities for home telehealth: IoT, big data Yeh-Liang Hsu