Care Support Systems Research Articles

Does subjective health matter? Predicting overall and specific ADL disability incidence

BackgroundThe aims of this study were to examine the incidence of activities of daily living (ADL) and instrumental activities of daily living (IADL) disability in a national sample of community‐living older adults, and to evaluate the value of baseline self-rated health (SRH) in predicting these outcomes. Additionally, we investigated whether SRH’s prognostic ability extended to individual ADL/IADL components (e.g. bathing, managing money). MethodsData were obtained from the 2014 and 2016 Korean Longitudinal Study of Aging (N = 3431). Respondents were aged 65+ and non-disabled at baseline. Setting the respondents with “very good” or “good” baseline SRH as the reference group, logistic regression models were applied to analyze the association between SRH and disability risk. ResultsThe overall incidence rates for ADL and IADL were 25.6 and 53.4/1000 person-years, respectively. Disability incidence increased significantly with poorer SRH. In multivariable regressions, subsequent 1 + ADL disability was significantly associated with “bad” (OR 2.86) and “very bad” SRH (OR 4.28). SRH also predicted 1 + IADL disability for respondents who reported “moderate”, “bad”, or “very bad” health (OR 2.01–3.39). SRH was predictive of three out of five ADL components, and seven out of 10 IADL components. ConclusionSRH predicted functional decline after two years in older adults without baseline disabilities, and its prognostic ability extended to individual ADL/IADL components. Patterns of SRH-morbidity associations can help health administrators identify those at risk of subsequent functional decline. Early interventions targeted at those with poor SRH can help alleviate the strain on long-term care support systems.

Results of a Qualitative Study to Understand Risk Factors for Amputation in Patients With Diabetes and/or Peripheral Arterial Disease in a Highly Rural State

Amputation is a devastating but preventable complication of diabetes and peripheral arterial disease (PAD). It serves as a marker for severe disease as well as for disparities in quality of care. The majority of studies on this issue use quantitative methods, which are useful for identifying prevalence rates and patterns of disease, but have difficulty providing deeper explanations about why certain groups have higher risks for amputation than others. Qualitative methods are ideal for providing rich, meaningful answers for such questions. The purpose of this study was to use a qualitative approach to understand barriers to limb preservation in patients with diabetes and/or PAD in the highly rural state of West Virginia. Participant recruitment was directed by preliminary research identifying high-risk areas for amputation across the state. Focus groups and interviews were conducted by a moderator using a semistructured interview guide focused on barriers to limb preservation. Four groups were interviewed: diabetic and/or PAD patients who have undergone amputation (and their caretakers), vascular providers and surgeons, wound care providers, and primary care providers. Audio recordings of each session were transcribed verbatim and data were analyzed by two coders using NVivo software. Conventional content analysis was carried out to develop a codebook and analyze data for themes related to patient and provider barriers. Eight focus groups, three phone interviews, and three in-person interviews (n = 64) were conducted. Lack of education was the most frequently cited barrier by both patients and providers across all sessions. Geographic isolation, lack of transportation, and cultural norms also emerged as barriers to limb preservation. There was also consensus that health care costs, access to care, and care coordination were major obstacles patients faced when attempting to manage their conditions. Providers emphasized that patient adherence to care plans was a significant barrier to limb preservation. In addition to these barriers, three main risk factors related to patient care emerged: depression, diabetes, and tobacco use. This qualitative study identified important themes contributing to the risk of amputation in West Virginia from the perspective of patients and providers. These include (1) lack of education, (2) geographic and cultural barriers, (3) difficulty with care coordination, (4) poor patient adherence and (5) depression, diabetes and tobacco use. Based on these themes, amputation prevention efforts in West Virginia should be directed toward improving patient education, improving access to care, improving social and mental health support systems, and providing culturally sensitive approaches to patient care.

