high-tech assistance, economic crisis and … assistance, economic crisis and longevity roberto...
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Longevity determinants
Adult
socio-economic
status
CAD
Hypertension
Dementia
Diabetes
Depression
Osteoarthritis
Frailty
Adverse outcomes
Disability
Morbidity
Hospitalization
Premature Death
Prevention
Accessibility
medical/social services
Social interaction and
support
Increasing age
Environment
Smoking
Nutrition
Exercise
Other
Growth in utero
Genetic APO-E
Childhood
socio-economic
status
Early Life
Experience
Education
“personal” resources,
personality, etc.
(Adapted from Ben-Shlomo, 2002)
Frail Elderly at
home
Community services,
care giver, other…
SINGLE ENTRY POINT
CGA1
GEU (Geriatrician, GP,
Case Manager, SW,
PT, OT) CGA 2
Community Services
Health/Social Nursing
Home
GP
Frail Elderly at
homeGP
Community services,
care giver, other…
SINGLE ENTRY POINT
CGA1
GEU (Geriatrician, GP,
Case Manager, SW,
PT, OT) CGA 2
Community Services
Health/Social Nursing
Home
ER
Silver Code
CGA 1
Frail Elderly at
homeGP
ER
Silver Code
CGA 1
Community services,
care giver, other…
SINGLE ENTRY POINT
CGA1
GEU (Geriatrician, GP,
Case Manager, SW,
PT, OT) CGA 2
Community Services
Health/Social Nursing
Home
Hospital
Internal Medicine and
Geriatric Department
Internal Medicine Unit
Geriatric Unit
Frail Elderly at
homeGP
ER
Silver Code
CGA 1
Community services,
care giver, other…
SINGLE ENTRY POINT
CGA1
GEU (Geriatrician, GP,
Case Manager, SW,
PT, OT) CGA 2
Community Services
Health/Social Nursing
Home
Hospital
Internal Medicine and
Geriatric Department
Internal Medicine Unit
Geriatric Unit
Frail Elderly at
homeGP
Protected
discharge
ER
Silver Code
CGA 1
Hospital
Internal Medicine and
Geriatric Department
Internal Medicine Unit
Geriatric Unit
Community services,
care giver, other…
SINGLE ENTRY POINT
CGA1
GEU (Geriatrician, GP,
Case Manager, SW,
PT, OT) CGA 2
Community Services
Health/Social Nursing
Home
Hospice
Rehabilitation
Post-acute care
Home Care
Frail Elderly at
homeGP
Protected
discharge
ER
Silver Code
CGA 1
Community services,
care giver, other…
SINGLE ENTRY POINT
CGA1
GEU (Geriatrician, GP,
Case Manager, SW,
PT, OT) CGA 2
Hospital
Internal Medicine and
Geriatric Department
Internal Medicine Unit
Geriatric Unit Community Services
Health/Social Nursing
Home
Hospice
Rehabilitation
Post-acute care
Home Care
Telemedicine
Impact of telemonitoring at home on the management of elderly patients with congestive heart failure. Journal of Telemedicine and Telecare 2008; 14: 300–305.
