Hsm Helianthe Kort

Ageing-in-place with the use of ambient intelligence technology: Perspectives of older users

INTRODUCTION Ambient intelligence technologies are a means to support ageing-in-place by monitoring clients in the home. In this study, monitoring is applied for the purpose of raising an alarm in an emergency situation, and thereby, providing an increased sense of safety and security. Apart from these technological solutions, there are numerous environmental interventions in the home environment that can support people to age-in-place. The aim of this study was to investigate the needs and motives, related to ageing-in-place, of the respondents receiving ambient intelligence technologies, and to investigate whether, and how, these technologies contributed to aspects of ageing-in-place. METHODOLOGY This paper presents the results of a qualitative study comprised of interviews and observations of technology and environmental interventions in the home environment among 18 community-dwelling older adults with a complex demand for care. These respondents had a prototype of the Unattended Autonomous Surveillance system, an example of ambient intelligence technology, installed in their homes as a means to age-in-place. The UAS-system offers a large range of functionalities, including mobility monitoring, voice response, fire detection, as well as wandering detection and prevention, which can be installed in different configurations. RESULTS The respondents had various motives to use ambient intelligence technologies to support ageing-in-place. The most prominent reason was to improve the sense of safety and security, in particular, in case of fall incidents, when people were afraid not to be able to use their existing emergency response systems. The ambient intelligence technologies were initially seen as a welcome addition to strategies already adopted by the respondents, including a variety of home modifications and assistive devices. The systems tested increased the sense of safety and security and helped to postpone institutionalisation. Respondents came up with a set of specifications in terms of the operation and the design of the technology. False alarms were also regarded as a sign that the ambient intelligence technology is functioning. Moreover, a good integration of the new technologies in the provision of health care is indispensable, and installation should be done in an acceptable and unobtrusive manner. CONCLUSIONS AND IMPLICATIONS Ambient intelligence technologies can contribute to an increased safety and security at home. The technologies alone offer no all encompassing solution as home care and additional environmental interventions are still needed to support ageing-in-place. Results of the study are used to further improve the ambient intelligence technologies and their implementation.

Environmental Interventions and the Design of Homes for Older Adults With Dementia: An Overview

In Western societies, the vast majority of people with dementia live at home and wish to remain doing so for as long as possible. Aging in place can be facilitated through a variety of environmental interventions, including home modifications. This article provides an overview of existing design principles and design goals, and environmental interventions implemented at home, based on literature study and additional focus group sessions. There is a multitude of design principles, design goals, and environmental interventions available to assist with activities of daily living and functions, although few systematic studies have been conducted on the efficacy of these goals and interventions. The own home seems to be a largely ignored territory in research and government policies, which implies that many problems concerning aging in place and environmental interventions for dementia are not adequately dealt with.

Supportive living environments: A first concept of a dwelling designed for older adults with dementia

The vast majority of older adults want to remain living independently at home, with or without a sufficient amount of professional home care, even when overall health is starting to decline. The ageing of society and the increase in the number of very old elders goes together with an increase in the number of people with dementia. About two thirds of the diagnosed people in the Netherlands live at home. Dementia has severe implications to the quality of daily life, in particular to independent functioning. This sets extra demands to living environments. Older adults with dementia and their partners ask for living environments that support independence, compensate for declining vitality, and lower the burden of family care. For this purpose, a first concept of a design for a dementia dwelling is presented in this paper, which incorporates modifications in terms of architecture, interior design, the indoor environment, and technological solutions. These design features were derived from literature search and focus group sessions. Current design guidelines are frequently based on practical experience only, and therefore, more systematic field research should be carried out to find evidence for the various design modifications. Also, it needs to be studied how the design features of the dementia dwelling can be incorporated into the existing housing stock.

The integrated and evidence-based design of healthcare environments

The design of healthcare facilities is a complex and dynamic process, which can be supported by design support models. This process involves a large number of stakeholders, of whom some have specific health-related needs. Evidence-based design is an emerging approach for the design of healthcare facilities, basing design choices on scientific data. Apart from the problems accompanying the limited access to, and limited availability of, scientific evidence, the design of a building itself is characterised by dimensional, technological and stakeholder complexities that are derived from technology philosophy. This article deals with the derivation of performance indicators and design solutions for healthcare facilities and links this search to the foundations of evidence-based building. The In2Health design model is elaborated as a framework to steer this process and support architects, programmers and process managers. The applicability of the model in the evaluation and design processes of buildings is illustrated by two case studies concerning (i) the evaluation of the indoor environment for older people with dementia and (ii) the design process of the redevelopment of an existing hospital.