Challenges, Opportunities, and Innovations in the Health and Well-being of the World’s Aging Citizens

Challenges, Opportunities, and Innovations in the Health and Well-being of the World’s Aging Citizens

Overcoming Heroin Addiction without the Use of Pharmaceuticals: A Qualitative Interview Study

ABSTRACT Although opioid maintenance treatment lowers mortality and has proven efficacy in reducing opioid use, it is not an option for every person with an opioid addiction. Studies of the experiences of those who have overcome their addiction without pharmaceuticals are rare, but vital to understanding the quitting process and how it can be facilitated. This study investigated what persons with a previous heroin addiction perceived as helpful when overcoming their addiction without the use of pharmaceuticals, and what they consider important for health services to consider. Eleven adults with former heroin addiction participated. Most described the leaving process as prolonged and including many attempts. Experiences such as being worn out and numb, life-threatening overdoses, personal losses or a growing feeling of missing important stages in life fueled the decision process. Envisioning a future without drugs was described as an important component. To maintain the decision to refrain from heroin use the possibility to gain a new social context was crucial. Results imply that health care professionals should be proactive by seizing the moment of opportunity for change (e.g., after an overdose), and should be empathetic and never give up on a person. Those concerned with care, welfare and other support or control systems in society must cooperate to offer more personalized support.

What bereaved parents want health care providers to know when their babies are stillborn: a community-based participatory study

BackgroundBereaved parents experience higher rates of depressive and post-traumatic stress symptoms after the stillbirth of a baby than after live-birth. Yet, these effects remain underreported in the literature and, consequently, insufficiently addressed in health provider education and practice. We conducted a participatory based study to explore the experiences of grieving parents during their interaction with health care providers during and after the stillbirth of a baby.MethodsThis community-based participatory study utilized four focus groups comprised of twenty-seven bereaved parents (44% fathers). Bereaved parents conceptualized the study, participating at all stages of research, analyses, and drafting. Data were reduced into a main theme and subthemes, then broad-based member checked to ensure fidelity and nuances within themes.ResultsThe major theme that emerged centered on provider acknowledgement of the baby as an irreplaceable individual. Subthemes reflected 1) acknowledgement of parenthood and grief, 2) recognition of the traumatic nature of stillbirth, and 3) acknowledgement of enduring grief coupled with access to support. It was important that providers realized how grief was experienced within health care and social support systems, concretized by their desire for long-term, specialized support.ConclusionsBoth mothers and fathers feel that acknowledgement of their baby as an individual, their parenthood, and their enduring traumatic grief by healthcare providers are key elements required in the process of initiating immediate and ongoing care after the stillbirth of a baby.

Development of LactaPedia: A lactation glossary for science and medicine.

During the last decade, there have been several publications highlighting the need for consistent terminology in breastfeeding research. Standard terms and definitions are essential for the comparison and interpretation of scientific studies that, in turn, support evidence‐based education, consistency of health care, and breastfeeding policy. Inconsistent advice is commonly reported by mothers to contribute to early weaning. A standard language is the fundamental starting point required for the provision of consistent advice. LactaPedia (www.lactapedia.com) is a comprehensive lactation glossary of over 500 terms and definitions created during the development of LactaMap (www.lactamap.com), an online lactation care support system. This paper describes the development of LactaPedia, a website that is accessible free of charge to anyone with access to the Internet. Multiple methodological frameworks were incorporated in LactaPedia's development in order to meet the needs of a glossary to support both consistent health care and scientific research. The resulting LactaPedia methodology is a six‐stage process that was developed inductively and includes framework to guide vetting and extension of its content using public feedback via discussion forums. The discussion forums support ongoing usability and refinement of the glossary. The development of LactaPedia provides a fundamental first step towards improving breastfeeding outcomes that are currently well below World Health Organisation recommendations globally.

Distress screening in cancer survivorship.

138 Background: Cancer survivors have varied physical, psychosocial, emotional and financial needs that may differ from needs of active cancer treatment patients. Distress screening identifies and monitors the needs of patients and is mandated for certain accreditations. There is a paucity of data on the application of distress screening among survivors. We used a validated distress screening tool to conduct a needs assessment of cancer survivors in solid oncology. Methods: The Cancer Support Source Distress Screening tool is an 18-item survey given on the 2nd and every 3-month clinic visit to assess depression and distress. The first analysis, merged patient data (patients completing ≥ 2) with cancer registry to identify solid cancer survivors from July 2015 to October 2018. A descriptive analysis of these patients was performed. The second analysis was cross-sectional with a larger data set of all solid tumor patients completing a survey at any time pre, during, or post treatment. We compared distress and depression scores using analysis of variance. A bivariate and multivariate analysis evaluating change in depression and distress scores over time is ongoing. Results: In analysis one, 92 patients were identified. Depression scores improved for most cancer types; distress scores improved for all cancers. Emotional, communication, provider relationship, system of care, body image and social support were associated with significant changes in survivorship concern. In the expanded dataset, 908 patients were identified. The distribution of depression and distress scores are shown in the table. There was a significant decrease for depression scores (p<.001) and distress scores (p<.001). Multivariate analysis to evaluate change in depression and distress scores across the survivorship trajectory is ongoing. Conclusions: A distress screening survey may be a useful tool in assessing the unmet needs of cancer survivors. Identifying prevalent domains of survivorship issues can highlight areas of greatest perceived need and can guide quality improvement initiatives within a cancer program. [Table: see text]

