Jürgen Howe

Health-enabling technologies for pervasive health care: on services and ICT architecture paradigms

Background. Progress in information and communication technologies (ICT) is providing new opportunities for pervasive health care services in aging societies. Objectives. To identify starting points of health-enabling technologies for pervasive health care. To describe typical services of and contemporary ICT architecture paradigms for pervasive health care. Methods. Summarizing outcomes of literature analyses and results from own research projects in this field. Results. Basic functions for pervasive health care with respect to home care comprise emergency detection and alarm, disease management, as well as health status feedback and advice. These functions are complemented by optional (non-health care) functions. Four major paradigms for contemporary ICT architectures are person-centered ICT architectures, home-centered ICT architectures, telehealth service-centered ICT architectures and health care institution-centered ICT architectures. Conclusions. Health-enabling technologies may lead to both new ways of living and new ways of health care. Both ways are interwoven. This has to be considered for appropriate ICT architectures of sensor-enhanced health information systems. IMIA, the International Medical Informatics Association, may be an appropriate forum for interdisciplinary research exchange on health-enabling technologies for pervasive health care.

Age-related changes in neural recruitment for cognitive control.

The dual mechanisms of control (DMC; Braver, Gray, & Burgess, 2007) framework postulates a distinction between proactive and reactive modes of cognitive control. Event-related brain potentials (ERPs) were used to examine age differences in the neural correlates of proactive and reactive control for task-switching. Whereas proactive control is associated with brain activity for anticipatory task preparation, reactive control is accompanied by reduced preparatory activity, but increased activation during task execution. Switching between tasks was based on feedback-based transition cueing which places particularly high demands on mechanisms for cognitive control. Older adults maintained good performance accuracy at the expense of slower response times. No age-related increase in behavioral switching costs was observed. The cue-locked ERP (P3a) data revealed an age-related decrease in neural activity related to the processing of switch cues. In the target-locked ERPs, there was an increased frontal focus of the P3b in older adults. These ERP data indicate an age-related neural under-recruitment for proactive cognitive control and an age-related neural over-recruitment for reactive cognitive control. They are consistent with the idea that older adults may not fully implement task settings before target onset, after which they need to catch up on the omitted preparatory task settings.

Predictions for Epidemiologic Indicators of Age-Related Diseases and Implications for the Development of Health-Enabling Technologies

The steady increase in life expectancy in our modern industrialized societies will not only lead to a significant change in demographics, but also in epidemiologic factors. This paper reviews current predictions for epidemiologic indicators and derives implications for the development of future health-enabling technologies. Methods: A literature search in PubMed/MEDLINE was conducted and several statistical data bases were used to obtain up-to-date prediction data on health in the elderly population. Results: Prevalence rates for the leading diseases such as cardiovascular diseases, diabetes mellitus and cancers will remain almost constant in the next decades, but incidence rates will rise markedly because of the increase in the elderly population. For neuropsychiatric diseases such as dementias and depression an increased impact is expected. Conclusion: One focus for the development of health-enabling technologies is and will remain on monitoring, especially cardiovascular parameters. More research needs to be conducted to tap the full technological potential of preventive measures, e.g. for the prevention of social isolation and the promotion of a healthy lifestyle.

Institutional Authority and Traces of Intergenerational Conflict

While societys level of education increases in a modernization process, the knowledge monopoly is taken over by the young. Increasing demand on knowledge attained through organized education leads to increasing power by the young. In the modernizing society of Turkey, this kind of struggle will occur between intellectual groups. Results of this study reveal a conflict between the elder generations granted institutional authority and the young population having the capability of seizing this authority. Obtained results demonstrate that there exist remarkable negative aspects in the attitudes of the university youth towards the institutional authority of the elderly. The importance of the study lies in the fact that it is the first study introducing the concept of “intergenerational conflict” to the sociological society of Turkey and, thus, paving the way to further research.

Potenziale der stationär pflegerischen Betreuung Schwerstdemenzkranker

ZusammenfassungDer vorliegende Beitrag thematisiert die Weiterentwicklung von Qualitätsmaßstäben für die Betreuung Schwerstdemenzkranker. Der Beitrag soll einen komprimierten Einblick in die stationär pflegerische Versorgung Schwerstdemenzkranker geben, da dieser Personenkreis einen besonderen Bedarf an Zuwendung beansprucht und eine angemessene Betreuung in diesem fortgeschrittenen Krankheitsstadium bisher kaum zur Verfügung steht. Neben der begrifflichen Eingrenzung gegenüber leichter und mittelschwerer Demenzerkrankung werden deshalb angewendete Qualitätsmaßstäbe vorgestellt. Hierzu wurden anhand von teilstandardisierten Leitfadeninterviews in ausgewählten europäischen „Best-practice“-Einrichtungen wissenschaftliche Studien vorgenommen, die neben der Sichtung von Fachtexten eine Gegenüberstellung und Diskussion einzelner Konzeptionen im Hinblick auf Wohlbefinden und Lebensqualität erlauben. Als Ergebnis werden optimierte Qualitätsmaßstäbe herausgearbeitet und resultierender Forschungsbedarf eruiert.AbstractThe present article discusses the further development of quality standards for the care of people suffering from severe dementia. The article provides an insight into the residential nursing care of people suffering from advanced dementia. Although they need particular attention there is a lack of adequate care for the most advanced cases. In addition to a conceptual classification of mild, moderate and advanced dementia, practical quality standards are presented. Based on semi-standardized guided interviews in selected European best practice facilities, scientific studies were carried out. These studies include a review of the literature as well as a comparison and discussion of concepts regarding the well-being and quality of life. As a result optimized quality standards and needs for further research were elicited.