Making Telecare desirable rather than a last resort

Assistive technologies and aging in place for people with dementia and disabilities: a proof-of-concept study with in-home passive remote monitoring with interactive communication functions

PURPOSE

Can assistive technologies (ATs) support aging in place for people with dementia and disability? In seeking to go beyond the persistent institutional care delivery paradigm, this proof-of-concept study tested the feasibility of home care delivery using sensors and remote communication devices. This article reports the collaborative efforts among care professionals, care recipients and family caregivers in their private home environment and the impact of in-home passive remote monitoring (PRM) system on the users. The purpose of this study was to investigate the usability and impact of a PRM system combining in-house passive remote monitoring and an interactive communication function.

METHODS

In order to realize AT-supported, person-centered aging in place, a new care delivery model was designed, developed and tested for the duration of 12 weeks. The study was conducted with 5 older people (1 with severe disability and 4 with dementia), their primary family carers with 15 care professionals as users.

RESULTS

The findings indicate that there were some technical issues. However, the overall assessment of the system performance was positive, and the users expressed favorable views regarding its preventive and interactive nature. The importance of team-based care delivery, adjusted to fit the PRM equipment, was also highlighted. Faced with the challenge of meeting the increasing demand for person-centered care with limited resources, there will be a greater need for better integration of improved ATs. The study indicates ATs' potential for enhancing the quality of life for those involved in caregiving, while stressing the significance of stakeholders' engagement, skills and teamwork.

Digital Adoption by an Organization Supporting Informal Caregivers During COVID-19 Pandemic Showing Impact on Service Use, Organizational Performance, and Carers' Well-Being: Retrospective Population-Based Database Study With Embedded User Survey

BACKGROUND

The COVID-19 pandemic has catalyzed a move from face-to-face to digital delivery of services by hospitals and primary care. However, little is known about the impact of digital transformation on organizations supporting unpaid caregivers. Since the start of the COVID-19 pandemic, the value of care provided by such informal caregivers is estimated to be £111 billion (US$ 152.7 billion) in England.

OBJECTIVE

This study aims to analyze service uptake patterns (including digital service options) over the pandemic period in an English caregivers' support organization covering a population of 0.98 million; measure changes in organizational performance, service efficiency, and quality; and identify the views of caregivers on service provision and future digital delivery.

METHODS

This was a retrospective analysis of the use of digital versus nondigital support services (January 2019 to June 2021) by caregivers in city and rural geographic areas. We compared organizational performance and service quality indicators for 2 financial years (2019-2020 and 2020-2021). A survey was conducted to identify barriers and facilitators to digital service uptake, the computer proficiency of caregivers (the Computer Proficiency Questionnaire, 12-item version), and preferences for future digital service provision. Quantitative data were analyzed using Stata 13 (StataCorp LLC). Thematic analysis was used for open-text survey responses.

RESULTS

The number of caregivers registered with the organization rose from 14,817 in 2019 to 20,237 in 2021. Monthly contacts rose from 1929 to 6741, with remote contacts increasing from 48.89% (943/1929) to 86.68% (5843/6741); distinctive patterns were observed for city versus rural caregivers. There was an increase in one-to-one contacts (88.8%) and caregiver assessments (20.9%), with no expansion in staffing. Service quality indicators showed an improvement in 5 of 8 variables (all P<.05). The 152 carers completing the survey had similar demographics to all registered caregivers. The Computer Proficiency Questionnaire, 12-item version, mean score of 25.61 (SD 4.40) indicated relatively high computer proficiency. The analysis of open-text responses identified a preference for the organization to continue to offer face-to-face services as well as web-based options. The digital services that were the most highly rated were carers' well-being assessments, support needs checks, and peer support groups.

CONCLUSIONS

Our findings show that staff in the caregiver support organization were agile in adapting their services to digital delivery while dealing with increased numbers of registered clients and higher monthly contacts, all without obvious detriment to service quality. Caregivers indicated a preference for blended services, even while recording high computer proficiency. Considering the economic importance of unpaid caregivers, more attention should be given to organizations funded to provide support for them and to the potential for technology to enhance caregivers' access to, and engagement with, such services.

Understanding the Value of a Proactive Telecare System in Supporting Older Adults' Independence at Home: Qualitative Interview Study Among Key Interest Groups

BACKGROUND

Telecare is claimed to support people to live in their own homes for longer by providing monitoring services that enable responses to emergencies at home. Although most telecare technologies commissioned in the United Kingdom predominantly supply reactive services, there has been recent interest among policy makers to develop proactive telecare services to provide additional understanding of older adults' health and well-being needs to provide a means for more preventive interventions. Proactive telecare refers to providing regular well-being calls or encouraging users to regularly confirm their well-being to anticipate and prevent crises through an increased understanding of individuals' needs and by building social relationships with older adults. Such technologies have already begun to be introduced, yet little research has explored the potential value of proactive telecare.

OBJECTIVE

This study explores the perceptions of different interest groups to understand the extent to which using a proactive telecare service can support older adults to live independently, what potential health and well-being benefits may be elicited from its use, and what the limitations are.