Women's perspective on life after total laryngectomy: a qualitative study.

BackgroundPhysical and psychosocial challenges are common after total laryngectomy. The surgery leads to lifelong changes in communication, airway, swallowing and appearance. As we move towards health models driven by patient‐centred care, understanding the differential impacts of surgical procedures on subgroups of patients can help improve our care models, patient education and support systems. This paper discusses the experiences of women following total laryngectomy.AimsTo gain an insight into the impact of total laryngectomy on women's daily life while identifying their specific rehabilitation needs.Methods & ProceduresThis paper is based on in‐depth, semi‐structured interviews with eight women who had undergone total laryngectomy. These interviews were conducted with women at least 1 year after they had undergone total laryngectomy, and the participants did not have recurrent disease. Using an interview guide, participants were encouraged to discuss their everyday experiences, while also focusing on issues typical to women. The transcribed interview data were analysed by thematic analysis, taking interpretative phenomenological analysis as a lead.Outcomes & ResultsThe interviews revealed three main themes: disease and treatment as a turning point, re‐establishing meaningful everyday activities, and persistent vulnerability. Participants reported experiencing challenges in their rehabilitation process due to physical disabilities, dependency on others and experienced stigma. Women‐specific challenges arose in dealing with the altered appearance and voice, performing care activities, and the spousal relationship (including intimacy).Conclusions & ImplicationsWomen who undergo total laryngectomy are likely to experience issues in returning to work, the performance of informal care‐work, the spousal relationship, intimacy and social interaction due to stigmatization. Medical pretreatment counselling and multidisciplinary rehabilitation programmes should help patients form realistic expectations and prepare them for the changes they will face. A gender‐ and age‐matched laryngectomized patient visitor can contribute to this process. Rehabilitation programmes should incorporate the partner and offer psychosocial support for women following total laryngectomy to return to their former roles in family life, social life and work‐related activities.

Assessing Functional Capacity and Factors Determining Functional Decline in the Elderly: A Cross-Sectional Study.

The aim of this study is to assess functional capacity and determine the factors associated with functional decline in the elderly in adult day care centres and home care support in the County of Coimbra, Portugal. Cross-sectional study. A total of 115 participants of both genders, aged between 65 and 98, were enrolled in the home care support and adult day care system of the County of Coimbra, Portugal. Functional capacity was assessed using the Barthel index and the Lawton index. Another questionnaire gathered social, demographic and health status information. The basic activities of daily living were significantly associated with age, cohabitation, medication usage, falls and multiple morbidity. Analysis of the study's variables and the instrumental activities of daily living found significant associations between age, institutional affiliation, perceived health status, hospitalizations, medication usage, physical exercise, multiple morbidities, falls, and fall prevention. The results demonstrate that no statistically observable differences were found between gender and functional dependence. A significant association between the Barthel index and cohabitation was also found. We should also highlight that this sample revealed the extremely important role of families in determining the protection of highly dependent older people. Likewise, a significant association was observed between instrumental activities of daily living and levels of physical activity in which greater independence was found in those seniors who practiced physical exercise three or more times per week. The results of this study allow us to identify factors that may be associated with the functional decline in the elderly. Useful evidence for the adoption of intervention strategies in the elderly population was added, focused on the prevention of functional decline and maintenance of the functional capacities of the elderly.

Distress screening in cancer survivorship.