Antonicelli R., et all
The effects of home telemonitoring in elderly patients with congestive
heart failure (CHF) on mortality and rate of hospitalization, compliance
with treatment, quality of life and costs of CHF management, by
comparison with a group receiving usual care
Home telemonitoring was associated with improvements in the
composite endpoint of mortality and rate of hospitalizations (P=0.006)
and a better compliance with therapy
11
Hub-Spoke Model
Hospital
Hospital LTC / Nursing home
Health and
Social Services
Local Health Unit
Central system
The set of methodological tools, technologies and artifacts that
support independent living of elderly people
Techno-Care
12
TE
CH
NO
CA
RE
External Environment Control
Humidity Control
Air Conditioning Heating System Lighting Control/ Switches
Door/Windows Opening
Elevators
Access control systems
Tools for disabled people
Multimedia Devices
Internet/e-mailing
INTEGRATION PLATFORM
Mobile Phone
Controlled Accesses
Call Center
Video Surveillance
Alarm Systems(Gas, Fire, Water,
Smoke, CO2 detectors)
Water
Electric power
Gas
Fall detection
Assistive Robotics
Tools/Devices for personal use and household
Remote health monitoring/ Telecare/Telemedicine
Mobile Phone
Computers
COMFORT/WELLNESS
HOMEAUTOMATION
HOUSEHOLD APPLIANCE NETWORK
COMMUNICATION/ENTERTAINMENT
REMOTECONTROL
SECURITY/SAFETY
MANAGEMENTOF ENERGY
SYSTEMS
AMBIENT ASSISTED
LIVING
TELEHEALTH
Memory support systems
Monitoring vital parameters
Computers
HR
SpO2
BP (systolic, diastolic)
HGB
Hct
CO/SV/SVV/CI (Cardiac Output ,
Stroke Volume, Stroke Volume Variation, CardiacIndex)
PCO2, PO2
PH
RBC
BV
MAP
A technocare model
o GP / Specialist
o Hospital Specialist
Settles a workgroup to define actors to be involved in the service on the basis of shared
criteria1
Public Institution
Clinician
Patient
o LHU
o Hospital
o Region
2
o Chronic complex patient
Call Center
• “Go live” at first patient/clinician
enrollment. Main activities:
o Training on service /system/devices utilization.
o Patient empowerment and
coaching/educational programs.
o Management of technical issues
o Triage within Service Protocol procedures
Selects eligible patients according
to the Service Protocol
3
Come si attiva il servizio e chi sono i principali
attori
o Medico Curante (es. MMG,
Specialisti)
o Specialista Ospedaliero
Istituisce un gruppo di lavoro per definire, sulla base di parametri condivisi, i diversi attori da
coinvolgere nel servizio.
1
Ente Pubblico/Accreditato
Clinici
Paziente
o ASL
o Azienda Ospedaliera
o Regione
2
o Paziente cronico complesso
Call Center
• A disposizione sin dal primo
medico/paziente arruolato svolge le seuenti
attività:
o formazione sull’utilizzo del sistema.
o supporto educazionale nella gestione dei
pazienti.
o gestione problematiche tecniche
o gestione sistema di Triage secondo il
protocollo di servizio.
Selezionano i pazienti elegibili per il
servizio sulla base di un protocollo
di servizio
3
USER TYPOLOGIES SPECIFIC RELATED NEEDS
All elderly people Increase level of safetyControl of the home environment to detect dangerous condition
Monitoring of daily activities to detect abnormal situations
Communication with families and caregivers
Receiving information on personal status and environment (monitoring)
Control of environmental condition and electronics after their use
Help in IADL (Instrumental Activities of Daily Living) (buying, etc)
Cognitive impaired older people MemoryRemind to take medicine
Remind scheduled appointment
Remind how/when use some tools
Remind when a food is out of date
Remind nutritional condition and diet
Remind telephone numbers
OrientationSee an obstacle in the path
Attention and concentration
Reasoning
Learning alternative strategies, cognitive training
Communication/Emotional/Psychological abilitiesGeneral ability of sending warnings/suggestions
Receiving information on personal status and environment (monitoring)
Control of environmental condition and electronics after their use
Communication with families and caregivers
Ageing – User Needs
USER TYPOLOGIES SPECIFIC RELATED NEEDS
Physical impaired older people MobilityBring heavy objects
Assistance while walking
Prevention of falls
Help if he/she falls in the home
Driving
Mobility in urban and rural areas
Help in dangerous situation
Vision
Hearing
