This week’s Modern Aging blog post comes from an American medical illustrator with a passion to improve health communication for elderly through visual media. Please read about the digital tool she is developing:
“I am excited to share with you an idea I have been developing as a social innovation for the elderly in health care. Today I will tell you about myself, and why I am considering the health needs of the elderly in Sweden. I will introduce the problem needing attention and how I propose to tackle it. Finally, I will let you know how you can connect with me if you would like to be part of this dialogue!
So who am I, and what brought me to Sweden? Well, my name is Anneliese, and I am an American citizen with Swedish heritage from both sides of my family. In 2010 I traveled to the “motherland” to see where my farmor, and my mormors parents came from. While visiting, I bonded with new friends and distant relatives, but visiting with relatives from my grandparent’s generation over fika was particularly special for me. During that trip I decided I wanted to come back to Sweden to study and experience more of Swedish society.
While back in the US making plans to return to Sweden, I was witness to the failing health and death of my mormor, Anna, and morfar, Winston. Winston lost his life, at 93 years of age, as a result of Alzheimer’s. While Anna, who suffered from morbidities common in the elderly, died only a few months after at 91 years. These experiences with my own family helped me to realize many of the challenges facing our aging global population. Now, I look to apply my education, work experience and research to help address these challenges.
My recent research has focused on the communications between patients and their care providers. The clinical setting can present many communication barriers, including a power dynamic between the patient, with limited knowledge, and the care provider, with greater knowledge. For the elderly, dementia, learning style, literacy and language skills can also contribute to communication barriers they face when determining their health needs. Further, many elderly patients have an increased number of health appointments where they might struggle to remember what to ask their care provider, or may not be aware of the proper questions to ask. Additionally, they will need to remember details communicated to them after an appointment. If not recorded, these details can be easily forgotten. My solution is simple, “Ask for Answers.”
Ask for Answers is a media based tool (web/app), which aims to arm the aging population with the questions they should have available when visiting a health provider. The questions target their specific communication needs and are broken down by medical specialties to be more effective. Patients can use the electronic interface to access their questions, type answers, exchange email with the provider, record audio of answers – which can then be transcribed, and even take photos of drawings or notes. The information would then be accessible later when the patient may have trouble recalling details from the appointment, or need to share them with another care provider.
Ask for Answers is centered on improving health communications between care providers and the elderly. It is a simple, user-friendly tool that focuses on enabling and empowering aging patients to better manage their health. With the aid of Ask for Answers, patient knowledge and satisfaction may increase, potentially resulting in improved health outcomes.”
Written by Anneliese Lilienthal
Our most loyal readers on Silverevolution may remember the program Modern Aging that we wrote about in April (see the post HERE). This innovation program for young entrepreneurs with ideas for the elderly kicked off in August this year. A group of 7 entrepreneurs have been selected based on the potential of their improvement idea as well as their motivation to lead the way in transforming the elderly care sector. We are currently in the act of developing their ideas with the help of mentors and coaches and in close discussion with the elderly themselves. During the next couple of weeks the participants will blog about their ideas on the Forum for Social Innovation Sweden and we will post them here on Silverevolution as well.
First in line; introducing himself and his idea is Victor Nordlind. This is his story:
One may ask why a person who is attending one of the world’s top hotel schools would want to pursue a career in developing and improving the elderly care. Most people expected me to walk in my father’s footsteps in the restaurant industry, rather than radically changing field to Elderly care.
But as I was required to carry out a feasibility study about an existing retirement home during my first two years at Ecole Hôtelière de Lausanne (EHL), I was given the opportunity to see the true potential within this industry. It encouraged me to apply for an internship within elderly care, which I am currently pursuing within Strategy and Business Development at Ambea Sverige, whose affiliation is Carema Care. For me, elderly care is an industry where innovation is necessary in order to provide the correct quality of life, which in my opinion is the meaning of hospitality.
When I first came across the Modern Aging program, I did not have a specific idea for elderly in mind. When developing the idea, it was equally important to link the project back to my studies, as to work with something that may truly make a difference within the elderly sector. I decided to contact a friend who has several years of experience within elderly care, and who is currently working in a nursing home here in Sweden. I was convinced that my determination combined with her extensive experience would bring something innovative out of the meeting.
As expected, we had a very interesting discussion, which brought several ideas to the table. Most of them were linked to the use of more technology, which is a frequently debated topic when talking about improvements within elderly care. The trend of using technology to improve efficiency is relatively new in the industry while it has been an essential part of the hotel and restaurant industry for years. More and more apps and other technical devices are being developed to simplify everyday activities for the elderly.
However, one question that came up during the meeting was “how can we use technology to better involve the caregivers within elderly care?” These professionals have valuable knowledge and experience, which they should be able to share easily. With today’s progression of social media and online forums, a place for caregivers and other health care professionals to meet online should be developed. There, they may share ideas, knowledge and ask questions to one another over space and time. This will not only simplify and streamline the daily work, but it will also improve the quality of care in nursing homes in the long run. A forum like this needs to be strictly confidential with only registered users permitted access. The idea is also that this platform shall be the forum that compiles and disseminates knowledge of the latest advances in medical, social and technological solutions for the elderly.
My current internship at Ambea combined with the Modern Aging program has helped me to better understand the current market as well as the future prospects of elderly care in Sweden. To date, Modern Aging has hosted several seminars and workshops carried out by inspiring guest speakers from various fields, such as young entrepreneurs, lecturers from top universities, and professionals from the public health care sector. With this promising start, I am curious and eager to find out where the program is going to take us.
EU-funded unique international project aimed at providing safer and healthier aging is led by researchers at Örebro University (Sweden) in collaboration with twelve partners from six countries Sweden, Italy, Spain, Portugal, UK and Slovenia. The unique feature of the project is that it will provide seniors with smart home system combining both long-term health evaluation and caregiver-user interaction.
