Home automation for the elderly and disabled

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Home automation for the elderly and disabled focuses on making it possible for older adults and people with disabilities to remain at home, safe and comfortable. Home automation is becoming a viable option for older adults and people with disabilities who would prefer to stay in the comfort of their homes rather than move to a healthcare facility. This field uses much of the same technology and equipment as home automation for security, entertainment, and energy conservation but tailors it towards old people and people with disabilities.

Contents

Concept

There are two basic forms of home automation systems for the elderly: embedded health systems and private health networks. Embedded health systems integrate sensors and microprocessors in appliances, furniture, and clothing which collect data that is analyzed and can be used to diagnose diseases and recognize risk patterns. Private health networks implement wireless technology to connect portable devices and store data in a household health database. Due to the need for more healthcare options for the aging population "there is a significant interest from industry and policy makers in developing these technologies". [1]

Home automation is implemented in homes of older adults and people with disabilities in order to maintain their independence and safety, also saving the costs and anxiety of moving to a health care facility. [2] For those with disabilities smart homes give them opportunity for independence, providing emergency assistance systems, security features, fall prevention, automated timers, and alerts, also allowing monitoring from family members via an internet connection.

Telehealth implementation

Background

Telehealth is the use of electronic technology services to provide patient care and improve the healthcare delivery system. The term is often confused with telemedicine, which specifically involves remote clinical services of healthcare delivery. Telehealth is the delivery of remote clinical and non-clinical services of healthcare delivery. Telehealth promotes the diagnosis, treatment, education, and self-management away from health care providers and into people's homes. [3]

Reasons for implementation

The goal of telehealth is to complement the traditional healthcare setting. There is an increased demand on the healthcare system from a growing elderly population and shortage of healthcare providers. [4] Many elderly and disabled patients are faced with limited access to health care and providers. Telehealth may bridge the gap between patient demand and healthcare accessibility. [4] Telehealth may also decrease healthcare costs and mitigate transportation concerns. [5] For the elderly and disabled populations, telehealth would allow them to stay in the comfort and convenience of their homes. [6]

Elderly population

Geriatrics is the role of healthcare in providing care to the elderly population. The elderly population involves many health complications. According to the National Institute of Health, "the main threats are non-communicable diseases, including heart, stroke, cancer, diabetes, hypertension, and dementia". Telehealth may help provide management and monitoring of chronic disease in patient homes. [6]

One telemonitoring device measures vital signs: blood pressure, pulse, oxygen saturation, and weight. [6] Another telemonitoring device is video-conferencing, which can provide patient-provider consultation and electronic delivery of medication instructions and general health information. [7] Some studies have been done to analyze the effectiveness of telehealth on the elderly population. Some have found positive telehealth effects including reduction of symptoms and self-efficacy in the elderly population with chronic conditions. [8] Other studies have found the opposite effect, where telehealth home care produced greater mortality than the traditional hospital setting. [9] Then there are other studies that have found inconclusive results.

Disabled population

Persons with severe functional disabilities are statistically the highest users of all health care services and represent a large portion of health care costs and designated service. The disabled population requires many self-monitoring and self-management strategies that place a strenuous burden on healthcare providers. Telecommunications technologies may provide a way to meet the healthcare demands of the disabled population. According to the National Institutes of Health, "the largest proportion of health care... result from individuals with severe functional disabilities, such as stroke and traumatic brain injury". [10] Patients with functional disabilities may benefit from telehealth care. According to the World Health Organization, functional limitation refers to the physical or mental conditions, which impair, interfere with, or impede one or more of the individual's major life activities and instrumental activities of daily living. [11] Patients with spina bifida, musculoskeletal disorders, mental illness, or neurological disorders may also benefit from telehealth care services. Telehealth technologies include vital sign telemonitoring devices, exercise routines, problem-solving assessments, and therapeutic self-care management tasks. [10] Telehealth care, however, is not sufficient in complete care but rather a supplement of separate care.