Chronic diseaseManagement of treatments, information on health condition, monitoring
RehabilitationCognitive and physical training at home
Communication/Emotional/Psychological abilitiesGeneral ability of sending warnings/suggestions
Receiving information on personal status and environment (monitoring)
Control of environmental condition and electronics after their use
Communication with families and caregivers
Horizontal: Level of autonomy Low assistance
Medium assistance
High assistance
Almost independent (Living alone people)
Horizontal: Attitude towards
technology
End-user characteristics (age, education…)
Interest and familiarity with technology
Attitude and predisposition
Learning and coping strategies
Ageing – User Needs
TE
CH
NO
CA
RE
External Environment Control
Humidity Control
Air Conditioning Heating System Lighting Control/ Switches
Door/Windows Opening
Elevators
Access control systems
Tools for disabled people
Multimedia Devices
Internet/e-mailing
INTEGRATION PLATFORM
Mobile Phone
Controlled Accesses
Call Center
Video Surveillance
Alarm Systems(Gas, Fire, Water,
Smoke, CO2 detectors)
Water
Electric power
Gas
Fall detection
Assistive Robotics
Tools/Devices for personal use and household
Remote health monitoring/ Telecare/Telemedicine
Mobile Phone
Computers
COMFORT/WELLNESS
HOMEAUTOMATION
HOUSEHOLD APPLIANCE NETWORK
COMMUNICATION/ENTERTAINMENT
REMOTECONTROL
SECURITY/SAFETY
MANAGEMENTOF ENERGY
SYSTEMS
AMBIENT ASSISTED
LIVING
TELEHEALTH
Memory support systems
Monitoring vital parameters
Computers
Come si attiva il servizio e chi sono i principali
attori
o Medico Curante (es. MMG,
Specialisti)
o Specialista Ospedaliero
Istituisce un gruppo di lavoro per definire, sulla base di parametri condivisi, i diversi attori da
coinvolgere nel servizio.
1
Ente Pubblico/Accreditato
Clinici
Paziente
o ASL
o Azienda Ospedaliera
o Regione
2
o Paziente cronico complesso
Call Center
• A disposizione sin dal primo
medico/paziente arruolato svolge le seuenti
attività:
o formazione sull’utilizzo del sistema.
o supporto educazionale nella gestione dei
pazienti.
o gestione problematiche tecniche
o gestione sistema di Triage secondo il
protocollo di servizio.
Selezionano i pazienti elegibili per il
servizio sulla base di un protocollo
di servizio
3
TE
CH
NO
CA
RE
External Environment Control
Humidity Control
Air Conditioning Heating System Lighting Control/ Switches
Door/Windows Opening
Elevators
Access control systems
Tools for disabled people
Multimedia Devices
Internet/e-mailing
INTEGRATION PLATFORM
Mobile Phone
Controlled Accesses
Call Center
Video Surveillance
Alarm Systems(Gas, Fire, Water,
Smoke, CO2 detectors)
Water
Electric power
Gas
Fall detection
Assistive Robotics
Tools/Devices for personal use and household
Remote health monitoring/ Telecare/Telemedicine
Mobile Phone
Computers
COMFORT/WELLNESS
HOMEAUTOMATION
HOUSEHOLD APPLIANCE NETWORK
COMMUNICATION/ENTERTAINMENT
REMOTECONTROL
SECURITY/SAFETY
MANAGEMENTOF ENERGY
SYSTEMS
AMBIENT ASSISTED
LIVING
TELEHEALTH
Memory support systems
Monitoring vital parameters
Computers
The set of methodological tools, technologies and artifacts that
support independent living of elderly people
Techno-Care
22
Telemedicine
Impact of telemonitoring at home on the management of elderly patients with congestive heart failure. Journal of Telemedicine and Telecare 2008; 14: 300–305.
Antonicelli R., et all
The effects of home telemonitoring in elderly patients with congestive
heart failure (CHF) on mortality and rate of hospitalization, compliance
with treatment, quality of life and costs of CHF management, by
comparison with a group receiving usual care
Home telemonitoring was associated with improvements in the
composite endpoint of mortality and rate of hospitalizations (P=0.006)
and a better compliance with therapy
23
Hub-Spoke Model
Hospital
Hospital LTC / Nursing home
Health and
Social Services
Local Health Unit
Central system
• Sardinia (Italy)• Okinawa (Japan)• Crete (Greece)• Cuba • Loma Linda (Ca – USA)
California
Eating legumes
Adequate resting
Religious participation
Japan
Supportive social network
and friendship
Healthy diet
Keeping objectives and
scopes
Italy
Drinking red wine
Sharing with spouse
Eating “pecorino” cheese
ALL
No smoking
Family first
Active daily living
Social inclusion
Eating fruits, vegetables and
cereals
Genetics explains 25% of longevity