197 Background: Cancer survivors have physical, psychosocial, emotional and financial needs that vary in prevalence and may differ from needs of patients on active cancer treatment. Distress screening is mandated for cancer program accreditation and identifies, addresses and monitors the needs of patients. There is a paucity of data on the clinical application of distress screening among survivors. We used a validated distress screening tool to conduct a needs assessment of cancer survivors in the solid oncology clinic. Methods: The Cancer Support Source Distress Screening tool is an 18-item questionnaire given to patients on their 2nd and every 3 month medical oncology clinic visit to assess depression and distress. We merged patient survey data (patients completing ≥ 2) with the cancer registry to identify cancer survivors from July 2015 to October 2018. We performed bivariate and multivariate analysis evaluating change in depression and distress scores over time. Results: 92 patients were identified. The table indicates changes in depression and distress scores by cancer. Depression scores improved for most cancer types with an improvement in distress scores across all cancers. Emotional/mental health, communication, provider relationship, system of care, body image and social support were associated with significant changes in survivorship concern. We are completing a multivariate analysis controlling for sociodemographic factors to evaluate change in depression and distress scores across the survivorship trajectory. Conclusions: A distress screening survey may be a useful tool in assessing the unmet needs of cancer survivors. Identifying prevalent domains of survivorship issues can highlight areas of greatest perceived need and can guide quality improvement initiatives within a cancer program. [Table: see text]

Variables Influencing Machine Learning-Based Cardiac Decision Support System: A Systematic Literature Review

Now a day, clinical decision support systems (CDSS) are widely used in the cardiac care due to the complexity of the cardiac disease. The objective of this systematic literature review (SLR) is to identify the most common variables and machine learning techniques used to build machine learning-based clinical decision support system for cardiac care. This SLR adopts the Preferred Reporting Item for Systematic Review and Meta-Analysis (PRISMA) format. Out of 530 papers, only 21 papers met the inclusion criteria. Amongst the 22 most common variables are age, gender, heart rate, respiration rate, systolic blood pressure and medical information variables. In addition, our results have shown that Simplified Acute Physiology Score (SAPS), Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHE) are some of the most common assessment scales used in CDSS for cardiac care. Logistic regression and support vector machine are the most common machine learning techniques applied in CDSS to predict mortality and other cardiac diseases like sepsis, cardiac arrest, heart failure and septic shock. These variables and assessment tools can be used to build a machine learning-based CDSS.

Position of the Academy of Nutrition and Dietetics and the Society for Nutrition Education and Behavior: Food and Nutrition Programs for Community-Residing Older Adults

Given the increasing number and diversity of older adults and the transformation of health care services in the United States, it is the position of the Academy of Nutrition and Dietetics and the Society for Nutrition Education and Behavior that all older adults should have access to evidence-based food and nutrition programs that ensure the availability of safe and adequate food to promote optimal nutrition, health, functionality, and quality of life. Registered dietitian nutritionists and nutrition and dietetics technicians, registered, in partnership with other practitioners and nutrition educators, should be actively involved in programs that provide coordinated services between the community and health care systems that include regular monitoring and evaluation of programming outcomes. The rapidly growing older population, increased demand for integrated continuous support systems, and rising cost of health care underscore the need for these programs. Programs must include food assistance and meal programs, nutritional screening and assessment, nutrition education, medical nutrition therapy, monitoring, evaluation, and documentation of evidence-based outcomes. Coordination with long-term care services and support systems is necessary to allow older adults to remain in their homes; improve or maintain their health and manage chronic disease; better navigate transitions of care; and reduce avoidable hospital, acute, or long-term care facility admissions. Funding of these programs requires evidence of their effectiveness, especially regarding health, functionality, and health care–related outcomes of interest to individuals, caregivers, payers, and policy makers. Targeting of food and nutrition programs involves addressing unmet needs for services, particularly among those at high risk for poor nutrition. Registered dietitian nutritionists and nutrition and dietetics technicians, registered must increase programmatic efforts to measure outcomes to evaluate community-based food and nutrition services. Position StatementIt is the position of the Academy of Nutrition and Dietetics and the Society for Nutrition Education and Behavior that older adults should have access to evidence-based food and nutrition programs that ensure the availability of safe and adequate food to promote optimal nutrition, health, functionality, and quality of life. Registered dietitian nutritionists and nutrition and dietetics technicians, registered, in partnership with other practitioners and nutrition educators, should be actively involved in programs that provide coordinated services between the community and health care systems that include regular monitoring and evaluation of programming outcomes. The rapidly growing older population, increased demand for integrated continuous support systems, and rising cost of health care underscore the need for these programs.

Parents' acceptance and regret about end of life care for children who died due to malignancy.