Ethical concerns and legalities

Concerns of telehealth implementation include the limited scope of research that confirm conclusive benefits of telehealth in comparison to the healthcare setting. Currently there is no definitive conclusion that telehealth is the superior mode of healthcare delivery. [12] There are also ethical issues about patient autonomy and patient acceptance of telehealth as a mode of healthcare. Lack of face-to-face patient-provider care in contrast to direct care in a traditional healthcare setting is an ethical concern for many. [13]

In 2015 the Texas Medical Board ruled that state physicians had to physically meet patients before remotely treating ailments or prescribing medication. The telemedicine company Teladoc sued [14] over the rule in Teladoc v. Texas Medical Board, arguing the bill violated antitrust laws [15] by inflating prices and limiting the supply of health care providers in the state. The bill, meant to go active on June 3, 2015, was then stalled. [14] Teladoc voluntarily dropped the lawsuit in 2017 after Texas passed a new bill allowing for remote treatment without a prior in-person interaction, which Teladoc Health had lobbied heavily for. [15] On September 15, 2017, the Texas Medical Board amended its regulations to allow state-licensed healthcare providers to care for patients without required face-to-face interaction, [16] potentially affecting up to 28 million patients in Texas. [16]

Systems

Home automation for healthcare can range from very simple alerts to lavish computer controlled network interfaces. Some of the monitoring or safety devices that can be installed in a home include lighting and motion sensors, environmental controls, video cameras, automated timers, emergency assistance systems, and alerts.

Security

In order to maintain the security of the home many home automation systems integrate features such as remote keyless entry systems which will allow seniors to view who is at the door and then remotely open the door. Home networks can also be programmed to automatically lock doors and shut blinds in order to maintain privacy.

Emergency assistance systems and tools

Emergency assistance for older adults and people with disabilities can be classified into three categories: First, Second, and Third Generation emergency assistance systems or tools. [17]

First generation

These simple systems and tools include personal alarm systems and emergency response telephones that do not have to be integrated into a smart home system. [17] A typical system consists of a small wireless pendant transceiver to be worn around the neck or wrist. The system has a central unit plugged into a telephone jack, with a loudspeaker and microphone. When the pendant is activated a 24-hour control center is contacted. Generally the 24 hour control center speaks to the user and identifies that help is required e.g. Emergency services are dispatched. The control center also has information of the user, e.g. medical symptoms, medication allergies, etc. The unit has a built in rechargeable battery backup and the ability to notify the control center if the battery is running low or if the system loses power. Modern systems have active wireless pendants that are polled frequently advising battery, and signal strength status as older style pendant could have a battery that has failed rendering the pendant useless when required in an emergency.

Second generation

These systems and tools generate alarms and alerts automatically if significant changes are observed in the user's vital signs. [17] These systems are usually fully integrated into a home network and allow health professionals to monitor patients at home. The system consists of an antenna that a patient holds over their implanted cardiac device to transmit data for downloading over the telephone line and viewing by the patient's physician. The collected data can be accessed by the patient or family members. Another example of this type of system is a Smart Shirt that measures heart rate, electrocardiogram results, respiration, temperature and other vital functions and alerts the patient or physician if there is a problem. [18]

Third generation

These types of systems would help older adults and people with disabilities deal with loneliness and depression by connecting them with other elderly or disabled individuals through the Internet, reducing their sense of isolation. [17]

Reminder systems

Home automation systems may include automatic reminder systems for the elderly. [2] Such systems are connected to the Internet and make announcements over an intercom. They can prompt about doctor's appointments and taking medicine, as well as everyday activities such as turning off the stove, closing the blinds, locking doors, etc. Users choose what activities to be reminded of. The system can be set up to automatically perform tasks based on user activity, such as turning on the lights or adjusting room temperature when the user enters specified areas. Other systems can remind users at home or away from home to take their medicine, and how much, by using an alarm wristwatch with text message and medical alert. Reminder systems can also remind about everyday tasks such as eating lunch or walking the dog.

