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Xu J, Smaling HJA, Schoones JW, Achterberg WP, van der Steen JT. Noninvasive monitoring technologies to identify discomfort and distressing symptoms in persons with limited communication at the end of life: a scoping review. BMC Palliat Care 2024; 23:78. [PMID: 38515049 PMCID: PMC10956214 DOI: 10.1186/s12904-024-01371-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/29/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Discomfort and distressing symptoms are common at the end of life, while people in this stage are often no longer able to express themselves. Technologies may aid clinicians in detecting and treating these symptoms to improve end-of-life care. This review provides an overview of noninvasive monitoring technologies that may be applied to persons with limited communication at the end of life to identify discomfort. METHODS A systematic search was performed in nine databases, and experts were consulted. Manuscripts were included if they were written in English, Dutch, German, French, Japanese or Chinese, if the monitoring technology measured discomfort or distressing symptoms, was noninvasive, could be continuously administered for 4 hours and was potentially applicable for bed-ridden people. The screening was performed by two researchers independently. Information about the technology, its clinimetrics (validity, reliability, sensitivity, specificity, responsiveness), acceptability, and feasibility were extracted. RESULTS Of the 3,414 identified manuscripts, 229 met the eligibility criteria. A variety of monitoring technologies were identified, including actigraphy, brain activity monitoring, electrocardiography, electrodermal activity monitoring, surface electromyography, incontinence sensors, multimodal systems, and noncontact monitoring systems. The main indicators of discomfort monitored by these technologies were sleep, level of consciousness, risk of pressure ulcers, urinary incontinence, agitation, and pain. For the end-of-life phase, brain activity monitors could be helpful and acceptable to monitor the level of consciousness during palliative sedation. However, no manuscripts have reported on the clinimetrics, feasibility, and acceptability of the other technologies for the end-of-life phase. CONCLUSIONS Noninvasive monitoring technologies are available to measure common symptoms at the end of life. Future research should evaluate the quality of evidence provided by existing studies and investigate the feasibility, acceptability, and usefulness of these technologies in the end-of-life setting. Guidelines for studies on healthcare technologies should be better implemented and further developed.
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Affiliation(s)
- Jingyuan Xu
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Gebouw 3, Postzone V0-P, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
| | - Hanneke J A Smaling
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Gebouw 3, Postzone V0-P, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
- University Network for the Care Sector Zuid-Holland, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan W Schoones
- Directorate of Research Policy, Leiden University Medical Center, Leiden, The Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Gebouw 3, Postzone V0-P, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
- University Network for the Care Sector Zuid-Holland, Leiden University Medical Center, Leiden, The Netherlands
| | - Jenny T van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Gebouw 3, Postzone V0-P, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
- Department of Primary and Community Care, and Radboudumc Alzheimer Center, Radboud university medical center, Nijmegen, The Netherlands
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Marshall F, Zhang S, Scotney BW. Automatic Assessment of the Type and Intensity of Agitated Hand Movements. JOURNAL OF HEALTHCARE INFORMATICS RESEARCH 2022; 6:401-422. [PMID: 36744085 PMCID: PMC9892388 DOI: 10.1007/s41666-022-00120-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 08/18/2022] [Accepted: 08/25/2022] [Indexed: 02/07/2023]
Abstract
With increasing numbers of people living with dementia, there is growing interest in the automatic monitoring of agitation. Current assessments rely on carer observations within a framework of behavioural scales. Automatic monitoring of agitation can supplement existing assessments, providing carers and clinicians with a greater understanding of the causes and extent of agitation. Despite agitation frequently manifesting in repetitive hand movements, the automatic assessment of repetitive hand movements remains a sparsely researched field. Monitoring hand movements is problematic due to the subtle differences between different types of hand movements and variations in how they can be carried out; the lack of training data creates additional challenges. This paper proposes a novel approach to assess the type and intensity of repetitive hand movements using skeletal model data derived from video. We introduce a video-based dataset of five repetitive hand movements symptomatic of agitation. Using skeletal keypoint locations extracted from video, we demonstrate a system to recognise repetitive hand movements using discriminative poses. By first learning characteristics of the movement, our system can accurately identify changes in the intensity of repetitive movements. Wide inter-subject variation in agitated behaviours suggests the benefit of personalising the recognition model with some end-user information. Our results suggest that data captured using a single conventional RGB video camera can be used to automatically monitor agitated hand movements of sedentary patients.
