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Independent Assistive Living Conference

The Telecare and Telehealth Market – Opportunities for SMEs Kevin Doughty JRF Centre for Usable Home Technologies University of York Iris Murdoch Centre, University of Stirling Thursday, 1st. October, 2009


10 Concerns of Ageing Populations Safety & Security Mobility Forgetfulness Checking up on carers Keeping healthy & active Social isolation/loneliness Shopping & accessing services Receiving information & news Community participation Boredom Š KD 2009


Supporting Independence in the Community OTHER FORMS OF SUPPORT HUMAN SUPPORT SERVICES

INFORMAL CARERS

• Family • Friends • Neighbours • Voluntary groups

HEALTH & SOCIAL WORK SERVICE

• Personal care • Medical staff • Reablement team • Home help

© KD 2009


Demand for Support Services


Demographic Realities

Percentage of population aged 65 & over

Dependency ratios:

Europe 2000 Europe 2025 Asia 2000 Asia 2025

= 4 = 2.5 = 6 =3 Š KD 2009


Types of Illness Feature

Acute Disease

Chronic Disease

Example

Urinary tract infection

Chronic Obstructive Pulmonary Disease

Onset

Abrupt

Usually gradual

Cause

Single

Multiple over time

Outcome

Can be cured

Incurable

Duration

Limited (a few days)

Lengthy & indefinite

Effect of medication

Usually effective

Indecisive with adverse effects

Š KD 2009


Major Recorded Causes of Death in USA in 1900 Rank Primary Cause of Death

Rate per 100,000

1

Pneumonia and influenza

202.2

2

Tuberculosis

194.4

3

Diarrhoea, enteritis, intestinal problems

142.7

4

Diseases of the heart

137.4

5

Intracranial lesions of a vascular nature

106.9

6

Nephritis

88.6

7

All accidents

72.3

8

Cancers and malignant tumours

64.0

9

Senility

50.2

10

Diphtheria

40.3


Comparison of Mortality Rates in Developed Countries from Different Diseases Deaths per annum per 100,000 population

250

200

Heart disease

150

Vascular disease

100

Common cancers 50

Breathing diseases 0

United States

Japan

Spain

England and Wales

Scotland

Country Š KD 2009


Chronic Disease and Functional Performance


Percentage Limited

Chronic Disease and Functional Performance 80 70 60 50 40 30 20 10 0 None

one

two

three

Number of chronic diseases

four

5+


Top 10 Lifestyle Diseases Alzheimer's Disease: a form of brain disease. Arteriosclerosis: A generic term for several diseases in which the arterial wall becomes thicken and loses elasticity. Atherosclerosis is the most common and serious vascular disease. Cancer: diseases characterized by uncontrolled, abnormal growth of cells. Chronic Liver Disease/Cirrhosis: any of a group of liver disorders. Chronic Obstructive Pulmonary Disease (COPD): a disease characterized by slowly progressing, irreversible airway obstruction. Diabetes: a disease affecting sugars used by the body. Heart Disease: any of several abnormalities that affect the heart muscle or the blood vessels of the heart. Nephritis/CRF: any disease of the kidney marked by swelling and abnormal function. Stroke: a condition due to the lack of oxygen to the brain that may lead to reversible or irreversible paralysis.

Š KD 2009


Why Are Lifestyle Disease Increasing?

< 2.5 million years >

< 100,000 years > < 50 years >

Š KD 2009


Future Resource Pressures on Long Term Care in the U.K. Long term care costs

Ratio Persons Aged 16-64 to 65+

Dependency ratio

45

4.0

40 35

3.5

30 3.0

25 20

2.5 15

UK Long Term Healthcare Cost (£B)