The project is called “Giraff” and received its name after remotely controlled mobile robot “Giraff” equipped with a display and loudspeaker. This robot lays in the heart of the smart home system in combination with continuous monitoring through a network of sensors.
Multiple sensors are installed in the apartment and can measure blood pressure, body temperature and register movements. Data from the sensors will enable to identify if someone takes a sudden fall or doesn’t move for unusually long time, analyze sleeping pattern and level of physical activity, which can be of particular importance for physiotherapists. All the data collected from sensors are analyzed by an intelligent system, which is able to quickly alert the caregiver if something goes wrong and to conduct long-term health assessment of the seniors, thus giving caregivers a tool to adapt care plan to guarantee better quality of life.
Robot “Giraff” is designed for conducting virtual visits based on users need or on caregiver’s and family member’s intention to talk to the senior about his/her health measurements. “Giraff” can move autonomously around the apartment, find where senior is located or follow the senior around the apartment during “virtual” physician visit. In future, it will be senior’s decision on whether to use “Giraff” to have a virtual meeting with caregiver or make a journey to the healthcare center instead.
When it comes to privacy of health data, it will be only user who can allow access to health information for concerned family members or other caregivers. This will contribute to creating a user-friendly environment, where seniors will understand that they can receive an opportunity to improve their quality of life while feeling secure about privacy of their data.
The project has come to a testing phase in 15 real homes in Sweden, Italy and Spain. Last news tells about system installation in the homes of elderly women living alone in Malaga (Spain) and in Örebro (Sweden).
It is inspiring to see how modern digital technology can improve quality of life for elderly people! Stay tuned for future blog posts on digital technology for elderly care.
Picture taken from:
For the last decades, development of Information Technologies (IT) and sensor technologies has resulted in a great number of new services such as smartphones, tablet PC’s, wireless video games, robotics, Skype to name a few. With some delay in time these technology advances started to change the way healthcare services are delivered with areas of mhealth (using mobile devices for healthcare service delivery) and telehealth (delivering healthcare over distance) gaining wider acceptance. So now it is time to create a series of blog posts under the common name “Digital aging” to highlight solutions that are already available and can be used. Stay tuned to the next blog posts, if You want to know more.
One of the trends of applying new technologies is remote home monitoring of elderly people using a set of sensor devices and wireless data transfer. The main advantage of these tools is that it gives today’s active seniors and their families freedom, security and the ability to manage their health at home or away. Basic functionality of the remote home monitoring system can include:
- automated fall detection
- location tracking
- remotely managed two-way voice
- alert system
Additionally, some of the systems support integration with other health measuring devices and can track blood pressure, weight, blood glucose level and even transfer all these data to the patient’s Electronic Health Record (I will tell more about it in the later posts)
How it works?
A senior active citizen will wear a lightweight pendant everywhere he goes: inside the house, to the library, swimming pool, supermarket, park, etc. This pendant will be waterproof, easy-to-use and not necessary to be taken off even while charging and constantly serving as a part of a “Mobile personal emergency response service”, which will track the senior person movements, detect any case of possible fall and location of a senior and send alert to the caregiver/assistant.
As an example, Susanne, 82 years old, wants to live an active life and not be tied to her healthcare team, which includes her family and healthcare professionals. She wears a light device with her anywhere she goes. While walking in the park, Susanne feels dizzy and presses the help button on the device, thus initiating a two-way voice conversation with a support center. She tells about her condition and the support center assistant makes a decision, whom to send to help Susanne to get home safely. In case Susanne falls, the system will automatically track her location and an ambulance car will pick her up.
I believe such techniques are very inspiring and these types of solutions are already on the market with for example “GoSafe” and “Libris”. Moreover, in US, AT&T is offering “Libris” solution as part of a managed service for doctors and health insurers already. Why not set “free” both active seniors and their families?
“AT&T and Numera Combine Personal Safety and Home Health management with New Personal Health Gateway”. Accessed at: http://www.att.com/gen/press-room?pid=23809&cdvn=news&newsarticleid=36052
Image : www.freedigitalphotos.net
A while ago I received an email from a developer at the Social Service Center in a municipality located in the south of Sweden. She had bought 30 iPads that she had distributed to disabled, elderly, drug addicts and mentally ill adults within the municipality. She wrote to me as she and her colleagues were amazed by the results! A young mentally disabled man who normally did not move much, all of a sudden became very active to everybody’s surprise. The personnel filmed him with an iPhone and sent to his parents who were thrilled. An elderly Czech woman with dementia got the opportunity to listen to her native language on the iPad. The happiness that brought to her was enormous. An elderly man known for always acting out and being aggressive became calm and happy simply from watching puppies on the iPad. An elderly lady photographed herself from different angles making sure she looked her best in every picture, strengthening her self-image and self-esteem.
In addition, the elderly could easily stay in touch with relatives, near and far, by using Skype. The drug addicts were able to go online and read magazines, play games, paint and play instrument through the iPad.
The woman who emailed me concluded by saying that these changes in behavior may look small and insignificant but for the people going through this it is of great importance. This is a great example on how we can update the way we provide care for the elderly and invite them to take part of the high-tech devices that have already become a natural part of our lives.
In 1983, the World Health Organization put cancer as a leading cause of death in South Korea. It has an immense impact with 64,000 people dying every year in Korea due to the disease. Luckily, the latest development in cancer treatment is available in Korea: Cyber Knife Radio Surgery. There are currently some hundred cyber knife systems installed in only few countries in the world. Korea was among the first to implement it and today, it has one of the most numbers of installed systems. Compared to UK and US, a cyber knife treatment costs less in Korea.