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Affiliation(s)
- Fiona Marshall
- School of Computing, University of Ulster, Shore Road, Newtownabbey, BT37 0QB Northern Ireland UK
| | - Shuai Zhang
- School of Computing, University of Ulster, Shore Road, Newtownabbey, BT37 0QB Northern Ireland UK
| | - Bryan W. Scotney
- School of Computing, University of Ulster, Shore Road, Newtownabbey, BT37 0QB Northern Ireland UK
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Huisman C, Huisman E, Kort H. Technological Applications Contributing to Relieve Care Burden or to Sleep of Caregivers and People With Dementia: A Scoping Review From the Perspective of Social Isolation. Front Public Health 2022; 10:797176. [PMID: 35425752 PMCID: PMC9002108 DOI: 10.3389/fpubh.2022.797176] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 02/09/2022] [Indexed: 12/04/2022] Open
Abstract
The need for care will increase in the coming years. Most people with a disability or old age receive support from an informal caregiver. Caring for a person with dementia can be difficult because of the BPSD (Behavioral and Psychological Symptoms of Dementia). BPSD, including sleep disturbance, is an important factor for a higher care load. In this scoping review, we aim to investigate whether technology is available to support the informal caregiver, to lower the care burden, improve sleep quality, and therefore influence the reduction of social isolation of informal caregivers of people with dementia. A scoping review is performed following the methodological framework by Arksey and O'Mally and Rumrill et al., the scoping review includes scientific and other sources (unpublished literature, websites, reports, etc.). The findings of the scoping review shows that there are technology applications available to support the informal caregiver of a person with dementia. The technology applications mostly contribute to lower the care burden and/or improve sleep quality and therefore may contribute to reduce social isolation. The technology applications found target either the person with dementia, the informal caregiver, or both.
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Affiliation(s)
- Chantal Huisman
- Research Group Technology for Healthcare Innovations, Research Center Healthy and Sustainable Living, University of Applied Science Utrecht, Utrecht, Netherlands
| | - Emelieke Huisman
- Research Group Technology for Healthcare Innovations, Research Center Healthy and Sustainable Living, University of Applied Science Utrecht, Utrecht, Netherlands
| | - Helianthe Kort
- Research Group Technology for Healthcare Innovations, Research Center Healthy and Sustainable Living, University of Applied Science Utrecht, Utrecht, Netherlands.,Building Healthy Environments for Future Users Group, Department of the Built Environment, Eindhoven University of Technology, Eindhoven, Netherlands
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Van Besien W, Shire S, Decalf V, Ervin CE, King S, Baldrey C, Da Silva A, Wagg A, Everaert KE, Bower WF. The Bladder at Night during Hospitalisation: Towards optimal care for elderly patients with nocturia. Int J Clin Pract 2021; 75:e14876. [PMID: 34525254 DOI: 10.1111/ijcp.14876] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 07/20/2021] [Accepted: 09/12/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE This study aimed to describe the characteristics of nocturia in older hospitalised patients and to explore knowledge, beliefs and experiences associated with night toileting while in hospital in order to identify unmet care needs. METHODS A multisite mixed methods cross-sectional study of older hospitalised adults who were admitted for ≥2 days was conducted using a standardised researcher-administered questionnaire. An additional cohort 16 older hospitalised adults with nocturia >twice per night were interviewed to understand the experience and impact of nocturia during hospitalisation. RESULTS Nocturia was experienced by 260 out of 308 participants. In-hospital nocturia was significantly correlated with nocturia in the month preceding admission, high diurnal voiding frequency and nocturnal urinary urgency. Bother was attributed to multiple nocturia episodes. Participants had poor knowledge and understanding of nocturia and believed the symptom to be a normal occurrence; only 20% had discussed management with staff. Disrupted sleep and fear of falling were common in older immobile participants with nocturia. CONCLUSION Nocturia is highly prevalent in hospitalised older people. Toileting multiple times at night bothers patients, disrupts sleep, heightens a fear of falling yet is rarely addressed in ward management plans. A screening process to identify, assess, provide education and intervene for nocturia has the potential to improve wellbeing, safety at night and to address risk factors.