50

4.5

£15bn p.a. to £18bn p.a. (20% increase) 10

2.0 1995

2005

2015

2025

2035

2045

2055

Year © KD 2009


Supporting Independence in the Community SMARTER HOMES

OTHER FORMS OF SUPPORT HUMAN SUPPORT SERVICES

• Warm & comfortable • Suitable location • Level access • Housing with care

INFORMAL CARERS

• Family • Friends • Neighbours • Voluntary groups

HEALTH & SOCIAL WORK SERVICE

• Personal care • Medical staff • Reablement team • Home help

© KD 2009


Changes in Household Composition

Š KD 2009


Smart Homes

Š KD 2009


Supporting Independence in the Community TECHNOLOGIES OTHER 4 INDEPENDENCE FORMS OF SUPPORT

HUMAN SUPPORT SERVICES

INFORMAL CARERS

• Family • Friends • Neighbours • Voluntary groups

SMART HOMES

• Warm & comfortable • Suitable location • Level access • Housing with care

HEALTH & SOCIAL WORK SERVICE

• Personal care • Medical staff • Reablement team • Home help


Assistive Technologies • Fixed Systems – Usually need to be planned for the property & individual – Need handyman or expert installation – Can be expensive – High maintenance costs – Usually takes a long time from start to finish – Often wasted when user moves on

© KD 2009


Assistive Technologies • Portable Systems – – – – – – –

Generally low-cost Go with the user Quick to install Easy to use Available off the shelf Ideal for loan use Little or no maintenance needed © KD 2009


Assistive Technologies • Electronic Systems – Environmental control – Remote devices – Communication aids – Appliances

– Sensors – Smart Homes – Telecare

Tango – speech synthesiser © KD 2009


Telecare

REACTIVE EMERGENCY ALARM SYSTEM 1st. Generation

ADVICE, INFORMATION, ENTERTAINMENT AND COMMUNICATION SYSTEMS (3rd. Generation)

t

STAND-ALONE ELECTRONIC ASSISTIVE TECHNOLOGIES Generation Zero

FUNCTIONAL COMPENSATION

PROACTIVE LIFE & HEALTH MONITORING (2nd. Generation)

Devices and systems to help overcome sensory or functional problems in performing activities of daily living © KD 2009


Mobility Problems • >250,000 people in Scotland have disabilities that greatly affect ability to mobilise • They are at risk of becoming housebound, socially isolated and depressed • They are more likely to suffer falls and of being unable to get up without help © KD 2009


Overcome anxiety, increase confidence, manage risks to independence ADVICE, INFORMATION, ENTERTAINMENT AND COMMUNICATION SYSTEMS (3rd. Generation)

REACTIVE EMERGENCY ALARM SYSTEM 1st. Generation

Telecare SENSORS FOR RISK MANAGEMENT

t

PROACTIVE LIFE & HEALTH MONITORING (2nd. Generation)

STAND-ALONE ELECTRONIC ASSISTIVE TECHNOLOGIES Generation Zero © KD 2009


Emergency Detection Sensors 1. Environmental concerns 2. Security Low issues temperature

Gas

Bogus caller

Fire

Noise

Air quality High temperature

Flood

Carbon monoxide

Door status Intruders

Š KD 2009


Emergency Detection Sensors 1. Environmental concerns 2. Security issues 3. Social problems

Nutrition

Hygiene

Mobility/ Instability

Cognition

Heavy drinking

Wandering

Mental health crises

Continence problems

Medication concordance Š KD 2009


Smart Telecare Sensors

Specific Modular Automatic Rapid Tested Š KD 2009


Components of a Social Alarm Telecare System Wireless alarm Advanced Lifeline Unit

SMART Sensors Telecarers + Emergency services

Response Team

Telecare Monitoring Centre Š KD 2009


Emergency Response Team Floating Support

Social Worker - EDT Emergency Treatment Team

Telecare Monitoring Centre

Relatives, Friends, & Carers

24 hour Gas fitter

Rapid Response Team Lifting service

Individual protocols - for each service userEmergency plumber - for every time of day - for every alarm + escalation procedure

Out-of-hours GP

Fire service

Police

24 hr. Home Care

Ambulance

Paramedic Home Treatment Team

Š KD 2009


Management of Risk • Level of risk can be reduced by: – Making an event less likely, or – Lessening the harm of such an event