PurposeTo analyse the preference of end of life care place in paediatric oncology patients, and to understand the end of life care needs and regrets among the care givers.MethodThis was an observational qualitative study. Parents of in-curable paediatric malignancy patients who died during the years 2016–2018 were interviewed using a pre-formed open-ended questionnaire. Fears during the last phase of child’s life, most disturbing symptoms, choice of end of life care plan, regret of care givers and reasons for such choices were noted and analysed.ResultTwenty six families were interviewed. A median of 3 months of discordance was noted between declaration of in-curability and acceptance of the same by the family. During terminal months, pain (84.62%) was described as the most bothersome symptom followed by respiratory distress (73.08%). Eighteen families (69%) opted for home-based terminal care, 8 (31%) for hospital-based terminal care. Regret of choice was noted in 62.5% families of the hospital-based care group (separation from home environment being the main reason) and 38.89% of the home-based care group (lack of access to health care personnel and pain medication being the main reasons).ConclusionHome-based care is the preferred option for end of life care by the care givers. Lack of community-based terminal care support system and availability of analgesics are the main areas to work on in India.

Research of Independent Living-Supporting Service for Developmental Disabilities in Era of Convergence-Focusing on supporting Developmental Disabilities in Japan

Background/Objectives: Independent living-supporting paradigm campaign that was launched from early of 2000's in Korea focused on physical disabilities but developmental disabilities these days. Methods/Statistical analysis: The analysis tool of social welfare policy of Gilbert and Terrell that can explain the social policy systemically through wide range of fields was used. The object of analysis is the independent living-supporting service that the developmental disabilities in Japan. Findings: First, the allocation means the mentally-handicapped person whose age is more than 18 and registered as the intellectual disability. All ages can be the object regarding the autistic disorder disable and it belongs to the mentally-handicapped. Second, there are disability basic pension, disability allowance, allowance and disability pension in national pension for the handicapped as cash benefit. There are home visiting care support system, nursing care benefit, work benefit and counselling as payment in kind. Third, supporting employment, finding job and supporting ordinary life are carried out support center for persons with Developmental and the associate of mentally-handicapped people as delivery system. Lastly, the combination that consists of 50% from the nation, 20% from prefectural road and towns and villages municipalities respectively and 10% of self-payment are chosen as its financial resource. Self-payment becomes free if there is no benefit and may be exempted in case of local government. In conclusion, home visiting care support system among cash benefit proves that it plays the big role for supporting the independent living of developmental disabilities first. Application/Improvements: First, the standard of grade system for supporting the disability should be changed from medically-centered based on physical disabilities-centered to social activity-centered. Second, various communication methods with developmental disabilities should be developed and professional manpower should be fostered.

Development of a Home Care Support System for Patients with Psychiatric Disorders

Development of a Home Care Support System for Patients with Psychiatric Disorders

A patient-oriented clinical decision support system for CRC risk assessment and preventative care

BackgroundColorectal Cancer (CRC) is the third leading cause of cancer death among men and women in the United States. Research has shown that the risk of CRC associates with genetic and lifestyle factors. It is possible to prevent or minimize certain CRC risks by adopting a healthy lifestyle. Existing Clinical Decision Support Systems (CDSS) mainly targeted physicians as the CDSS users. As a result, the availability of patient-oriented CDSS is limited. Our project is to develop patient-oriented CDSS for active CRC management.MethodsWe implemented an online patient-oriented CRC CDSS for the public to learn about CRC, assess CRC risk levels, understand personalized CRC risk factors, and seek professional advices for people with CRC concerns. The system is implemented based on the Django Model-View-Controller (MVC) framework with an extensible background MySQL database. A CRC absolute risk prediction model is applied to calculate the personalized CRC risk score with a user-friendly web survey. An interactive dashboard using advanced data visualization technics will display and interpret the risk scores and factors. Based on the risk assessment, a structured decision tree algorithm will provide the recommendations on customized CRC screening methods. The CDSS also provides a search function for preferred providers and hospitals based on geographical information and patient preferences.ResultsA prototype of the patient-oriented CRC CDSS has been developed. It provides an open assessment of potential CRC risks via an online survey. The CRC risk predictive model has been implemented. The prediction outcomes of risk levels and factors are presented to the users through a personalized interactive visualization interface, to guide the public on how to reduce the CRC risks by changing their living styles (such as smoking and drinking) and diet characteristics (such as consumptions of red meat and milk). The CDSS will also provide customized recommendations on screening methods based on the corresponding risk factors. For users seeking professional clinicians, the CDSS also provides a convenient tool for searching nearby hospitals and available doctors based on the location preferences and providers characteristics (such as gender, language, and specialty).ConclusionsThis CRC CDSS prototype provides a patient-friendly interface for CRC risk assessment and gives a personalized interpretation on important CRC risk factors. It is a useful tool to educate the public on CRC, to provide guidance on minimizing CRC risks, and to promote early CRC screening that reduces the CRC occurrences.

