Assistive technology focus on Health & Environment

1. Assistive technology focus on Health & Environment Helianthe S.M. Kort, PhD Full professor Demand Driven care, Utrecht University of Applied Sciences / Hogeschool Utrecht Full professorBuilding healthy environments for future users, Eindhoven University of Technology / TU/e August 2014

2. Overview • Trends in healthcare • Active ageing • Research framework • eHealth • Selfmanagement and personalized health

3. AAATE • "to stimulate the advancement of assistive technology for the benefit of people with disabilities, including elderly people" • The AAATE is the interdisciplinary pan-European association devoted to all aspects of assistive technology, such as use, research, development, manufacture, supply, provision and policy.

4. Research Center For Innovations in Healthcare • Care for older people and family care • Lifestyle and Health • Demand Driven Care • Speech Therapy • Dissemination of Pharmaceutical innovations

5. Mission KC IVZ • the ability of professionals trained at the Faculty of Health Sciences to act critically and reflectively within professional practice; • process existing and new knowledge in such a way that this is applicable in the care sector; • produce knowledge in response to concrete questions from the field.

6. Trends in Care • Ageing of the population • Growth in 55-plus • Hazing of the population • Potential working force decreases • Increase of chronic diseases • Limitations in care supply (professional and family) • Ageing in Place

7. Increasing care demand • Older adults deteriorating health • Diseases increases • Dementia, COPD, Diabetes mellitus, • Mental disorders • Limitation in ADL • Domestic work • Mobility • Personal Care

8. Availability of professional carers • The need for professional care givers increases every year, by 2% on average. • More than one out of ten people of the professional population work in the care- and welfare sector. • of which 78% are women working part time. • Approximately 22% of the work force should be employed in the care- and welfare sector by the year 2025.

9. Telecare • Care after hospital admission • Admission length ↓ • Re-admission ↓ • Therapy compliance ↑ • Care and support • Travelling time • Satisfied customers • Satisfied employees • Smart Homes (AAL) • Comfort and safety • Information and Entertainment • Services (alarm / telehelp)

10. World population ageing

11. Effects due to ageing • Shrinking workforce • Old age dependency ratio (Grijzedruk) = TP 60 plus / TP 15 – 60 • TP = Total population • Financial implications of pension and care policy

12. Rapid ageing in developingcountries

13. Trends • Vergrijzing verdeeld 2010 CPB

14. Trends • Vergrijzing verdeeld 2010 CPB

15. World profile of ageing 2013

17. Availability of family care in NL

19. Meaning of ageing • Oma op stap • Whataboutyourage?

20. Assistive Technology • ALT; eALT; eHealth; Telecare • WHO: • With the aid of these technologies, people with a loss in functioning are better able to live independently and participate in their societies.

21. Active ageing concept1990 WHO • Active ageing is the process of optimizingopportunitiesfor • Health • Participation • Security • In order to enhancequality of life as peopleage • Need base Rights base

22. Possible intervention moments

23. Determinants of activeageing

24. Gerontechnology • Gerontechnology is an interdisciplinary academic and professional field combining gerontology and technology • Assistive technology and inclusive design for innovative and independent living and social participation of older adults in good health, comfort and safety • Gerontechnolgy concerns matching technological environment to health, housing, mobility, communication, leisure and work for older people

25. Herman Bouma. GT Basics and Impact Matrix. May 22, 2006

26. Challenges • The double burden of Disease (acute -> chronic) • Increased Risk of Disability • Providing Care for Ageing Populations • The Feminization of Ageing • Ethics and Inequities • The Economics of an Ageing population • Forging a new paradigm (passive -> active older people)

27. Approach prevention and reduction • Prevention and effective treatments • Age-friendly, safe environments • Reduce avoidable hearing impairment • Reduce and eliminate blindness • Provide approitae eye care services • Barrier-free living • Quality of life

28. Approach reduction of risks • Physical activity • Healthy eating • Oral health • Psychological factors • Medications (access to safe medications) • Adherence

29. ICF

30. Health and self management • WHO : Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. The correct bibliographic citation for the definition is: Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948. • The Definition has not been amended since 1948. A new approach: • “health, as the ability to adapt and to self manage” is to identify and characterise it for the three domains of health: physical, mental, and social. The following examples attempt to illustrate this.

