Richard Curry

A systematic review of the benefits of home telecare for frail elderly people and those with long-term conditions

We have conducted a systematic review of home telecare for frail elderly people and for patients with chronic conditions. We searched 17 electronic databases, the reference lists of identified studies, conference proceedings and Websites for studies available in January 2006. We identified summaries of 8666 studies, which were assessed independently for relevance by two reviewers. Randomized controlled trials of any size and observational studies with 80 or more participants were eligible for inclusion if they examined the effects of using telecommunications technology to (a) monitor vital signs or safety and security in the home, or (b) provide information and support. The review included 68 randomized controlled trials (69%) and 30 observational studies with 80 or more participants (31%). Most studies focused on people with diabetes (31%) or heart failure (29%). Almost two-thirds (64%) of the studies originated in the US; more than half (55%) had been published within the previous three years. Based on the evidence reviewed, the most effective telecare interventions appear to be automated vital signs monitoring (for reducing health service use) and telephone follow-up by nurses (for improving clinical indicators and reducing health service use). The cost-effectiveness of these interventions was less certain. There is insufficient evidence about the effects of home safety and security alert systems. It is important to note that just because there is insufficient evidence about some interventions, this does not mean that those interventions have no effect.

Flexible Homes, Flexible Care, Inflexible Organisations? The Role of Telecare in Supporting Independence

‘Telecare’ involves the use of information and communications technologies to provide support for vulnerable individuals living in the community. The UK government wishes to make telecare available in all homes that need it by 2010. This expansion is seen as central to the improvement of older peoples independence and quality of life by enabling them to live at home whenever possible. The paper discusses the range of initiatives now in place to facilitate the introduction of telecare in the UK. It argues that while there is now experience of telecare through pilot and demonstration schemes, moving to mainstream service delivery is far from straightforward. Using a case study of a telecare scheme, along with supplementary data from other schemes, the paper explores the reasons why it may be hard to meet government objectives. These include the organisational and cultural characteristics of local care institutions and the complexity of scheme objectives. It draws conclusions on the challenges in meeting aspirations for mass telecare over the next decade and on the future role of the housing stock in care provision.

Meeting government objectives for telecare in moving from local implementation to mainstream services

The UK government wishes to deploy a mainstream telecare service by 2010. We believe that it will be necessary to overcome the organizational and structural barriers to such an implementation. A better understanding of the effect of telecare across the care system as a whole will also be needed. In the absence of rigorous data from trials and because of the time taken for systemic effects to emerge, the evidence for the benefits of telecare needs to be explored through simulation modelling.

Lifestyle monitoring as a predictive tool in telecare

Six people with multiple health problems living in an extra care housing scheme for older people with vision impairment agreed to take part in a telecare trial. An average of 14.8 sensors was installed in each of the flats. The monitoring period began in January 2006 and lasted for 10 months. The data acquired by the sensors installed in each flat was transmitted from the home unit to a central computer. Four interviews were conducted with each participant. Halfway through the study we created a number of case studies of sensor activity at the time of known events in the lives of the participants, together with an attempt to interpret these patterns of activity with the benefit of available contextual information. Although our investigation showed that sensors are capable of identifying some changes in daily routines at the time of important events, the interpretation of such changes requires a large amount of contextual information and the involvement of participants themselves. Various technical and operational difficulties will need to be resolved before it will be possible to use lifestyle monitoring predictively.