Some communities offer free telephone reassurance services [19] to residents, which includes both safety check calls as well as reminders. These services have been credited with saving the lives of many elderly and senior citizens who choose to remain at home. [20]

Medication dispensing and spoon-feeding

Smart homes can implement medication dispensing devices in order to ensure that necessary medications are taken at appropriate times. Automated pill dispensers can dispense only the pills that are to be taken at that time and are locked; versions are available for Alzheimer's patients that have a lock on them. For diabetic patients a talking glucose monitor allows the patient to check their blood sugar level and take the appropriate injection. [2] Digital thermometers are able to recognize a fever and alert physicians. Blood pressure and pulse monitors dispense hypertensive medications when needed.

There are also spoon-feeding robots.

Home robotics

Domestic robots, connected to the domotic network, are included to perform or help in household chores such as cooking, cleaning etc. Dedicated robots can administer medications and alert a remote caregiver if the patient is about to miss his or her medicine dose (oral or no-oral medications). [21]

Challenges

The recent advances made in tailoring home automation toward the elderly have generated opposition. It has been stated that "Smart home technology will be helpful only if it is tailored to meet the individual needs of each patient". This currently creates a problem because many of the interfaces designed for home automation "are not designed to take functional limitations, associated with age, into consideration". [2] Another presented problem involves making the system user-friendly for the elderly who often have difficulty operating electronic devices. The cost of the systems has also presented a challenge, as the U.S. government currently provides no assistance to seniors who choose to install these systems (in some countries such as Spain the Dependency Law includes this assistance).

The biggest concern expressed by potential users of smart home technology is "fear of lack of human responders or the possible replacement of human caregivers by technology", [2] but home automation should be seen as something that augments, but does not replace, human care.

See also

Related Research Articles

<span class="mw-page-title-main">Assistive technology</span> Assistive devices for people with disabilities

Assistive technology (AT) is a term for assistive, adaptive, and rehabilitative devices for people with disabilities and the elderly. Disabled people often have difficulty performing activities of daily living (ADLs) independently, or even with assistance. ADLs are self-care activities that include toileting, mobility (ambulation), eating, bathing, dressing, grooming, and personal device care. Assistive technology can ameliorate the effects of disabilities that limit the ability to perform ADLs. Assistive technology promotes greater independence by enabling people to perform tasks they were formerly unable to accomplish, or had great difficulty accomplishing, by providing enhancements to, or changing methods of interacting with, the technology needed to accomplish such tasks. For example, wheelchairs provide independent mobility for those who cannot walk, while assistive eating devices can enable people who cannot feed themselves to do so. Due to assistive technology, disabled people have an opportunity of a more positive and easygoing lifestyle, with an increase in "social participation", "security and control", and a greater chance to "reduce institutional costs without significantly increasing household expenses." In schools, assistive technology can be critical in allowing students with disabilities to access the general education curriculum. Students who experience challenges writing or keyboarding, for example, can use voice recognition software instead. Assistive technologies assist people who are recovering from strokes and people who have sustained injuries that affect their daily tasks.

<span class="mw-page-title-main">Telehealth</span> Health care by telecommunication

Telehealth is the distribution of health-related services and information via electronic information and telecommunication technologies. It allows long-distance patient and clinician contact, care, advice, reminders, education, intervention, monitoring, and remote admissions. Telemedicine is sometimes used as a synonym, or is used in a more limited sense to describe remote clinical services, such as diagnosis and monitoring. When rural settings, lack of transport, a lack of mobility, conditions due to outbreaks, epidemics or pandemics, decreased funding, or a lack of staff restrict access to care, telehealth may bridge the gap as well as provide distance-learning; meetings, supervision, and presentations between practitioners; online information and health data management and healthcare system integration. Telehealth could include two clinicians discussing a case over video conference; a robotic surgery occurring through remote access; physical therapy done via digital monitoring instruments, live feed and application combinations; tests being forwarded between facilities for interpretation by a higher specialist; home monitoring through continuous sending of patient health data; client to practitioner online conference; or even videophone interpretation during a consult.