Cyber knife systems have been used to treat tumors in upper spine, head and neck since 1999 and in the rest of the body since 2001. John Adler invented the system for cancer treatment. It is made to deliver radiotherapy for malign and benign cancer tumors at all stages in specific parts of the body in a non-invasive way. It uses a real-time image guide to find tumors even if the patient is moving, and to deliver radiation with highest accuracy. It eliminates the need for invasive surgeries.
There are various benefits of the technique, e.g. faster procedures in comparison to other radiation methods, no requirement for hospitalization, no need for anesthesia and almost no post-operative care. Cyber knife surgery can even be used for tumors that have already received the maximum dose of radiation. There are no incisions or cuts, and recovery time is not needed. It can even be used for tumors in the spine, which are hard to treat because they are moving while the patient is breathing. The cyber knife can pinpoint the exact location of the tumor and beam into it without damaging other surrounding tissues. That leads to a shorter treatment period and a quick recovery. Treatment can be finished in less than five days on an outpatient basis, without spending a single night at the hospital.
One hospital in Korea is specialized in treating spine cancer. The oncology experts in Korea are highly trained and have years of experience in radiology and cyber knife cancer treatment. Medical staff in Korean hospitals are English speaking and communication will not be a problem when getting medical treatment there.
Cyber knife surgery abroad:
Cyber knife Treatment for Spine Cancer
Imagine you were able to simply replace one of your organs once you fall sick. You just go to the hospital and quickly come out with a new intestine, kidney, liver or even heart, if an incurable disease was present. This sounds more like an idea from a science fiction movie than a like a feasible therapeutic option, but research on regenerative medicine and the engineering of “artificial” organs is happening to make these options a reality for many patients worldwide in the near future.
Nowadays, chronic diseases are a major health issue in almost every country – they cannot be cured and the patient’s best bet is to prevent those diseases and their complications. We are talking about e.g. diabetes, heart and kidney failure, hepatic disease and hypertension. After treatment has failed the last resort for many patients is organ transplantation. However, as simple as it may sound, there are countless complications involved, as the organ has to be compatible with the patient. The patient will have to remain on medication to lower his immune system response to the minimal for the rest of his life, which can make him more vulnerable to infections.
By the year 2010, over 90,000 people were signed in for the waiting list for a kidney transplant in the US and 3,000 at any given day for a heart transplant. Many patients who have no other choice of treatment wait, and most of the times death arrives faster than the suitable organ.
What if you could build a custom-made organ according to a patient’s need? A group of biomedical researchers at Karolinska Institutet in Sweden have pioneered what can be the first step in the beginning of a science fiction medicine: working with stem cells, which are cells capable of giving rise to any human tissue. They have managed to make a fully artificial trachea from scratch and implant it in a patient with cancer without any immunological reaction. The newly formed organ is built on a PET mold, yes the same used in bottles, which is as anatomically identical to the patient’s actual trachea – not only in shape but also in composition. The mold is filled with stem cells from the patient himself. Giving rise to a new and fully functional organ ready to be replaced.
The patient who went under this treatment is currently under annual checkups while living a normal life without health related restrictions. This is only the first step, but it is a firm step.
Thanks to Antonio Beltrán Rodríguez for sharing this post with our silverevolution-readers. Antonio is a biomedical student at Karolinska Institutet. Contact: firstname.lastname@example.org
In the case of increasing life expectancy and low fertility rates, the percentage of elderly in Singapore is on a rise. The percentage of elderly aged 65 and above increased from 7.3% in 2000 to 9.3% in 2011.
This percentage is expected to rise up to 18.7% by 2030. This shows that the percentage of elderly in Singapore has been and will be increasing drastically over the years. Indeed, the ‘silver tsunami’ is approaching Singapore.
With the growing concern for the elderly, ideas and innovations are constantly tapped into to find new ways to counter the problems the elderly faces.One such take was by a Singapore-based sustainable business incubator, Silverline — which has decided to take on an initiative with SingTel. While several elderly are unable to afford to buy and use smartphones due to the price and perhaps not being IT-savvy enough, Silverline has offered an ingenious way which can kill two birds with one stone. One, it solves the problem the elderly faces. Two, it also reduces e-waste, which is an environmental problem.
“The mobile phone industry works by enticing customers to swap their old phones for new ones in just a year or two. That is a tremendous waste. Electronic devices can leak toxic chemicals once they are disposed of.” – Silverline
Sliverline saw an opportunity in these wastes and decided to turn it into their advantage to them. By introducing a new policy, SingTel customers who are renewing their contract and purchasing a new smartphone with SingTel will be offered the option of gifting their old devices to a senior citizen. In this way, both parties are able to gain something out of it. When the user decides to get the newest model, his/her older phone still can come into good use and benefit the society (in this case, the elderly) and also the environment (in this case, decreasing e-waste).
By collaborating with SingTel, the user also gets to enjoy the benefits such as having a cut in their monthly bills.
Therefore and however, these smartphones that the elderly can expect are not just any ordinary smartphones. They are refurbished second-hand devices that come along with senior-friendly apps installed.
An example of such an application is Connect, which presents the contact list in a visual format to aid the visually impaired. Another senior-friendly application, Well Being, provides reminders for taking medicine, drinking water, and doing exercise.
These are just some of the apps that are available out of several others, which can be found here.
Furthermore, if a user decides to nominate a senior citizen they know (normally it would be their parents), a refurbished smartphone by Silverline will be provided on the spot — with the addition of a mobile plan being fee for the senior citizen and will be added to the customer’s existing monthly mobile bills. This in turn for the business parties involved will create a new market.
The solution also poses some challenges to be overcome. Even though social workers are available to help out the elderly in using the smartphones, it will still take time for the elderly to get used to it.