• Early detection is important in many types of domestic problem: – Heart attacks – quick response and resuscitation reduces permanent damage to cardiac muscles – Stroke – Use of clot busting drugs within 3 hours greatly improves outcomes – Falls – rapid intervention prevents dehydration, pressure sores, hypothermia and pneumonia © KD 2009


Components of a Social Alarm Telecare System Wireless alarm Advanced Lifeline Unit

SMART Sensors Telecarers + Emergency services

Response Team

Primary Care Prevention Services

Telecare Monitoring Centre Š KD 2009


Prevention Teams Care & Support Coordination & Telecare Centre

Strength training

Sitting Osteoporosis service check Dietician Healthy living centre

Tai Chi Medication review Medical Memory Continence advice assessment O.T. Keep warm clinic Keep well

Electric Safety blanket checks checks

Therapy Day centre

Meals on wheels

Energy adviser

Optician Balance training

A.T. Installer

Bobbyvan Š KD 2009


REACTIVE EMERGENCY ALARM SYSTEM

ADVICE, INFORMATION, ENTERTAINMENT AND COMMUNICATION SYSTEMS

t

ENVIRONMENTAL SENSING & CONTROL TECHNOLOGIES

Detect changes in habit, activities and vital signs to predict and prevent problems escalating

PROACTIVE LIFE & HEALTH MONITORING

PREVENTION AGENDA © KD 2009


Medical Telecare Equipment

IEM blood pressure monitor (Bluetooth)

Viasys AM-1 peakflow (Bluetooth)

Nonin 4100 SpO2 (Bluetooth)

Š KD 2009


HEALTH PROMOTION

ADVICE, INFORMATION, ENTERTAINMENT AND COMMUNICATION SYSTEMS

Technology systems to provide advice, news, entertainment and new on-line services

REACTIVE EMERGENCY ALARM SYSTEM

t

PROACTIVE LIFE & HEALTH MONITORING

ENVIRONMENTAL SENSING & CONTROL TECHNOLOGIES

© KD 2009


Integrated Telecare Services SSA/NHS Records

Vital Signs Monitoring User display

PSTN (BT 21CN)

Community Response & Support Services

Home Hub Set Top Box

Activity Sensors & Actuators Smart Home Automation 1st Generation Alarms

Service User‟s Home

Telecare Centre

© KD 2009


Technology Drivers • Sensors – Smaller – Longer battery life – More aethestically pleasing – Body worn (inside or outside) – Integrated into fabric of home

• Connectivity – Blue-tooth – Zigbee – RFID – RuBee – Interoperability

• Mobile Communication


REACTIVE EMERGENCY ALARM SYSTEM 1st. Generation ADVICE, INFORMATION, ENTERTAINMENT AND COMMUNICATION SYSTEMS (3rd. Generation)

Telecare SENSORS FOR RISK MANAGEMENT

t

PROACTIVE LIFE & HEALTH MONITORING (2nd. Generation)

STAND-ALONE ELECTRONIC ASSISTIVE TECHNOLOGIES Generation Zero © KD 2009


Causes of Unplanned Hospital Admissions Focus Group of Community Matrons 1. COPD 2. Chest pain/heart failure 3. Polypharmacy (drug errors) 4. Falls (and “off legs”) 5. Panic with long term conditions 6. Confusion 7. Constipation 8. Urinary retention

Actual Reasons (based on HES data 2003-04)

1. 2. 3. 4. 5. 6. 7. 8.