Clinical improvement after unusual avoidance measures in the home of an atopic dermatitis patient

A 27‐year‐old female office clerk with widespread atopic dermatitis (AD) since infancy appeared to be highly sensitized and exposed to molds, storage mites, and chicken feathers and moderately sensitized to house‐dust mites and grass and birch pollens. Hardly any textiles were present in her home; that is, only 28 m2, which is less than 25% of the Dutch national average. The causal relationship between eczema and molds plus storage mites in this case of AD was strengthened by the positive effect of an unusual, multidisciplinary home‐sanitation program involving cleaning of mineral surfaces and ventilation improvement. This home‐sanitation program led to a gradual drop of total IgE and clinical symptom scores to 21% and 13%, respectively, of the original values.

Telehomecare in The Netherlands: Barriers to Implementation

Telehomecare is one of the technological solutions used by older persons to remain living at home in their own community. A selection of 85 Dutch telehomecare projects was examined in terms of the barriers to their implementation. Three categories of telehomecare technologies were distinguished: i remote telecare, ii activity monitoring, and iii a category comprising telemedicine and e-health solutions and services. There are numerous barriers to the implementation of telehomecare technologies. In the majority of the Dutch telehomecare projects, the needs of both care recipients and family carers are addressed. The integration of needs derived from ones health condition and the requirements set to technology are not always a match. Some projects give consideration to how to get commitment of the care professionals and their managers. Only a few projects consider economic aspects, for instance by the development of a social business case. To lift the barriers to the implementation of telehomecare, a better exchange of knowledge and experiences related to functionalities and user needs, the use of home modifications and assistive technologies, as well as the available care support should be considered.

Design of a website for home modifications for older persons with dementia

BACKGROUND: At present, persons with dementia and their family caregivers in the Netherlands are not adequately supported to modify their dwellings to match their personal needs. OBJECTIVE: To facilitate aging-in-place for persons with dementia, a website was designed. METHODS: The website was designed with persons with dementia and their spouses. In consultation sessions existing websites were discussed. Based on this discussion, a demonstration website was created and then discussed with and judged by the participants. Visits to the website were monitored using Google Analytics. RESULTS: Participants prefer a website that is easy to print. In addition, the navigation menu should have a maximum of three levels, and the website menu should be positioned on the left. Participants dislike the use of meaningless photographs because these do not add any value to the information given. CONCLUSIONS: Participants prefer a website that is as accessible as reading a book. Some differences are related to culture, such as the participants dislike for the use of English terms. Therefore, preferences or dislikes of items on a website could not be generalized as such. However, the preferences and dislikes may provide useful input for the design process of an appropriate website.

Samenwerken op afstand met inzet van eHealth

Technologische veranderingen zijn niet meer weg te denken in het dagelijks leven. Informatie- en communicatietechnologische (ICT) ontwikkelingen hebben bezit genomen van activiteiten thuis. Denk hierbij aan het gebruik van de tablet, mobiele telefoon, navigatiesystemen. Ze zijn ook niet meer weg te denken uit de spreekkamer van de arts. Het steeds verder verkleinen van apparatuur, ook wel aangeduid als miniaturisering, de flexibilisering en digitalisering zorgen ervoor dat een aantal zorghandelingen op afstand kan gebeuren, afzonderlijk van de artsenpraktijk dan wel het ziekenhuis. Samenwerken op afstand met behulp van ICT kan tussen artsen en andere zorgprofessionals onderling plaatsvinden via eHealthtoepassingen. Deze toepassingen zijn grofweg te verdelen in toepassingen door middel van digitale vragenlijsten, door middel van beeld, door middel van sensoren en in combinaties. Hoe eHealth ingezet kan worden komt aan bod aan door beschrijving van een aantal studies over eHealth bij COPD en bij hartfalen.

Samenwerking door nieuwe technologieën

Samenwerking in de zorg verandert. Dit heeft te maken met onder andere de volgende relevante ontwikkelingen: verschuiving van acute zorg naar meer chronische zorg, verandering in de bekostiging van de zorg, invoering van nieuwe beroepen door taakherschikking, een toenemende inbreng van de patient, empowerment van patienten en invoering van nieuwe technologieen. Nieuwe technologieen zoals eHealth-toepassingen en gebruik van IT in gezondheidsinformatiesystemen zijn niet meer weg te denken in de zorg. De technologische ontwikkelingen en de toepassingen daarvan schrijden voort.

Samenwerking middels informaticatechnologie

De recente ontwikkelingen in de informaticatechnologie brengen de mogelijkheid met zich mee tot samenwerken bij afstandsbegeleiding en/of zorg op afstand van de chronisch zieke patient. Afstandsbegeleiding is een onderdeel van een vakgebied dat wordt aangeduid met de term ‘health informatics’. Health informatics is een overkoepelende term en deze duidt op het verzamelen van data in het secundaire proces ten behoeve van het primaire proces. Health informatics is een interdisciplinair vakgebied, waar zowel eHealth, mHealth of xHealth in thuishoren, waarbij onder de laatste de nog te ontwikkelen applicaties vallen. xHealth bestaat nog niet; deze term geeft aan dat er nog andere ontwikkelingen aan kunnen komen.