31. Self management • Management of or by oneself; the taking of responsibility for one’s own behavior and well-being: • The individual capacity to deal with symptoms, treatment, physical and mental consequences. Life style changes due to the life with a chronic disorder.

32. Telehome care andSelf management • Special attention for frail people: • Persons with dementia, • Older oldest (85+), • With complex problems, • With a low SES • Those with a low literacy in language / health • In a terminal phase. • With low self management skills

33. Telehomecare in the Netherland • Health conditions: • Dementia (19 projects) • COPD (11 projects) • Diabetes (11 projects) Kort e.a., Telehomecare in the Netherlands: value-based analysis for full implementation, in: A.P. Glascock, Kutzik, D.M. (Eds.), Essential lessons for the success of telehomecare: why it's not plug and play 30, 145-160, IOS Press, Amsterdam, 2012.

34. Telehomecare in Nederland

35. eHealth eHealth or Telehealth • Exchange of data between patient and professionals for diagnosis or management of the health condition • Encompasses electronic health records, AAL, smart systems, telecare, telemedicine, ALT

36. Possible Barriers • Telehomecare: support of AiP or quality of life. • No consideration with requirements to building construction, building systems ,.. • Not all stakeholders are involved and not all of the needs of these stakeholders are met in the design and implementation • The execution of the projects seems to exist merely out of an analysis of the technological applications only H.S.M. Kort, J. Van Hoof, Telehomecare in The Netherlands: Barriers to Implementation, International Journal of Ambient Computing and Intelligence 4 (2012), 64-73.

37. Possible Barriers • Accessibility of computers • Availability of support • Technology generations • Technical • Structure of the Healthcare system • Legal • Education • User Acceptance

38. Possible Barriers • The paradigm of telehomecare implies an innovation in the provision of care. • Hardly any knowledge exchange about telehomecare services between producers /enterprises and care professionals

39. Challenges Technology Cost TELEHOMECARE Client Professionals Users factors

40. Challenges Technology Cost User factors Professionals Client TELEHOMECARE

41. Studies • WSD (UK) • NRW (GE) • PETZ (NL / USA)

42. Whole Systems DemonstratesTelehealth in de UK • Largest RCT in the world • Telehealth and telecare • Aim is to provide benefit for 3 million lives • The programme will provide a clear evidence base to support important investment decisions and show how technology supports people to live independently, take control and be responsible for their own health and care. • N = 3230 people with a long term condition (HF / COPD)

43. WSD • Benefit analysis of costs and outcomes (QALY) & costs (N = 965) • Qualified Adjusted Life Year gained in Telehealth group = usual care group • Total cost in Telehealth group is slightly higher, but non significantly than usual care group • Similarcosts • Cost effectiveness is depended with the willingness to pay for generated health outcomes

44. WSD: Cost effectiveness & QALY Assuming an 80% reduction in equipment costs at a willingness to pay for the service = (£ 30.K per QALY (€ 35.K), telehealth was 34% cost effective Henderson e.a. BMJ 2013; 346 – f1035 doi: 10.1136/bmj.f1035

45. NRW • Health survey in North Rhine-Westphalian in 2009 (to identify health needs, initiate policies, and evaluate effects on population health) • Regular yearly survey • Awareness; willingness to use; reasons for use • N = 1993 ( 23% low SES; 36% has a chronic disease part 50 -69 years old) • Y 18 – 93

46. NRW: Willingness to use Telemonitoring • Willingness to use telemonitoring seems to be high in the general population of Germany • decreases with age and targets groups with individuals with Cardiovascular diseases • Health status is an important factor that influences the willingness to use

47. NWR: Disadvantages using Telemonitoring • Bürmann e.a., 2013, Telemedicineand e-Health

48. NRW • Possible explanation for a lower willingness to use telemonitoring then men could be cause by computer illiteracy with women • Older women particular should be assisted and educated regarding use of telemedical devices at home. • Fear to lose social contact (No GP visits) • Better understand how telemonitoring can help them to control their health status

49. PETZ • Predictors to use eHealth by professionals and older adults • Ageing adults 65 plus with a long term condition • E-Panel N= 218 (183 completed the survey) • Selection at a market for social care (hard copy) • Professionals from home care (N= 500, 207 responded • Selection by team managers • N = 207 • Survey and observations

50. UnifiedTheory of acceptanceanduse of Technology Venkatesh et.al, 2003