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Domotics and Cure & Care

Dr. Ir. Jan A. Van Alsté

University of Twente

Biomedical Engineering

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Cure and care

• Cure

• Prevention• Diagnostics• Therapy• Back to normal activities• Short duration• High specialised• High tech

• Care

• Nursing• Support of vital functions• Normal activities not

always possible • Often long duration• Medium specialised• Low tech

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Relevant trends

• Demographic changes• More grey: demand for cure & care• Less green: supply of caretakers• More colour: different life styles • Slow process: time to action• Reduction of costs• Horizontal and vertical substitution in

medicine

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Care processes

• Distinction between– Cure and care– Care and household– Health and well-being

• Types of care processes– Short, directed towards recovery– Chronically ill or functional disorders– Terminally ill patients

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Demand for care

• Two trends

• Changing epidemiological profile– People live longer and are longer ill– Demand for health care is increasing

• Socio-cultural change in needs– Changing conditions of living– Information and self-realisation– Wish to function independently

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Supply of care

• Organisational changes– Shorter stay in hospital– More medical interventions at home– Business Process Redesign: continuity of care

• Problems of personnel– Shortage: technology, self management, productivity,

disability• New players and roles

– Specific companies, call centres– Mergers and collaboration– Improved coherence: contents, efficiency

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Focus on end-user (patient)

• Continuity in care processes

• More possibilities to choose

• Less restricted to certain localities

• Home care technology: quality of live

• Assistive devices: self care, independence

• ICT: choice based on information

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Maslows hierarchy of needs

• Physiological: food, air, water, sex

• Safety and security

• Belonging to, love, acceptation, affection

• Esteem, competence, approval, recognition

• Esthetical and cognitive needs

• Self realisation

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Universal self care activities(after D.E. Orem)

• Intake of air, water and food

• Excretion

• Balance between activity and rest

• Prevention of threats against human happiness, functioning and well-being

• Live in social communities according human possibilities, limitations and dignity

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Health related self care activities(after D.E. Orem)

• Adequate medical care• Knowledge and insight in health and illness• Execution of diagnostic, therapeutic or

rehabilitation activities• Anticipate troublesome or harmful effect of

medical interventions• Changing one’s self image• Learn to live with the consequences of illness

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Trends in society

• Individuality

• Demand in control

• Various target groups:different wants

• People over 50 are more in control

• More market, less government

• Room for innovation and renewal

• Decentralised living, care and healthcare

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Challenges for Domotics

• Independent living

• Activities of Daily Life

• Social contacts

• Entertainment

• Medical treatment

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Challenges for the near future

• New homes– One level– Living well-cared

• Adaptation of existing homes

• Points of support of care functions

• Domotics and personal alarm

• Living environment more care oriented

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Consequences of domotics for the organisation of healthcare

• Security / safety• Support functions at home• Quality improvement• Efficacy• Efficiency• Costs: government; institutions; housing

associations, caretakers• Personnel

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Possible services and applications

• Level of lighting adapted to biorhythm• Climate control• Individual control of freedom to walk around• Monitoring / Surveillance of activities during the

night• Asking for help (by calling)• Automatic detection of water overflow• Automatic control of cooking equipment• Support in independent communication

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Palliative care adds life to days when days cannot be added to life (Saunders, 1995)

• Symptom and pain relief

• Monitoring

• Support of self support

• Continuity of care

• ADL support

• Communication, social, healthcare

• Workload reduction care providers

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Telemedicine: moving data, instead of patient or healthcare provider

Tele cure– Tele consultation

• dermatology

– Tele diagnostics• monitoring

– Tele communication• Electronic patient

record

– Tele therapy• psychiatry

– Tele surgery• robotics

• Tele care– Tele monitoring– Tele supervision– Tele coaching– Tele communication

• Electronic care record

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Tele plus & minus

• Plus (stimuli)– Longer at home– Self management– Master of one’s life– Double

• Increasing # singles• Increasing # chronic ill

– Quality of care– Decreasing costs of

care

• Minus (obstructions)– Contents– Infrastructure /

organisation– Changes in job care

provider and the care chain

– Finances (no stimuli)

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Design for all

• Usable for all groups of users

• Flexible in use

• Simple, intuitive use

• Readable information

• Fault tolerant

• Low physical load

• Accessible

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Feasible technology, not always available(Centre for Universal design, 1994)

• Electronic lock (strength, coordination, authorisation)

• Intercom front door (voice activated)• GPS for way-finding• Icy walkway / ramp warning• Motorized trash removal system• Motorized window openers• Adjustable height toilet seat• Robotic washer / dryer assistance

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Feasible technology

• Indicator to show hot cook top• Automatic shutoff when pot is removed• Kitchen shelves, accessible heights• Potable robot for heavy lifting• Motorized extending refrigerator shelves• Remote cook top controls• Attractive, self-storing transfer device• Keypad controlled lockout for dangerous areas /

appliances

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Feasible technology

• Mechanized crib to assist lifting infant• Raised infant tub at wheelchair height• Multi-sensory displays and controls for

appliances• Central house status display on TV• Electrical power back-up system• Voice recognition computer• Remote health monitoring• Expanded on line information services

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Home requirements

• Wide rooms, including toilets• Many power outlets, power rails• Facilities for care provider

– Workspace, workload (limitations)– Privacy (day, overnight)

• Easy room separation (privacy)• Functions to bed instead of person to functions• Mobile care facilities, limited medical look• Communication, leisure facilities

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Contradictions when designing equipment

• Invisible versus easy to use

• Foolproof versus adjustable

• Multi-functional versus manageability

• Continuity versus adjustment-preferences

• Self support versus loneliness

• Privacy versus social safety

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Older adults attitude(Demiris et all, 2004)

• Emergency help• Preventing or detecting falls• Assisting with visual or hearing

impairments• Improving mobility• Reducing isolation• Managing medications• Monitoring physiological parameters

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Attitude conclusions(Demiris et all, 2004)

• Benefits:– Emergency help– Prevention and detection of falls– Monitoring physiological parameters etc.

• Concerns:– User-friendliness of devices– Lack of human response– Need for training tailored to older users

• Conclusion:– Overall positive attitude towards devices and sensors

installed

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Health “smart” home(Rialle et all, 2002, review)

• HSH systems provide health care services• Large diversity in needs in home-based

patient population• Complex technology needed:

– Distributed approach, many hard and software techniques

– Wide scope of new information, communication and data-acquisition technologies

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Desired properties of technology

• User / patient– Minimal load / burden– Simple in use– Good ergonomics and aesthetics– Mobility

• Care provider– Communication with client– Work processes– Content and status of profession– Added value for the organisation

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Communicationcomputer with internet connection

• Care receivers– Information– About hospice, illness,– From doctor, nurse– Calls / alarms – Contacts family, friends– Fellow patients– Shopping– Social– Diary– Play station

• Care providers• Work planning• Patient-record• Continuity of care• Consultation• Communication with

colleagues• Adjusting equipment

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Domotics, ICT and Care

• Less costs of facility management

• Less hours of care supply

• Simpler user processes

• Less costs of communication

• Better functionality and reduction of costs