Mental health conditions COPD Heart disease Gastrointestinal complaints Renal disease Flu & pneumonia Falls (and “off legs”) Polypharmacy


Emergency Detection Sensors 1. Environmental concerns 2. Security issues 3. Social problems 4. Medical alerts Cognition Diabetic coma

Nutrition

Hygiene

Medication concordance

Mobility/ Instability

Continence problems

Heavy drinking

Fever

Mental health crises

Seizures

Blocked catheter

Stroke

Asthma attack

Cardiac arrestŠ KD 2009


TOOLS 4 EASIER LIVING ASSISTIVE TECHNOLOGIES Walking aids

Pavement scooter

TELECARE

Smart homes Health Wheelchairs Promotion Speaking communicator Stair lift

VIRTUAL PRESENCE

Granny-cams Activity monitors Reminder devices Proactive calling Virtual visits Hearing aids Alarm sensors Telehospice Holography Bath hoist Door intercom Movement analysers Remote consultation Exoskeletons Virtual health Level access Actuators & valves coach shower Finder devices Video doorbell Vital signs measurements Remote door entry Spectacles Energy consumption Remote cognitive therapies Page turners Chat-bots Hug suits Security devices monitor Internet Grab rails Remote controls shopping Gait analysis Environmental controller Prediction Ramp

Tap turner

INCREASING LEVEL OF TELECOMMUNICATIONS


Toolbox Approach

Everyone is different! Š KD 2009


Medication Aids

Š KD 2009


Medication Reminders

Š KD 2009


Medication Reminders

Š KD 2009


Generic Reminder Devices

ProActive Reminder Card Used as a Fridge Magnet ~ £30 each (soon)

The MEM-X Device ~ £100 now Neuropage - standard cost of pager rental, airtime and unlimited messages is £60 month, plus a deposit for the pager © KD 2009


In su

lt & si pe c Bu Mu al s rg gg att Ra teri la ac ng r y in g k pe

Fear of Crime Women

Ph y

Men 0

5

10

15

20

25

Percentage of Public Expressing Fear

• Many women live in constant fear of crime against their person or against their property • This fear is particularly high amongst those who live alone and those who are full-time carers • It is one of the most likely reasons for older people to give up their own homes and to move into residential care © KD 2009


Older People & the Fear of Crime Older People Worrying About Local Crime 37

London

34

UK Countries/Regions

North East

33

Scotland

31

Midlands

27

Northern Ireland

23

North West

21

South East

19

Wales South West Eastern/Anglia

18 16 % of People Aged over 65

..older people whose homes had been broken into were

twice as likely to be dead within two years as people of a similar age who had not been burgled. ..health deteriorated faster than expected ..some became so frail they had to be moved into care Š KD 2009


Access Management • Key-safes are the easiest method of accessing a key – providing there‟s a key inside! • Digital locks are also becoming popular • Code generation and storage must be managed • Make sure that only door-chains with locks and keys are employed

© KD 2009


Intercoms & Camera Security

Wireless Doorbell & Intercom

Visibell 3 ÂŁ125

With Integrated Door Release Š KD 2009


Fear of Becoming Lost

Š KD 2009


Improving Transport Options

Š KD 2009


Other Mobility Answers

Š KD 2009


Robotic Helpers Rovio 2

enon

CareBot

ConnectR Š KD 2009


Even More Robotic Helpers

UBot5 from the University of Massachusetts Amherst helps older people live at home

Japanese Ladybird toilet cleaning robot for public restrooms Š KD 2009


Where Do We Draw the Line?

Japanese bathing system for older people

RI-MAN robot is equipped with sensors that show it a body's weight, position and smell!

Š KD 2009


Increasing Appeal of Devices in the Home

Therapeutic sensors

Š KD 2009


Practical Digital Assistants • Smart bed – Monitors breathing & sleep disturbance – Turns occupant to avoid pressure sores – Gets you up in the morning

• Dynamic zimmer frame – Helps people to move about – Guides user to destination – Offers supportive comments

• Clever coffee table – Has holes to hold drink containers – Contains compartments for medication – Issues reminders for food, drink & tablets

• Wizard wardrobe – Helps with dressing – Steams shirts, blouses & trousers – Sends dirty clothes down laundry shoot © KD 2009


Amplifying the Body‟s Muscles Exoskeletons

Tibion Powerknee © KD 2009


Cyberdyne out of Tsukuba, Japan is making its power assist robosuit, dubbed Hybrid Assistive Limb (HAL), available as a rental to Japanese patients suffering from neuromuscular disorders, and to those who simply have difficulty walking.

