Telecare Monitoring Research Articles

Heart Failure Patients’ Adherence to Hybrid Comprehensive Telerehabilitation and Its Impact on Prognosis Based on Data from TELEREH-HF Randomized Clinical Trial

(1) Background Adherence to treatment guidelines in heart failure (HF) patients is of major prognostic importance, but thorough implementation of guidelines in routine care remains insufficient. Introducing hybrid comprehensive telerehabilitation (HCTR) consisting of telecare, telerehabilitation, and remote monitoring of implantable devices might be an option to improve adherence to recommendation and can affect the prognosis. The purpose is to investigate the association of adherence to HCTR with mortality and hospitalization. (2) Methods This analysis formed part of TELEREH-HF multi-center, randomized trial that enrolled 850HF patients (NYHA I-III;LVEF ≤ 40%). Patients were randomized 1:1 to 9-week HCTR (1 week in hospital and 8 weeks at home) plus usual care or usual care only and followed-up for 14 to 26 months. This analysis focuses on the HCTR group. Adherent patients were those who adhered both to the number of training sessions prescribed and to the duration of the prescribed cycle by at least 80%; non-adherent patients were those who adhered<20% to the prescribed number of training sessions and their duration. The remaining patients were classified as partially adherent. (3) Results There were 350 (88.4%) adherent patients, 39 (9.8%) partially adherent patients, and 7 (1.8%) non-adherent patients. There were 46 deaths during follow-up. Non-adherence or partial adherence was associated with higher risk of cardiovascular (CV) mortality (hazard ratio (HR) = 2.62, p = 0.021); all-cause mortality or HF hospitalization (HR = 1.71, p = 0.038); CV mortality or HF hospitalization (HR = 1.89, p = 0.014). (4) Conclusions The adherence to HCTR was high. Adherence to HCTR was associated with improved prognosis for CV mortality and the reduction in the combined outcome of CV mortality or HF hospitalization.

Why do few assistive technology systems make it to market? The case of the HandyHelper project

Assistive technologies, such as telecare monitoring applications installed in the home, are being promoted to help reduce pressure on health care systems caused by an aging population and as such promise a large market for new products. However, despite many projects undertaken by commercial companies, and despite significant investments both by the companies and by national and international funding programs in the EU, such systems are not widespread. This paper reports on a retrospective study of the development of one early system, HandyHelper. We were interested in what challenges the development team faced and why the system is no longer on the market. Qualitative research methods were applied, including document analysis and interviews of key people involved in its development. Even though the system worked technically, the input of older users was sought, and a pilot installation was run, the development was stopped. The findings from a thematic analysis point to complex issues. Some problems were avoidable, e.g., by providing more support for new users, though other problems point to inherent tensions, such as the different needs of sensor-based security features and interactive services aimed at the older users. Yet other aspects are outside of the developer’s control, such as available public funding. We summarize these findings and suggest lessons learnt for future projects.

SonicAIR

Sonic Atomic Interaction Radio (SonicAIR) is an ambient awareness technology probe designed to explore how connecting the soundscapes of friends or family members might reduce the isolation of seniors living independently. At its core, SonicAIR instruments kitchen activity sites to produce an always-on real-time aural representation of remote domestic rhythms. This article reports how users in two pilot SonicAIR deployments used the sounds as resources for recognizing comfortable narratives of sociability. Used alongside telecare monitoring, such technologized interaction might enable older people to engage in community-oriented soundscape narratives of shared social responsibility.

An Interoperability Solution for Legacy Healthcare Devices

The exchange of vital sign data between legacy healthcare devices and application hosting devices requires interoperability and has become a critical issue for telecare monitoring systems. This study proposes an ISO/IEEE 11073 personal health device (x73-PHD) system that enables legacy healthcare devices to transmit vital sign data to an application-hosting device on a network. The proposed architecture is composed of the x73-PHD gateway, x73-PHD adapter, and legacy healthcare devices. Using a firmware upgrade mechanism provided by the system, the adapter connects legacy healthcare devices to transmit vital sign data to the application-hosting device, based on international x73-PHD standards and the interoperable platform. The proposed solution overcomes the problems of existing legacy healthcare device support and interoperability for personal healthcare systems. This system will enable legacy healthcare devices to link with a standard platform and supports telecare promotion.

By any means? Questioning the link between gerontechnological innovation and older people's wish to live at home

This paper investigates the ‘natural’ and strong link between the often expressed desire of older people to remain living in the own home and gerontechnological innovations as a dominant way of making this possible. Drawing on theories of representations of users, this paper analyses the development and test use of a telecare monitoring system for older people with severe health problems. It will show how the view of older people as people-who-want-to-live-at-home aligns actors, draws on the ageing-and-innovation discourse and is embedded in a normative discourse in which developing gerontechnologies to allow older people to continue living at home is positioned as “evidently the right thing to do.” Attention will subsequently turn to the effects of this system on the lives of its older users and will show that the monitoring system did allow older people to stay at home, but that its introduction introduced a passive age script and reconfigured the home on a physical, virtual and emotional level, seriously affecting the experience of being at home. Such reconfigurations are, however, rendered invisible as allowing older people to live at home is positioned as “evidently the right thing to do”, leaving little room for debate.