Here is a video on how one of the many elderly is being impacted.
We believe that this project is the start of a neat solution socially, environmentally and economically.
Sources and references:
Nowadays, a lot of research is conducted in the area of healthcare robotics, which has the potential to increase the quality of life for our silver population. Imagine!
I would like to tell you about the examples of New Zealand and South Korea – two countries that are combining their knowledge in order to build and develop something groundbreaking. Here, South Korea contributes from the hardware-side, while New Zealand is busy developing the latest software (check out: HealthBots Project, launched in 2008).
Healthcare robots that can take grandma’s heart rate or blood pressure are the outcome of the research. But besides simple medical jobs, robots can also play a tremendous role in monitoring, as they are able to store and manage the patient’s relevant medical data. All this can make elderly care much more cost-effective.
Another idea is that robots can enhance old people’s quality of live by offering entertainment, e.g. through music, films, games and the use of social media as Skype.
All this sounds futuristic, but the question is if it is a concept that will be feasible: Will decision-makers be willing to invest in healthcare robotics? And will our grandparents (our parents? we? our kids?) enjoy interaction with robots? A lot more studies have to be carried out in order to find out more about cost-effectiveness, but particularly about interaction between human beings and machines – and thus, about the increase (or not) of people’s quality of life.
Healthcare robots could change lives: http://www.msi.govt.nz/update-me/success-stories/research/healthcare-robots-could-change-lives/ (December 2011)
The Community Transportation Association (CTAA) and the Beverly Foundation of the United States brought forth a quote in their report from rural America: “Many of our innovations are by necessity, not by design.” Being driven by necessity is, unfortunately, a hard and cold fact for innovations in general. Only at the brink of when we are about to run out of a resource are our major leaders interested in bringing something new forward. Concerning transportation — and particularly in rural areas — it is indeed a necessity to consider the elderly population.
A summary of CTAA’s and Beverly Foundation’s findings :
(1) The out-migration of the younger population,
and the in-migration and aging-in-place of the older
population, has resulted in an increase in the
population that is less mobile and less able to drive
or navigate transportation services.
(2) Many seniors, especially those who are frail and
in need of assistance, depend on community
transportation services to get to both life sustaining
and life enriching activities.
(3) Transportation services face numerous
operational and financial challenges in meeting the
transportation needs of seniors.
(4) Transportation services generally address
everyday challenges such as scheduling with everyday
solutions such as technology.
(5) In addition to everyday solutions, many
transportation services successfully introduce new
or novel changes from the standard way of doing
things. Such changes generally are described as
According to this source, the Keys to Innovation (beyond leadership) include A Point of Origin (i.e. Why is this innovation needed? In this case, transportation may be forced to shut down if nothing is done due to a financial crisis with driver salaries, etc.), An Idea Factory (i.e. Where innovations are created. For example, a volunteer driving program), People Markers (i.e. The people define the innovation. For example, riders recruit drivers and drivers recruit riders), and last but not least, a Receptive Culture (i.e. The status of the society’s willingness for change.)
As the decline of infrastructure was apparent in rural America — and the rate with which the elderly population rose higher than when compared to urban America (also considering the differential between the youth leaving vs. the older staying) — the elderly in these areas have been having a challenge. Limitations include the lack of novel treatments and care, destination travel (with the factor of time — especially for long medical trips), and social isolation. But despite these enormous challenges, the Beverly Foundation and CTAA claimed that rural America is “doing a lot with a little,” so to speak.
My grandmother is in her 90′s and lives around 200 kilometers north of Manila, Philippines. She’s cared for by a live-in informal caregiver and my little heartache is that I don’t get to visit her often. I’m a doctor and the least I could do is monitor how she’s doing. Her physical therapist drops in once a week, but leaves no beside record of the physical therapy regimen administered to my grandma.
I’ve heard that some households install a CCTV camera in their grandmother’s room, and monitor granny online from London or wherever they work. Others make regular phone calls, or at least sends a SMS to the caregiver to ask for updates. Given the concern and high care we give our grandparents, telehealth services similar to the ones described above could allow for regular monitoring of their condition, which would provide loved ones with security and peace of mind.
Telehealth for the elderly, or telegeriatric services could be provided more widely if local governments would take the lead. It would be great, for instance, if my grandmother could be enrolled in an elderly care program in her town. Aside from being a viable health program, this is also a politically attractive project. The elderly account for around 7% of the population and are influential voters. The question is, how do we induce mayors to include telegeriatrics in their health programs?
Government staff do not readily adopt new technologies for their workflow unless sanctioned by their supervisors. Telehealth is already widely practiced, albeit informally. Doctors and nurses often get SMS and voice calls from family and friends asking them for health advice for little complaints that are too minor to warrant an actual visit to the clinic.
How do we shift from informal telegeriatrics to more programmatic and sanctioned telegeriatrics? Telehealth improves health services when it enhances the interaction between the patient and health care team in between face-to-face visits (Rupper et al 2008). Smith and Clay (2009) recommend that adequate funding be provided by government to jump-start the development of telegeriatric services, and it seems to be the case for the Philippines. Funding is a start, and we also need to figure out the financial details for such services.
First, we can shift informal telehealth to the formal sphere by getting the municipal physician to start officially monitoring three elderly patients using SMS or voice. It could be monitoring blood pressure, blood glucose, or insulin administration, but we should keep the first cellphone-mediated interactions simple and low risk.
After a few weeks, a time and motion study can be done of the first three patients. If it took say five minutes to check on each patient per day via cellphone, then we can multiply that by the number fifty patients with a similar type of hypertension in town, then do the math in terms of financing it as a next phase. The arithmetic on the budget is a rough estimate, but it should help the program managers start designing a program for implementing telegeriatrics on a larger scale.