Evaluating lexical similarity and modeling discrepancies in the procedure hierarchy of SNOMED CT

BackgroundSNOMED CT is a standardized and comprehensive clinical terminology that is used in Electronic Health Records to capture, store and access clinical data of patients. Studies have, however, shown that there are inconsistencies inherent in the modeling of concepts in SNOMED CT that can have an impact on its usage to record clinical data and in clinical decision-making tools.MethodsAn effective lexical approach to identifying inconsistencies with high likelihood in the structural modeling of the concepts of SNOMED CT is discussed and assessed. The approach uses the two or more concepts in the context of their lexical similarity to compare their modeling in order to identify inconsistencies. A sample of 50 sets is randomly picked from the Procedure hierarchy of SNOMED CT and evaluated for inconsistencies.ResultsOf the 50 randomly picked sets, 58% are found to exhibit one or more concepts with inconsistencies. In terms of concepts, 29% of the 146 concepts are found to exhibit one or more inconsistencies.ConclusionsThe assessment of the sample concepts shows that SNOMED CT is not free from inconsistencies which may affect its use in clinical care and decision support systems. The proposed methodology is found to be effective in identifying areas of SNOMED CT that may be in need of quality assessment.

Fog assisted IoT based medical cyber system for cardiovascular diseases affected patients

SummaryIoT based Patient monitoring is the current need of the hour. The critical care services have been a crucial part for patients, who suffer from serious health conditions and heart diseases. Increased population is one of the major reasons behind waiting for clinical health monitoring services in hospitals. The current internet era and IoT based health support systems provide medical services for individuals and hospitals to forecast or early‐detect probable critical care situations. The proposed approach is a new health care support system for heart patients to monitor and report with hospitals. We have introduced a Fog assisted IoT based cardio monitoring application to help the decision support system, which also tested with the existing analogues health care applications to show its elevated performance.

Transition From Pediatric to Adult Services: Challenges for Family Caregivers of Young Adults With Traumatic Brain Injury

Family caregivers are the main source of support for survivors of traumatic brain injury (TBI) while they transition from pediatric to adult care service and support systems. Yet there is little research that examines the needs of these caregivers during the transition phase. The aim of this qualitative phenomenological study was to examine the lived experiences of family caregivers of young adults with TBI who had recently transitioned from services for children and adolescents to adult care service and supports. The study sample comprised 15 family caregivers of young adult TBI survivors who had transitioned to adult services in the last 5 years. They were recruited from two large hospitals and a caregiver support center in a city in Western Canada. Semistructured interviews were conducted with the caregivers and the data were analyzed using Colaizzi’s approach in developing an essential structure of the phenomenon of caregiving. Fifteen themes emerged from the analysis and these are discussed under two broad domains: (a) caregivers’ experiences and challenges with their relative at the time of transition; (b) caregivers’ challenges with services and supports systems during transition. Findings suggest that there is a wide gap between what caregivers need and what is available to them to support their young adult relative through the transition process and beyond. Most caregivers reported that the transition phase is overwhelming and has a profound and pervasive impact on their lives. Implications of the findings and recommendations for policy and practice are discussed.

Ontology-based Dementia Care Support System.

In this paper, we have designed an ontology-based knowledge system for caring person with dementia at home or care facility. Proposed system contains an ontology that describes the knowledge of dementia patient, dementia symptoms, indoor environment, qualitative things and various patient's situation happening during daily life. We first describe the overall system architecture of the proposed system targeting at supporting caregivers or family members that can provide appropriate care guides for distinct symptoms of a dementia patient. We have tested the feasibility of the proposed system with two different prototypal application systems: robot platform and knowledge sharing system.