eHealth describes healthcare services which are supported by digital processes, communication or technology such as electronic prescribing, Telehealth, or Electronic Health Records (EHRs). The use of electronic processes in healthcare dated back to at least the 1990s. Usage of the term varies as it covers not just "Internet medicine" as it was conceived during that time, but also "virtually everything related to computers and medicine". A study in 2005 found 51 unique definitions. Some argue that it is interchangeable with health informatics with a broad definition covering electronic/digital processes in health while others use it in the narrower sense of healthcare practice using the Internet. It can also include health applications and links on mobile phones, referred to as mHealth or m-Health.

<span class="mw-page-title-main">Telenursing</span>

Telenursing refers to the use of information technology in the provision of nursing services whenever physical distance exists between patient and nurse, or between any number of nurses. As a field, it is part of telemedicine, and has many points of contacts with other medical and non-medical applications, such as telediagnosis, teleconsultation, and telemonitoring. The field, however, is still being developed as the information on telenursing isn't comprehensive enough.

Telecare is technology-based healthcare such as the monitoring of patient vital organs so that they may remain safe and independent in their own homes. Devices may include health and fitness apps, such as exercise tracking tools and digital medication reminder apps, or technologies that issue early warning and detection. The use of sensors may be part of a package which can provide support for people with illnesses such as dementia, or people at risk of falling.

Health technology is defined by the World Health Organization as the "application of organized knowledge and skills in the form of devices, medicines, vaccines, procedures, and systems developed to solve a health problem and improve quality of lives". This includes pharmaceuticals, devices, procedures, and organizational systems used in the healthcare industry, as well as computer-supported information systems. In the United States, these technologies involve standardized physical objects, as well as traditional and designed social means and methods to treat or care for patients.

<span class="mw-page-title-main">Telerehabilitation</span> Delivery of rehabilitation services over the internet

Telerehabilitation (or e-rehabilitation is the delivery of rehabilitation services over telecommunication networks and the internet. Telerehabilitation allows patients to interact with providers remotely and can be used both to assess patients and to deliver therapy. Fields of medicine that utilize telerehabilitation include: physical therapy, occupational therapy, speech-language pathology, audiology, and psychology. Therapy sessions can be individual or community-based. Types of therapy available include motor training exercises, speech therapy, virtual reality, robotic therapy, goal setting, and group exercise.

A medical alarm is an alarm system designed to signal the presence of a hazard requiring urgent attention and to summon emergency medical personnel. Other terms for a medical alarm are Personal Emergency Response System (PERS) or medical alert. It is especially important to recognize the need to respond to situations where the person is unable to summon help.

<span class="mw-page-title-main">Telepsychiatry</span> Mental-health care by telecommunication

Telepsychiatry or telemental health refers to the use of telecommunications technology to deliver psychiatric care remotely for people with mental health conditions. It is a branch of telemedicine.

<span class="mw-page-title-main">Caregiver</span> Person helping another with activities of daily living

A caregiver, carer or support worker is a paid or unpaid person who helps an individual with activities of daily living. Caregivers who are members of a care recipient's family or social network, and who may have no specific professional training, are often described as informal caregivers. Caregivers most commonly assist with impairments related to old age, disability, a disease, or a mental disorder.

<span class="mw-page-title-main">First Databank</span>

First Databank (FDB) is a major provider of drug and medical device databases that help inform healthcare professionals to make decisions. FDB partners with information system developers to deliver useful medication- and medical device-related information to clinicians, business associates, and patients. FDB is part of Hearst and the Hearst Health network.