Our teacher once accused us: “You’re incredible! What you guys don’t find on Wikipedia does not exist in your world – or what?”
Trying to find out more about “u-health”, I remembered that and it made me smile. U-health or u-health care cannot be found on Wikipedia (yet) and on the first sight it does not seem to be on many peoples’ minds in today’s world, but dig a little deeper!
U-health stands for ubiquitous health – omnipresent, universal, ever-present health. Sounds big! And there you go with your online-search… [Small note: I found so many interesting aspects that I don’t know where to start now – so let me just give you a basic idea with this blog post and let’s explore the topic further within the following ones.]
On the Congress on Nursing Informatics 2006 in Korea, u-health did cause lively discussions. The Korean Government had started a project on u-health services for the provision of health care services in the country’s rural areas using the advanced broadband infrastructure (NI 2006).
U-health care is a developing area of technology to monitor and improve a patient’s health status. It uses different environmental and patient sensors to gather data on almost any physiological characteristic to diagnose health problems (Brown et al. 2007). U-health should stand out through availability, transparency, seamlessness, awareness and trustworthiness – anytime and anywhere (Cha 2008).
Many industrialized countries are sitting on a demographic time bomb – facing problems in health care that are related to the growing number of elderly. Their limited resources in health need to be used more efficiently and effectively. So especially these societies could benefit from u-health care and its innovations to reach better diagnosis and treatment. It also has a lot of potential in improving hospital administration and patient management with reduction of medical errors, and in enhancing service quality, communication and collaboration. (Chang) However, at the same time, u-health care confronts ethical issues, e.g. when it comes to trust, privacy and liability, or in combining computer and information ethics with medical ethics (Brown 2007).
Hence, the bottom line is that yes, u-health is and will increasingly be on peoples’ minds (and it will probably soon appear on Wikipedia).
Societies as well as individuals will have to make difficult choices in the future.
1 Korea IT Times offers a variety of more interesting articles by Cha Joo-hak on the topic: http://www.koreaittimes.com/source/cha-joo-hak
2 Brown I and Adams A A 2007. The ethical challenges of ubiquitous healthcare. International Review of Information Ethics Vol. 8. www.i-r-i-e.net/inhalt/008/008_9.pdf
3 Cha J-H (2008). Defining the Perfect Ubiquitous Healthcare Information System. Korea IT Times. http://www.koreaittimes.com/story/56/defining-perfect-ubiquitous-healthcare-information-system
4 Cha J-H (2010)Who Shall Live Better? – Health Care and Socioeconomic Choice. Korea IT Times. http://www.koreaittimes.com/story/8559/who-shall-live-better-health-care-and-socioeconomic-choice
5 Chang B-C ().Ubiquitous-Healthcare Changed paradigm after introduction of EHR. Yonsei University. www.health-informatics.kk.usm.my/resources/2_Chang.pdf
6 NI 2006. The 9th International Congress on Nursing Informatics. Seoul, Korea June 2006. http://differance-engine.net/ni2006blog/?p=22
Over- and polymedication among the elderly is a risky business that we have covered earlier, eg. in a blog post by agjessica on Polypharmacy among the elderly. As Jessica recounts studies have shown that the risk of drug interactions (with potential negative consequences) increase from 6% to 50% in patients on 2 or 4-5 medications, respectively. Nevertheless, as the digitalization of healthcare gains grounds there are a couple of really interesting ideas out there on both how to better document the side effects caused by taking various medications at a time as well as on how to use technology to help elders (and others) out with keeping track of when they need to take their medications.
Last week I had the privilege to listen in to parts of a high level summit on the Globalization of the Healthcare Market, namely the Swedish American Life Sciences Summit, where Digital Healthcare was one of the subtopics of the year. As a former Mechatronics student I took a particular liking to two innovative solutions tackling the above challenge.
The first was presented by Nicolaus Henke, McKinsey’s Director of Healthcare Practice in Europe, the Middle East and Africa, as an example of the future potential of the mix of technology and healthcare. Dr Henke explained how Proteus Digital Health (that just got FDA approval to sell their solution as a medical device a little over a month ago) has created a pill that, swallowed, together with the gastric acids of the body gets activated and the energy needed to start analyzing real-time conditions of the body, such as information related to the medication taken. This information is communicated to a wearable patch, that apart from receiving the signal from the edible sensor also records the time that the medication was taken, as well as a number of other factors related to the person’s health, such as heart beat, temperature, physical activity, position (standing, lying down) and rest patterns. The patch further communicates this information to one’s smartphone and a secure server in order to collect and analyze data in order to support medical adherence and effective monitoring of a person’s health. The person being monitored can, in turn, choose who can see this information (physicians, caregivers and/or family members, only him-/herself etc) as well as get feedback via notifications when medications are overdue.
Fascinating piece of solution in my opinion. Proteus Digital Health’s edible sensor can currently ‘only’ monitor the time, characteristics and identity of what you swallow, but the company is working on a solution that can analyze bodily measures on a more advanced scale. Since estimations have shown that as many as a third to half of the world’s patients don’t take their medications properly solutions like these apparently have a large target market. Even though development and research on biomedical telemetry from ingestible electronics has been around since the 60s Proteus D. H. have managed to put the first (and currently only) product on the market within this particular field. Looking forward to follow what the research community on related solutions is planning in the years to come.
The second solution was developed by one of the conference participants, Mr. Robert Pakter, CEO and founder of Pilljogger, a company that has created an app that helps people track their medical intakes and thanks them when they stay on track. Mr. Pakter shared that he and his company are planning on developing a feature where patients will be enabled to report side effects that they experience when taking different medicines. Given that the Pilljogger app already will keep track of the different medications the patient is taking, this will also provide for an opportunity to track different side effects that arise from the combination of different medications in certain patients on a wider scale, providing a unique material that can later be used for further research and conclusions in the field of polypharmacy.