METHODS

Semistructured interviews were conducted with older people (those with experience in using proactive telecare and those without), family members of proactive telecare users, and proactive telecare staff regarding their perceptions and opinions about the value of a proactive telecare service. Data were analyzed using inductive thematic analysis.

RESULTS

A total of 30 individuals participated in this study. Older adults described the value of proactive telecare in feeling safe and in control and appreciated feeling connected. Family members and staff valued the potential to detect early health deterioration in older adults, and all participants highlighted the benefit of strengthening access to social networks, particularly for socially isolated older people. However, telecare is often viewed as a last resort, and therefore, anticipatory care may not suit all populations, as demonstrated by the mixed acceptance of the technology among older adults who did not have experience using it. Participants also reported limitations, including the requirement for family, friends, or neighbors to assist older adults during an emergency and the need for financial resources to fund the service.

CONCLUSIONS

This study presents the first known qualitative inquiry about a proactive telecare system, which provides rich and detailed insights from different perspectives into the potential benefits of this intervention. Proactive telecare may promote and facilitate the accumulation of social and technological resources as individuals prepare to cope with age-related challenges, thus helping to avoid negative outcomes prematurely. However, similar to reactive telecare, proactive telecare must be matched to individual preferences and existing financial and social resources.

Trends in Telecare Use among Community-Dwelling Older Adults: A Scoping Review

A scoping review was conducted to map and analyze the concept of telecare services and the trends in telecare use. This scoping review was conducted according to Arksey and O'Malley's framework. A search was conducted in CINAHL (via EBSCO), ERIC, Academic Search Ultimate, and MEDLINE/PubMed databases. This scoping review considered quantitative (e.g., analytical observational studies, including prospective and retrospective cohort studies, case-control, analytical cross-sectional, and descriptive-observational studies), qualitative (e.g., phenomenology, grounded theory, ethnography, and action research), and mixed-method primary studies. Forty research articles published from 1 January 2012, to 1 January 2022 were included in this review, these studies met the eligibility criteria as all were focused on telecare and targeting older adults over 65 living at home. The reviewers coded the data in an Excel spreadsheet, including the articles' title, year, author, journal information and subject, research methods, sample size, location, and summary. Then, the researchers analyzed the conceptual definitions, measurement techniques, and findings in detail and the findings were grouped into categories. The trends around the concept of telecare are independent living, remote care, aging in place, and safety. Telecare research focuses mainly on service use, chronic illness, ethics, and cost-effectiveness. Technology acceptance among older individuals is a critical factor for telecare use. The results found in the literature about the cost-effectiveness of telecare are inconsistent.

Digital ageing in Europe: a comparative analysis of Italian, Finnish and Swedish national policies on eHealth

Ageing Europeans are today healthier than previous generations and often manage to live independently up to a high age. The proportion of people 80 years of age and older has increased significantly, and with high age the risk of multi-illness and dementia increases. Strong urbanisation processes have changed the demographic structure in rural areas, and young women and men have migrated towards the urban areas to study and work, while older persons have remained behind. This demographic challenge of increasing numbers of persons older than 80 years with care needs living in remote rural areas has become a major European social problem. In tackling this dilemma, many European countries have high expectations for eHealth, digitalisation and welfare technology. In this comparative study of policy debates in Italy, Finland and Sweden, we analyse how – between 2009 and 2019 – the issues of eHealth have been articulated in national and regional policies of the three countries with deep differences in terms of digitalisation and health systems, but with similar ageing populations. We identify in the documents three core topics – the role of technology, the rural issue and responsibility for care. These topics are treated in the documents with differences and similarities between the three countries. Beyond the differences and similarities, the documents reveal both a certain techno-enthusiasm about the role of eHealth in the life of the older adults as well as a limited understanding of the complexity (relationally as well as spatially) of the digital landscape of caring for older adults.

Telecare at a crossroads? Finding researchable questions

Purpose

This paper aims to report on a structured attempt to develop new directions for research into telecare. Current research evidence suggests that telecare in the UK is not optimally cost-effective and does not deliver better outcomes than more traditional forms of care and support. To address this problem, an analysis of expert opinion about future directions for research is provided.

Design/methodology/approach

Two electronic surveys of UK based academic experts were conducted. Participants were drawn from a range of professional disciplines, including medicine, social care, occupational therapy and social policy and identified were by their contribution in this, or allied fields. The first survey included nine questions intended to identify at least one new research question that could form the basis of a funding proposal to the Nuffield Foundation, which provided “seedcorn” funding to support this work. Ten themes were identified following thematic analysis. The second survey asked participants to prioritise three of these themes.

Findings

Key themes emerging as priority areas for future research were as follows: the role of assessment in ensuring technology deployment meets the needs of service users; ethical implications of technology and how these might be addressed in the future; and the use of end user co-production/co-creation approaches in the development of new assistive technologies and digital enabled care.

Research limitations/implications

The findings are based on academic expert opinion; perspectives of practitioners, service users and family members are unrepresented.

Practical implications

The findings of this study could contribute to development of new directions for telecare research, and future strategic funding decisions in this rapidly changing field.

Originality/value

Evidence for sub-optimal outcomes for telecare requires new thinking. The authors are not aware of any other study that offers an analysis of expert opinion of fruitful areas for new research into telecare.