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Issue 01, December 2011
By Sue Yeandle, Director of CRICLE at the University of Leeds and AKTIVE's director
Leading centres of research on care and ageing at the Universities of Leeds and Oxford have joined forces with industrial partner Tunstall (UK) Ltd and commercial and market research partner Inventya Solutions Ltd to develop AKTIVE, a major new study on how telecare supports older people at risk when living at home because they suffer from memory problems or are likely to fall.
The centrepiece of AKTIVE, based at CIRCLE (Centre for International Research on Care, Labour and Equalities, University of Leeds) and the Oxford Institute of Population Ageing, is a path-breaking new study of the everyday lives of 80 older people with these conditions in Leeds and Oxfordshire. Each older person in the study will have state-of-the-art telecare support installed in their home to help them to live as safely and independently as possible.
The study also has the support of a consortium of key agencies and experts to advise, support and contribute to the AKTIVE project. The telecare services of Leeds City Council and Oxfordshire County Council already have much experience of providing telecare support to older people, but have joined the AKTIVE consortium to contribute to and benefit from the study. The researchers will help them analyse existing evidence about how telecare is used, while they will help the research team identify older people suitable to be invited to join the study.
With other members of the AKTIVE consortium - which includes experts on memory problems and falls in older people, on design, ergonomics and assisted living, and on the support needs of older people and those who care for them - the councils will also assist the researchers in identifying carers (family members, neighbours and friends) and paid home care workers who support an older person with telecare in place, so that their perspective on the usefulness and potential of telecare solutions can also be understood.
Professor Sue Yeandle, who leads the study, says: "Our aim is to improve understanding of how telecare can benefit both older people living at home and the people and agencies who assist them to do this. We also plan to develop new intelligence on how telecare can gain acceptability among home care providers, family carers and others involved in an older person's support in later life. This exciting new study, which has funding from the Technology Strategy Board and ESRC as well as from our industrial partners, will help UK telecare companies, distributors and technical support services - already ahead of the field in global terms - to explore all available options in getting telecare products and services to market."
By Richard Farrell-Smith , Product Manager at Tunstall Healthcare (UK) Ltd
Tunstall Healthcare (UK) Ltd is proud to be a partner in the AKTIVE project, and make its contribution towards increasing the UK's knowledge of how telecare can support people with memory problems and those at risk of falls to live safely and independently. Established for over fifty years Tunstall has a rich heritage of innovation and invests 4-5% of turnover each year into research and development. The AKTIVE project will complement and augment our own ongoing programme of market research and product testing, and offers an excellent opportunity for our product development team to work with respected partners such as Leeds CIRCLE and Oxford Ageing Institute.
Falls prevention and supporting people with memory problems and those who care for them have long been identified as areas where technology can make a real difference to people's lives, and undertaking this kind of large-scale, multi-faceted research project will increase enormously our understanding of the needs and wants of end users. This in turn will enable future product development to be truly responsive to their requirements, and focus our roadmap on solutions that will provide the most benefit.
We also hope the project will educate the wider marketplace regarding barriers to the large-scale uptake of assistive technologies, both at a service user and commissioner level, and how best these can be overcome. At a time when health and social care budgets are under unprecedented pressure, providing evidence of how telehealthcare can help to make effective use of care resources is more vital than ever before.
Steve Sadler, Group Chief Technology Officer at Tunstall said "We are excited to have this opportunity to be a part of such a groundbreaking project, and to increase our understanding of how users would like to see our products and services develop. We expect the project will contribute significantly to our knowledge base regarding both the current use of telecare, and the possibilities for its future development and deployment."
More information on Tunstall Healthcare and its products and services can be found at www.tunstall.co.uk
By Paul Cann, CEO AgeUK Oxfordshire
I have a favourite presentation slide. It is of an older man smiling, standing by what appears to be a kettle. He lives in Japan and the kettle is a noodle machine. When his noodle machine boils it sends his son (who lives 60 miles away) an email reassuring him that his father is about to eat some lunch. That this story seems outlandish says a lot about the gap in our appreciating and exploiting all that telecare offers.
We have two recent triumphs: demographic, of two years of added life expectancy with every passing decade; and technological, with a wealth of new ways in which we can communicate better, faster, at greater distance. But we must hurry. The number of people over 85 doubles in the next few. They are the group most likely to experience frailty, as in for example risk of losing balance (a fall being the commonest reason for a 999 call) or cognitive impairment, where more than 1 in 5 of that age group will experience memory problems.
But I don't hear that urgency in the public debate. Telecare ought not to be some newfangled mystery, little understood and warily adopted. It should be mainstream to every home and care setting. The economic case for using it needs to be proclaimed from the rooftops; Tunstall and others argue that £1 investment can save £5. When councils are being hit by a 25% cut in their social care budgets for older people we should passionately investigate how telecare can help people stay, more cost-effectively, in their own home for longer, and how carers can use telecare to support them to be able to go on caring for their loved one with poor memory, as they dearly wish.