Thus, after my brief and intense opportunity to rub shoulders with some of the Healthcare industry’s finest, I feel reassured that we can expect to see a lot of exciting things in the field of digital health in the year’s to come.
PS. I also wanted to shine a little light on an unrelated topic, namely the Not-For-Profit research organization MEND (Medicine in Need), that I also got the chance to listen in to last week, and that are doing amazing work on the formulation of vaccines, reengineering them in order to make them more easily distributed to the developing world (mainly by taking them out of the cold chain, that is often so much more difficult to maintain in the developing world). Really inspiring work! DS.
I went Friday night to see a movie just released here, Robot & Frank. I knew I would love it just based on the premise, but it may just be my favorite movie in the last couple years.
Set in the “near future”, it tells the story of Frank, an older man suffering from early dementia, who is given a robot by his children to help take care of him. The man, bored and isolated in a country town, gradually comes to enjoy the company and stimulation the robot provides. The story gets moving when you learn that before his retirement he was a professional jewelry thief and now, with the encouragement the robot provides to be active, he realizes he can get back in the game and teach the robot to help him steal. It’s a movie, so inevitably they get into trouble.
I am a sucker for movies about dementia because it is complex and a hard topic to do sensitively and well. But Robot & Frank is about more than the vanishing mind. It is about the person Frank was, is and always will be, and how dementia is just a part of that. The movie and the actor, Frank Langella, make him shine as a character. It is also about the stress that an aging and vulnerable parent puts on children, especially in the US, who live far away and have their own families or geographically distant careers. In this way it touches on the way Americans in particular are dealing with dementia.
But it went from good to great because it got how we treat dementia right (Sadly, in the near future we still don’t have better medication to treat dementia it seems). Now we largely treat dementia with lifestyle changes and support via caregivers and adult day programs. The robot is basically a lifestyle manager– he gets Frank on a routine; he makes sure he sleeps enough; he keeps the house clean and orderly; he cooks and serves him well-balanced meals at regular times. He endlessly proposes activites: let’s garden, let’s go for a walk, let’s play a game. He knows that to keep Frank well he needs to keep him as physically and mentally as active as possible and keep a routine. And then when Frank gets upset or angry, naturally he does not take it personally and can continue to work with Frank. He does not get upset or burnt out — an unfortunate reality for many human caregivers. By the end I was intrigued on how robots could be the perfect treatment to help people with dementia have the best functioning possible.
I would even suggest that Frank gets the idea to have the robot help him with burglaries because his brain is working better at this point, after the robot’s interventions have made him sharper. This is not unusual. When someone with dementia starts getting good care, they start doing better in many ways– mentally, socially and physically.
No matter, it’s all a movie anyway and such sophisticated technologies, while present in small ways– eg. alerts installed at home to help family monitor their loved ones from afar, small fuzzy robots to help demented patients with behavior issues (see this prior post)— are a long way from being fully autonomous beings that can live with otherwise independent elders. But I was impressed with how the screenplay and the movie treated the tangled issues of dementia, aging, and family tension and made it fun and funny. Like anyone with dementia, Frank never stops surprising everyone, even the robot, who he reminds that “the human brain, it’s a lovely piece of hardware.” Indeed.
See other reviews:
Dean Kamen’s Segway® Personal Transporter (PT) unleashed waves of enthusiasm with its release in 2001 quite frankly as a vehicle for the new age. The self-balancing gyrometers — with their fascinating ability to sustain an upright position — posited a truly bizarre realization for our populace: that times are changing and we need to be ready for it.
This realization certainly does not exclude the elderly population, whom have gone perhaps through the most changes humanity have ever faced in history; with such a dramatic recombination of technology in this past century.
If you browse through search engines and correlate the Segway with the elderly, you won’t find many innovations concerning our aged population. You will find concerns on how the elderly view such devices as the Segway — particularly the operator not being able to control it safely enough in order to prevent collisions with said elders. Forums may reveal that Segways are user-friendly for the elderly if they wish to operate them for themselves, however, safety and bug issues are always notable. It is difficult to find information, if any, regarding devices such as these specifically tailored for those in our population who require more care in their designs for mobility.
Personal Transportation Vehicles such as the Segway have brought a hallmark of inventive changes for the general population. Now, however, with a global, dramatically aging population, focus needs to be directed on the safety and effectiveness of such devices for those with more frail or limited mobility.
Why do people stay together and why don’t they? Why marry or why break up/divorce? Those are common questions for people to ask themselves at some point during their lifetime. While the act of getting married is seeing a boost in eg. Sweden (with the number of new marriages up with 33% in the past 10 years (due to among other things a larger cultural popularity, more kids being born etc – see embedded article (in Swedish))) we also live in a time when many countries have statistics where one out of two marriages end in divorce (Sweden, US, Spain, Germany, Russia, Belarus, Cuba (even more) etc*). Something that might seem strange to the generation of pensioners and grand-parents around today that married in a time when divorces where not as common and the view on marriage was quite different from what it is today. (See an interesting interview on the topic with sociologist Dr Paul Amato, who has conducted extensive research on marital quality and stability, under the paragraph ‘The 1950s and “companionate marriage”‘ in this blog post where he argues that marriages today have more individualistic/psychological/existential reasons (find one’s soul mate, help each other fulfil one another’s lives and grow as persons) as opposed to the more pragmatic/companionate approach of the 50s and 60s.)