Rental charges are ~ $2200 per month Š KD 2009


REACTIVE EMERGENCY ALARM SYSTEM

ADVICE, INFORMATION, ENTERTAINMENT AND COMMUNICATION SYSTEMS

t

ENVIRONMENTAL SENSING & CONTROL TECHNOLOGIES

Detect changes in habit, activities and vital signs to predict and prevent problems escalating

PROACTIVE LIFE & HEALTH MONITORING

PREVENTION AGENDA © KD 2009


Applying Lifestyle Monitoring

Š KD 2009


Display of Well-being Index Overall average

Mobility Vital signs Nutritional input Personal hygiene Medication compliance

Week Š KD 2009


Presentation of Results

John Smith Bet Jones

Vera Brown

Vera Brown

Average

Elsie Tanner

Mobility

Ena Sharp

Vital signs

Emily Parsons

Nutrition

Maggie Smith

Breathing

Bob Thomas

Medication

63 Š KD 2009


Data Fusion – Dashboard Approach

© KD 2009


HEALTH PROMOTION

ADVICE, INFORMATION, ENTERTAINMENT AND COMMUNICATION SYSTEMS

Technology systems to provide advice, news, entertainment and new on-line services

REACTIVE EMERGENCY ALARM SYSTEM

t

PROACTIVE LIFE & HEALTH MONITORING

ENVIRONMENTAL SENSING & CONTROL TECHNOLOGIES

© KD 2009


Future Telehealthcare Interface Teleconsultations On-line Assessments

Public Health Games & Information & Promotion Entertainment Therapeutic exercises

Health coaching E-Gov news & services

Community news & events Digital/ Interactive TV

Video clips on specific topics

E-mail & Social networks

Discussion groups, „Expert‟ patient forum

Weather & flooding alerts Access to the Internet E-Commerce

Booking transport & appointments Video telephone

Prompts & Reminders

View Well-being Data for self-care

© KD 2009


Telerehabilitation and Prosthesis

Š KD 2009


Virtual Presence Technology

Š KD 2009


Internet Shopping York University & Age Concern Net Neighbours Scheme

Also shopping on-line in this aisle are: John Smith Mary Jones Doris Davies Click on to speak to them Click on to see in their trolley Š KD 2009


What Are the Obstacles? • People still trust and prefer people – – – –

Fear of “Big Brother” Reliability is questioned “Technology” name isn‟t liked LET‟S FIND A NEW ONE

• Devices are stigmatising – People deny that they are old and unable to perform routine tasks until it‟s too late – Designs tend to be for younger people – DEMAND INCLUSIVE DESIGNS

• Reluctance to pay for anything – BUT PEOPLE WILL PAY PRIVATELY OR CONTRIBUTE IF THEY KNOW IT WILL HELP THEM

• Lack of knowledge on what‟s available & useful – USABILITY REPORTS, GOOD NEWS STORIES

© KD 2009


What Can We All Do? • Fully understand the needs of the target market – Older people are heterogeneous – Their views change in response to difference circumstances including cost and their needs – Give prototypes to focus groups for comment

• Understand the strengths (and weaknesses) of existing players in this market – Reluctance to throw away existing infrastructure investment – Know the limits of what can be changed

• Work together to overcome the hurdles – Establish Special Interest Groups to develop partnerships – Use knowledge of government support agencies & universities

• Don‟t try to move too quickly – The window of opportunity is wide – You can‟t afford to mass produce products that don‟t work! © KD 2009


THANK YOU FOR YOUR ATTENTION

For copies of papers and articles on which this presentation has been based, please e-mail: dr.k.doughty@btinternet.com Tel.: 01286 678648


The Telecare and Telehealth Market – Opportunities for SMEs