Connected health is a socio-technical model for healthcare management and delivery by using technology to provide healthcare services remotely. Connected health, also known as technology enabled care (TEC) aims to maximize healthcare resources and provide increased, flexible opportunities for consumers to engage with clinicians and better self-manage their care. It uses readily available consumer technologies to deliver patient care outside of the hospital or doctor's office. Connected health encompasses programs in telehealth, remote care and disease and lifestyle management, often leverages existing technologies such as connected devices using cellular networks and is associated with efforts to improve chronic care. However, there is an increasing blur between software capabilities and healthcare needs whereby technologists are now providing the solutions to support consumer wellness and provide the connectivity between patient data, information and decisions. This calls for new techniques to guide Connected Health solutions such as "design thinking" to support software developers in clearly identifying healthcare requirements, and extend and enrich traditional software requirements gathering techniques.

Interactive patient care (IPC) refers to an approach in health care that places the emphasis on providing entertainment and educational resources to the patient bedside via the in-room TV. However, momentum is growing for IPC to include more patient-facing interfaces such as mobile, Smart TV, and social applications as well as the self-service patient portal. This evolution of IPC expands the engagement footprint beyond the bedside to include the entire continuum of a patient's care - primarily adding the home. These technologies can provide interactive services that are personalized to the patient’s condition and provide healthcare workers with patient education, pain assessment and medication teaching. IPC solutions can also integrate with traditional EMR and hospital IT systems such as Cerner, McKesson, and GE Healthcare, for example, but are more directly patient-centric applications, whose delivery helps hospitals meet service and quality requirements. In light of meaningful use, it is also speculated that providing IPC through multiple technology modes will help US hospitals reach their 5% patient-utilization requirement expected in 2014.

<span class="mw-page-title-main">Remote patient monitoring</span>

Remote patient monitoring (RPM) is a technology to enable monitoring of patients outside of conventional clinical settings, such as in the home or in a remote area, which may increase access to care and decrease healthcare delivery costs. RPM involves the constant remote care of patients by their physicians, often to track physical symptoms, chronic conditions, or post-hospitalization rehab.

Digital health is a discipline that includes digital care programs, technologies with health, healthcare, living, and society to enhance the efficiency of healthcare delivery and to make medicine more personalized and precise. It uses information and communication technologies to facilitate understanding of health problems and challenges faced by people receiving medical treatment and social prescribing in more personalised and precise ways. The definitions of digital health and its remits overlap in many ways with those of health and medical informatics.

Telehomecare (THC) is a subfield within telehealth. It involves the delivery of healthcare services to patients at home through the use of telecommunications technologies, which enable the interaction of voice, video, and health-related data. The management of care is done from an external site by a healthcare professional.

Healthcare CRM, also known as Healthcare Relationship Management, is a broadly used term for a Customer relationship management system, or CRM, used in healthcare.

Teladoc Health, Inc. is a multinational telemedicine and virtual healthcare company headquartered in the United States. Primary services include telehealth, medical opinions, AI and analytics, telehealth devices and licensable platform services. In particular, Teladoc Health uses telephone and videoconferencing software as well as mobile apps to provide on-demand remote medical care.

This list of telemedicine services providers is for notable telemedicine, telehealth, and mobile health providers and services. This includes virtual care facilities for remote care, services or platforms used for specific steps within the healthcare industry, and clinical navigation.

<span class="mw-page-title-main">Impact of the COVID-19 pandemic on the telehealth industry</span> Impact of coronavirus on telehealth

Telehealth is the practice of providing healthcare via communication between the healthcare practitioner and the patient through electronic (virtual) methods such as telephones, smartphones, tablets, and computers. Telehealth permits patients to communicate with professionals via telephone, secure email, video chat, and in some instances secure messaging. Physicians may also utilize the telehealth systems for remote monitoring of patients at home. When the telehealth industry was founded, it was primarily used to provide services to underserved and rural area patients, enabled people to connect to specialists not located nearby. Telehealth was initially used predominantly for specialties such as cardiology, neurology, mental health, and dermatology. Telehealth has expanded to include many new applications such as physical therapy through digital monitoring tools and surgery done remotely using robots. The first major telehealth company, Teladoc, was founded in 2002.

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Further reading