While the view on life-long love and marriage as an institution obviously gets a lot of influences from the trends and tides of the society around it, there are those that argue that there are few things that makes us as happy as being in a relationship. Anders Sandberg, philosopher and computational neuroscientist working for Future of Humanity Institute at Oxford University, means that people in a relationship live longer, are less ill and generally feel more content with life than those that don’t. Money or intelligence doesn’t even come close in comparison for the importance for our well-being. Thus, as the human enhancement scientist that he is, Dr Sandberg looks to biology to find ways to increase the likelihood of people forming and staying in relationships. According to Dr Sandberg, even though much of society has changed around us in the past 1000s of years, the same is not true for our psychology. The average life time of a person did for a very long time not pass 35 years, meaning that we seldom would be in relationships for more than 15 years – ironically close to the median duration of marriage today – 11 years. In a recent article co-written with Julian Savulescu and published in the New Scientist, Dr Sandberg argues that in order to increase the chances of people’s well-being caused by being in a relationship, while sparing them the pain break-ups can often inflict, we can look to some recent findings from another research article published in The Journal of Neuroscience with experiments on voles in order to find new ways forward.
The results published in The Journal of Neuroscience show that introducing vasopressin (known as one of the ‘love hormones’ together with eg. oxytocin) by gene modification in polygamous male meadow voles made them more monogamous and similar to their cousin, the prairie vole, that is already monogamous as a species (and that also has more receptors for oxytocin and vasopressin in their brains from a start). Given their other argument that helping humans stay in relationships would generally imply more happiness for them, Sandberg and Savulescu thus argue that it would be ethically correct to develop methods that would make possible the same biological alterations in humans. Of course, Sandberg admits such methods would have to be used with caution not to have people entrapped in bad relationships. One of the authors of the article in The Journal of Neuroscience, Dr Larry Young, along with Dr Hasse Valum at Karolinska Institutet (who in a recent PhD thesis proved that the same correlations between pair bonding and vasopressin (in males) and oxytocin (in females) could be found in humans), however argue that they don’t believe in creating medicinal treatment based on those findings, especially since there are also potential negative side effects by eg. increased vasopressin in males such as that they become more aggressive and defendant of their partner with higher rates of this hormone.
Even though convention, rather than biology, is more likely to be the reason for the lower divorce rates on a macro scale among pensioners and grand-parents back in their day (and maybe, as a result of holding true to that convention, even today) I think it is still interesting to see how we can unlock some of the secrets of the world around us through science. Let’s see what the future holds. (Apart from being love hormones both vasopressin and oxytocin has shown potential of treating both autism, social anxiety disorder, borderline personality disorder and schizophrenia.)
On a final note, when researching for this blog post I came across another very interesting study showing that friends, rather than family, are more important to help people live longer after the age of 70 according to a recent Australian study (in a way contradicting, or at least weakening, Dr Sandberg’s argumentation above). I think I will have to save that topic for my next blog post.
Sources: http://www.dn.se/nyheter/vetenskap/livslang-romans-med-hjalp-av-medicin (in Swedish, including short interview with Dr Sandberg)
http://www.practicalethics.ox.ac.uk/latest_news/love_machine_engineering_lifelong_romance (abstract of Dr Sandberg’s research article)
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2768419/ (full research article in The Journal of Neuroscience)
Image source: http://www.flickr.com/photos/aneesprince/7202772588/
*Statistics sources: Sweden: SCB – Central Bureau of Statistics (see above embedded link – in Swedish), US, Spain, Germany (and some other countries): United States Census Bureau – Table 1336 (see above embedded link), Russia, Belarus, Cuba (and many other countries): United Nations Demographic Yearbook 2009-2010 comparing tables 23 and 24 per country (see above embedded link)
”There are no children on the streets. No pregnant women. Of course you notice it!” Nhat Vuong, social entrepreneur and Founder of i-kifu shakes his head. Japan is not an aging society, in many aspects it has already aged. But as Nhat points out, the elderly still have money. They get care. A report from the Japanese Research Institute, 2008, on Household Expenditures supports his statement. The household spending power is redistributed from the young to the elderly. But the question is how long the economy can cope with a hastily declining number of workers in the national work force.
As Nhat points out, people are not that engaged in giving for the cause of the well-being of the elderly. If they give to society, they prefer to look at investments for the future, supporting children, education, the environment. The elderly will need support but they are not seen as investments.
The reason to why we meet with Nhat, a social entrepreneur based out of Tokyo since 5 years back, is to learn about the mentality of the young in Japan. The mentality of the entrepreneurs, the shakers and movers. Nhat himself is the founder of the i-kifu, meaning ”I donate” in Japanese. He has been working on the crowd funding venture since 2007, to give people the opportunity to achieve a social impact through their social engagements. His venture hands out karma points that can be exchanged for rewards to people that do good; either by donations or volunteering.
Nhat’s personal story is fascinating. Following the end of the Vietnam war, Nhat’s parents fled Vietnam in a boat and he was born in a refugee camp in Malaysia. From there his family was given asylum in Switzerland, with the help of the Red Cross, and Nhat enjoyed a safe upbringing just like any other child in the stable economy of the Swiss. His parents would mention to him how lucky he was that he could just go to school, not having to work, but the concept of poverty was hard to grasp. The only comparison he had was with his Swiss peers and just like them he desired the latest toys and the nicest gadgets. It was when Nhat for the first time visited Vietnam, 15 years old, that he was confronted with social injustice and extreme poverty. It was then that he realized that he wanted to make a positive social contribution to the world.
After finalizing his studies in Switzerland Nhat moved to Japan (mostly for love), started looking for job opportunities in the digital sphere and soon saw the opportunity to connect his skills in IT, marketing and gamification (peoples’ addiction to games and the reward systems these offer) with his social impact aspirations. The idea of i-kifu was born and now, some time and a lot of hard work later, Nhat has 25 Non-for-profits that share their projects through his site. Several socially minded businesses support the platform. The traffic to the site is growing even though the concept of crowd funding and donations is much less common than in other markets. In the US, for example, there are over 1 Million Not-for-profits whereas Japan only has 60 000. After the earth quake and the Fukushima disaster this is slowly starting to change, both in the social scene and in Japan’s orientation towards entrepreneurial ventures.