Calling for Care: ‘Disembodied’ Work, Teleoperators and Older People Living at Home

The provision of ‘distant’ care to older people living at home through telecare technologies is often contrasted negatively to hands-on, face-to-face care: telecare is seen as a loss of care, a dehumanization. Here we challenge this view, arguing that teleoperators in telecare services do provide care to older people, often at significant emotional cost to themselves. Based on a European Commission-funded ethnographic study of two English telecare monitoring centres, we argue that telecare is not ‘disembodied’ work, but a form of care performed through the use of voice, knowledge sharing and emotional labour or self-management. We also show, in distinction to discourses promoting telecare in the UK, that successful telecare relies on the existence of social networks and the availability of hands-on care. Telecare is not a substitute for, or the opposite of, hands-on care but is at its best interwoven with it.

Electromechanical telecare ‐ overcoming functional needs

An ageing population will include increasing numbers of people who have mobility problems, and many who will be unable to perform personal care tasks such as toileting. Support for these groups is likely to be provided by a combination of human carers and electromechanical telecare devices. Many of the technologies that will be needed are already available, and the challenge may be to make them aesthetically appealing to the users. This paper describes some of the current approaches and the likely emergence of robotic devices or personal electronic appliances that will offer people an alternative means of support when they feel that they are unable to perform tasks for themselves. The devices may provide telecare monitoring so that people are only able to accept the electromechanical support when it is actually needed.

Safety assessment of a home-based telecare system for adults with developmental disabilities in Indiana: a multi-stakeholder perspective

We investigated the perceptions of people about the safety, security and privacy of a telecare monitoring system for adults with developmental disabilities living in residential settings. The telecare system was used by remote caregivers overnight, when staff were not present in the homes. We surveyed 127 people from different stakeholder groups in the state of Indiana. The people surveyed included those with knowledge or experience of telecare, and those without. The stakeholders were clients, their advocates, service provider administrators and independent case coordinators. The responses in each category for every group were positive except one: only 4 of the 11 telecare case coordinators agreed that the telecare system provided a secure environment. Overall, the telecare system was perceived to be as safe, secure and private as the conventional alternative of having staff in the home.

Predicting need for intervention in individuals with congestive heart failure using a home-based telecare system

We have studied how well the need for a medical intervention can be predicted by a telecare monitoring system. During a study period of about 18 months, 45 elderly individuals with congestive heart failure used a home health monitor to enter daily information pertaining to their symptoms and health status. A total of 8576 alerts were generated by the monitoring system, although in most cases, patient and service provider interaction was not required. When system alerts were considered to be serious, or if symptoms persisted, the patient was contacted. A total of 171 key medical events (6 deaths; 28 hospital admissions; 59 changes in medication; 54 cases of advice given; 24 instances where immediate medical attention was recommended) were recorded in the monitoring logs. A multivariate logistic regression model was developed to predict these medical interventions/events. The model correctly predicted key medical events in 75% of cases with a specificity of 74% and an overall cross-validated accuracy of 74% (95% CI, 68-80%). Key predictors included the number of system alerts, self-rated mobility, self-rated health and self-rated anxiety. This suggests that subjective measures are useful in addition to physiological ones for predicting health status. A multivariate decision support model has potential to supplement practitioners and current telecare systems in identifying heart failure patients in need of medical intervention.

Death and dying in the US: the barriers to the benefits of palliative and hospice care

In August 2006, after a trip to the New Jersey Shore, Peggy was having great difficulty catching her breath. In consultation with her children, Peggy decided that she was ready for hospice care. But, she did not want to relinquish her independence just because shortness of breath and a weakening heart overtook her daily stride. However, a single episode at home had thrown Peggy into crisis. Since Peggy lived alone, hospice care at home presented a host of challenges including safety and how to manage her unstable cardiopulmonary condition. Peggy was an ideal candidate for the hospice’s TeleCare (see box) monitoring program which provided a passive monitoring system, a medication dispenser, and vital signs monitoring for blood pressure, weight, and blood oxygen levels. In addition, the hospice authorized routine draws of BNP (beta naturetic peptide) and BMP (basic metabolic profile) with GFR (glomerular filtration rate) to manage her symptoms aggressively. Medications were adjusted accordingly to maximize quality of life and minimize symptoms. Though some would consider this treatment aggressive, it was the aggressive treatment of Peggy’s symptoms that allowed for an extended quality of life. There was sufficient evidence to support this action based on the concept of risk and reward, especially as there was a minimum of invasive therapies required. In Peggy’s case she went from being homebound and short of breath to living her life up to her final days. TeleCare monitoring enabled a hospice patient like Peggy to not only live independently, but also to leverage the hospice staff ’s ability to care for her. The nurse case manager could identify Peggy’s changing medical status for immediate intervention before symptoms escalated into a crisis. Making more informed and timely adjustments to Peggy’s treatment protocol allowed for intensive treatment of her symptoms and improved her overall quality of life. In Peggy’s case TeleCare monitoring played an important part in her living longer, more comfortably, and with peace of mind. Peggy had witnessed her father suffocate with emphysema and she feared that would also be her fate. But with her hospice care augmented with Telecare, Peggy’s children agreed that their mother never struggled to breathe. Peggy lived at home for another 2 months, and it was there she was able to celebrate her last birthday, close to her children and family.