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Affiliation(s)
- Wouter Van Besien
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Samia Shire
- Faculty of Medicine and Dentistry, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Veerle Decalf
- Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Claire E Ervin
- Continence Service, Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
| | - Sharyn King
- Continence Service, Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
| | - Christine Baldrey
- Continence Service, Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
| | - Alisha Da Silva
- Department of Allied Health, Discipline of Physiotherapy, Royal Melbourne Hospital, Parkville, Australia
| | - Adrian Wagg
- Faculty of Medicine and Dentistry, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Karel E Everaert
- Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Wendy F Bower
- Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Continence Service, Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
- Department of Allied Health, Discipline of Physiotherapy, Royal Melbourne Hospital, Parkville, Australia
- Department of Aged Care, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia
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Behavioral Interventions for Alzheimer’s Management Using Technology: Home-Based Monitoring. CURRENT GERIATRICS REPORTS 2020. [DOI: 10.1007/s13670-020-00312-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Sayabalian A, Easton-Garrett S, Kassabian A, Kunze MB. The impact of a resident's occasional incontinence: The under-recognized incontinence. Geriatr Nurs 2019; 40:648-650. [PMID: 31735452 DOI: 10.1016/j.gerinurse.2019.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Ara Sayabalian
- Director of Clinical Services of TotalDry; SVP of Clinical Services for Belmont Village and a member of the National Board of Directors of AALNA.
| | - Sheri Easton-Garrett
- SVP of Clinical Services for Belmont Village and a member of the National Board of Directors of AALNA
| | - Armen Kassabian
- Board-certified urologist specialist in Los Angeles with over 20 years of experience
| | - Margo B Kunze
- Secretary Treasurer of the American Assisted Living Nurses Association, President, AL Consulting
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Khan SS, Ye B, Taati B, Mihailidis A. Detecting agitation and aggression in people with dementia using sensors-A systematic review. Alzheimers Dement 2018; 14:824-832. [PMID: 29571749 DOI: 10.1016/j.jalz.2018.02.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 01/30/2018] [Accepted: 02/05/2018] [Indexed: 01/13/2023]
Abstract
Agitation and aggression are among the most challenging symptoms of dementia. Agitated persons with dementia can harm themselves, their caregivers, or other patients in a care facility. Automatic detection of agitation would be useful to alert caregivers so that appropriate interventions can be performed. The building blocks in the automatic detection of agitation and aggression are appropriate sensing platforms and generalized predictive models. In this article, we perform a systematic review of studies that use different types of sensors to detect agitation and aggression in persons with dementia. We conclude that actigraphy shows some evidence of correlation with incidences of agitation and aggression; however, multimodal sensing has not been fully evaluated for this purpose. Based on this systematic review, we provide guidelines and recommendations for future research directions in this field.
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Affiliation(s)
- Shehroz S Khan
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada; Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada; AGE-WELL Network of Centres of Excellence, Toronto, ON, Canada.
| | - Bing Ye
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada; Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Babak Taati
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada; Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada; AGE-WELL Network of Centres of Excellence, Toronto, ON, Canada
| | - Alex Mihailidis
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada; Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada; AGE-WELL Network of Centres of Excellence, Toronto, ON, Canada
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Morley JE. Sleep and the Nursing Home. J Am Med Dir Assoc 2015; 16:539-43. [DOI: 10.1016/j.jamda.2015.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 05/06/2015] [Indexed: 12/14/2022]
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