”Japan is waiting for an awakening. Some people were hoping that the earth quake would have the effect but that still remains to be seen. People live in invisible prisons, entrepreneurs and innovators are held back by social expectations- you are not solely responsible for your own success or failure, your family and friends share the shame if you don’t succeed. The circle of responsibility is strong and rigid. That is why it is difficult for Japanese people to try something new. The risk is too big”.
“When you approach someone with a really great idea the first question is: Has this been done before? Not? Well, please come back when a large corporation has tried it and it became really succesful. The entrepreneur scene is not easy. There is a lack of role models and the school system still focuses on training workers for long-term positions at large corporations”. But Nhat is optimistic. And determined to work the system. He says: “If I can make it work here, then I can succeed anywhere. Plus, as we learned from Steve Jobs, if you only ask people what they want and give it to them you will never reach the really groundbreaking innovation.”
Nhat also mentions the island effect; “Everything is so easy and accessible to the Japanese, they don’t really need to travel overseas or to learn English. Even if Japan was heavily dependent on technology export for a long time, cars and electronics, they themselves did not embrace technology at the same rate. Despite high-tech innovation in some Japanese corporations, there are still offices in japan that use their fax machine actively.” A country of contrasts, as Nhat describes it.
And the vision for the future? “The era when Japan thrived is gone. There is no longer time for time-consuming, hierarchical decision-making and deeply anchored decisions. Now the speed of technical development requires that companies try, fail, succeed, iterate faster. In previous times it could take a Japanese company six months to reach a decision, now, in six months, innovators from China and India would have rolled out the product already, succeeded or failed and moved on. That’s how innovation is achieved nowadays. Trial and error. Fast. Not processes with full internal consensus. Japan needs to embrace this. Iterate faster.”
Nhat pauses and formulates his conviction: “Japan has a huge potential. The people here are extra-ordinary. I have seen people achieve here what I didn’t think was humanly possible. They can do it. They truly can. With the right support they can achieve anything.”
A topic not actively discussed includes the potential therapeutic effect of architecture as well as horticulture to produce an innovative effect in preventing or slowing the development of chronic disease. Could architecture regarding the application of human factors and re-engineering serve as a significant treatment for the elderly?
The Medical Architectural Research Unit (MARU) of London South Bank University evaluated some European cases of architecture that specifically targeted the elderly, as cited in the World Health Design organization’s website. Field visits from 2005-2008 included Finland, Spain, and France.
Various facilities that focus on dementia care were visited by MARU and offer innovative architectural experiences with holistic approaches that appear to influence the elderly. The Viola-koti of Tampere and Kamppi Service Centre of Helsinki facilities are highlights of Finland, and include human factors-oriented recreational facilities with special exercise activities and workshops; multi-level saunas; and buildings with bi-folding windows that give elderly a wonderful view of the on-goings of the world even in the times of cold, dreary winter months. Next, in Spain, the Madrid Alzheimer Centre has been engineered to conduct bio-mechanistic studies on the probable causes of Alzheimer’s, while at the same time influencing those staying at the clinic with units of residence all independent of each other in design – each topped with well-protected, inspiring courtyard gardens. By understanding ways to incorporate a whole spectrum of care, a central garden even is integrated as being part of a horticultural therapy program. Finally, in Paris, France, the Residence de l’Abbaye allows the elderly in a secure environment simulated as a ‘salon’ on a ‘street of activities’ to learn and discuss about the matters of modern politics and societal issues, keeping their worldly lore active and up-to-date.
This process of course is up to the human experience and how we each individually perceive phenomena. Therefore, architectural human factors and re-engineering would have – like any method of therapy – different effects on different individuals. Yet, the truth remains: an often under looked yet obviously significant stimulus is there, right before our eyes, influencing how we move, perceive, and experience our world. What would our world be like, after all, if our city squares were circles, and our buildings ovals instead of rectangles?
World Health Design (2012) Elderly Care: Active Ageing. WorldHealthDesign.com. Retrieved April 19th, 2012 from: http://www.worldhealthdesign.com/Elderly-Care-Active-Ageing.aspx
I was recently at a fair in Sweden called Worldclass Senior Life where one of the many booths belonged to a company called Suntech. At Suntech’s booth, instead of a pile of brochures and a bowl of candy, Suntech had rigged a beach with sand, sun chairs and parasols. Here, the fair visitors could take a break from the intense fair and enjoy the bright sun light. Swedish company Suntech is the first one to simulate real sunlight worldwide, meaning that they produce light that contain the whole spectrum of the real sun with wave-lengths of the exact same proportions. Compared to light therapies that can be found in hospitals, Suntech’s light is 10 times stronger but the light is still on a controlled and safe level as 90% of the UV radiation is filtered out.
The Suntech light is particularly suitable for elderly. They can enjoy a quiet indulgence in an environment that affect all senses. The ones that have enjoyed holidays in the sun earlier in their lives get the chance to relive the experience inside the nursing home. The light makes people happier and more alert at the same time as it serves as a meeting place for elderly at the nursing home. Research has shown that the light helps the body to produce vitamins and it affects the epiphysis positively. The immune defense is strengthened at the same time as the replicated sun’s heat mitigates stiffness and muscle pain.
Nursing homes installing a Suntech room are free to design their own scenography; Suntech can build anything from a coastal landscape in the archipelago to a tropical beach including light, sound and wind. In its smallest design, which fits 7 people, the price for the Suntech room is approximately 25.000 USD.