I think it is a lot about attitudes. Attitudes of users of technology themselves and their families, to break down phobias. Attitudes of those who worry that telecare is going to be used as a substitute for companionship rather than the complementary support it should be. Attitudes of commissioners who have not yet roused themselves to appreciate all that is out there. The challenge, I would argue and to coin a phrase, lies not in our stars but in ourselves. And my charity hopes to be out there at the frontiers, working to help us all to develop our thinking and enjoy the new dawn.
By Dr. Adam Darowski, Oxfordshire Falls Service
Dr. Adam Darowski leads the Oxfordshire Falls Service and will contribute a briefing paper on the topic of falls to the AKTIVE project. He highlights the significance and prevalence of falls, and describes some of the challenges ALT will need to address.
Falls are one of the most common conditions affecting older people and the related injuries result in as many hospital bed days being occupied as heart disease, lung disease, diabetes and stroke put together. They are also the major cause of admissions to a care homes. From the age of 65, the rate of falls and the injuries increases.
Broadly speaking, the causes of falls can be divided into four groups. First, are accidents such as slips and trips. We all fall due to a mishap from time to time, but an older person is less likely to be able to regain their balance and merely stumble, as a younger person might. Second, falls may be caused by impairments of gait, balance or vision resulting from neurological disease, musculoskeletal degeneration, disability caused by chronic disease or the effects of medicines or alcohol. Similarly, illness can also increase the likelihood of falling. Finally, sudden events such as fainting, seizures or stroke may also cause a fall.
In terms of prevention, what we do at the Oxfordshire Falls Service is to undertake an assessment that diagnoses the underlying cause of falls for that person. A plan of what can be done, and what the patient wishes to do, is then discussed with the patient. Interventions may consist of exercise, a medication review, diagnosing the causes of fainting and faintness, the provision of walking aids and education on the factors which increase the risk of falling.
The only piece of assistive technology in widespread use is the pendant / wrist alarm. The characteristics of older patients that limit the use of ALT are their unfamiliarity with and limited access to modern technology, as well as physical factors such as visual, cognitive and hearing impairment. These are the factors which present challenges for ALT manufacturers and designers, as well as creating an attitudinal shift in older people prone to falls to recognise the risks they pose. Although nearly half of those aged 80 or over will fall at least once a year, those of us who work in this field of medicine have great difficulty persuading people of its importance. The AKTIVE project will explore the feelings of those suffering from falls about the risks they face, and the ALT they encounter, which could ultimately contribute to better products and services for this group.
By Dr. Rupert McShane, Thames Valley Dementias and Neurodegenerative Diseases local research network
Dr. Rupert McShane is clinical lead for the Thames Valley Dementias and Neurodegenerative Diseases local research network. Like Dr. Darowski, Dr. McShane will provide the AKTIVE project with expertise on dementia and ALT. Rupert outlines the cost of memory problems, both for the UK economy and unpaid carers and some of the factors ALT design will have to take into account when creating products for those with memory problems.
The term 'dementia' refers to the syndrome of progressive cognitive impairment which affects social or occupational functioning. Over 820,000 people in the UK live with Alzheimer's and other dementias. It costs the UK economy £23 billion annually - more than heart disease and cancer combined - and dementia research is severely underfunded, receiving 12 times less than research support than cancer research. Per patient with dementia, the combined health and social care costs are estimated at £12, 521 annually - about six times the costs for stroke (£2,559) and cancer (£2,283) and 12 times the cost of ischaemic heart disease.
Most of the costs of dementia - £12.4 billion - are met by unpaid carers who provide 1.5 billion hours of unpaid care (55% of total costs). A third (34%) of informal care hours are provided by economically active relatives/friends. Or to put it the other way round - 66% of informal care is provided by relatives/friends who do not work, usually because they themselves are elderly and retired. Social care costs are £9 billion (40%) and health care costs amount to £1.2 billion (5% of total costs).
Some of the symptoms of dementia present an opportunity for ALT to provide assistance for both the individual and their carers. However, at the same time these symptoms can present barriers for ALT usage. Dementia symptoms include difficulties with tasks and activities that require concentration and planning, as well as loss of memory and periods of mental confusion. In addition, some dementia patients also experience visual hallucinations and begin wandering, particularly during the night. These symptoms are particularly worrying for carers for whom ALT can provide peace of mind, and given the high numbers providing unpaid care, the demand for effective technological solutions is increasing. This project will therefore make a really important contribution to our understanding of what are the strengths and limitations of current ALT for those with dementia, and provide insight into opportunities for improvement and development.