The OCarePlatform : a context-aware system to support independent living

Background: Currently, healthcare services, such as institutional care facilities, are burdened with an increasing number of elderly people and individuals with chronic illnesses and a decreasing number of competent caregivers. Objectives: To relieve the burden on healthcare services, independent living at home could be facilitated, by offering individuals and their (in)formal caregivers support in their daily care and needs. With the rise of pervasive healthcare, new information technology solutions can assist elderly people ("residents") and their caregivers to allow residents to live independently for as long as possible. Methods: To this end, the OCarePlatform system was designed. This semantic, data-driven and cloud based back-end system facilitates independent living by offering information and knowledge-based services to the resident and his/her (in)formal caregivers. Data and context information are gathered to realize context-aware and personalized services and to support residents in meeting their daily needs. This body of data, originating from heterogeneous data and information sources, is sent to personalized services, where is fused, thus creating an overview of the resident's current situation. Results: The architecture of the OCarePlatform is proposed, which is based on a service-oriented approach, together with its different components and their interactions. The implementation details are presented, together with a running example. A scalability and performance study of the OCarePlatform was performed. The results indicate that the OCarePlatform is able to support a realistic working environment and respond to a trigger in less than 5 seconds. The system is highly dependent on the allocated memory. Conclusion: The data-driven character of the OCarePlatform facilitates easy plug-in of new functionality, enabling the design of personalized, context-aware services. The OCarePlatform leads to better support for elderly people and individuals with chronic illnesses, who live independently. (C) 2016 Elsevier Ireland Ltd. All rights reserved

User-centered design of a dynamic-autonomy remote interaction concept for manipulation-capable robots to assist elderly people in the home

In this article, we describe the development of a human-robot interaction concept for service robots to assist elderly people in the home with physical tasks. Our approach is based on the insight that robots are not yet able to handle all tasks autonomously with sufficient reliability in the complex and heterogeneous environments of private homes. We therefore employ remote human operators to assist on tasks a robot cannot handle completely autonomously. Our development methodology was user-centric and iterative, with six user studies carried out at various stages involving a total of 241 participants. The concept is under implementation on the Care-O-bot 3 robotic platform. The main contributions of this article are (1) the results of a survey in form of a ranking of the demands of elderly people and informal caregivers for a range of 25 robot services, (2) the results of an ethnography investigating the suitability of emergency teleassistance and telemedical centers for incorporating robotic teleassistance, and (3) a user-validated human-robot interaction concept with three user roles and corresponding three user interfaces designed as a solution to the problem of engineering reliable service robots for home environments

Independent Aging with the Help of Smart Technology:Investigating the Acceptance of Ambient Assisted Living Technologies

Who takes care of our older adults? According to the European Union, smart technologies that support independent living and active aging, introduced as ‘Ambient Assisted Living’ (AAL), are the future for our aging population. Promises of AAL include saving long-term care costs, improving the quality of care, unburdening family caregivers, and increasing the older adults’ independence and overall quality of life. While the policy enthusiasm for AAL technology is high, it is unclear if the potential users of AAL are willing to embrace AAL technologies in their daily lives. This dissertation addressed this issue by focusing on the perspective of older adults and their caregivers. Using a combination of qualitative and quantitative approaches, we developed a comprehensive and theoretically grounded understanding of how and why users perceive AAL technologies in a certain way. Important factors that drive or hinder the acceptance were identified. These insights resulted in a model of AAL acceptance that was validated in a representative sample (n = 1296) of the Dutch older adult population. This dissertation contributes to a more user-driven approach in AAL research and development and has important implications for researchers, developers and policy makers alike. We hope that our results will guide future research efforts, design and policy directions in the AAL field

Hospital to home : family caregiver perspectives of discharge transitions of seniors with dementia

Hospital discharge transitions can be challenging for seniors and their caregivers. Seniors with dementia are particularly vulnerable and are at increased risk for adverse outcomes from poorly executed hospital to home discharge transitions. Family caregivers play a vital role in supporting seniors with dementia by coordinating care among healthcare providers across the continuum of care. Research suggests there is significant opportunity for improvement in hospital discharge processes to ensure that patients with dementia and their family caregivers are prepared to resume care at home after hospital discharge. Family caregivers of hospitalized patients with dementia continue to report unmet needs and the extent to hospital discharge interventions are provided and how they are perceived by family caregivers of patients with dementia is unknown. Guided by Meleis’ middle-range theory of transitions, a critical incident technique study was designed to explore family caregiver perceptions of the hospital discharge process for seniors with dementia. Five categories of healthcare provider activities were identified as important to the hospital discharge process for persons with dementia. Providing person-centered dementia care involved recognizing dementia in the patient and the importance of taking a different approach. Getting on the same page emphasized the crucial role of communication and involved seeing a capable person and knowing the plan. Caregivers expressed concern for Maximizing function and strong enough to go home. Managing medications was critical to ensure behavioral symptoms of dementia were well managed. Post-discharge support involved getting needed information, arranging for services after discharge, and calling for help. These categories are consistent with the literature regarding hospital to home discharges for seniors and their caregivers. Family caregivers of hospitalized patients with dementia have additional needs beyond those of typical patients and collaboration with healthcare providers is vital to ensure patient needs are met. These findings highlight the importance of person-centered care delivery so that hospital discharge processes are tailored to the unique circumstances of each patient and caregiver.Nursin

Palliative care at home : supportive needs of informal caregivers of patients with amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis (ALS) is a fatal, neurodegenerative disease primarily of the motor neurons. As the disease progresses, people with ALS become more and more immobile, in need of care, and are less able to do everyday activities themselves. Around 600 people live with ALS in Switzerland. Informal caregivers, primarily family members, but also friends and relatives, the so-called informal caregivers, play a central role in accompanying, looking after and caring for people with ALS. Taking on these activities can be stressful for informal caregivers, so that different types of support may be required. This cumulative doctoral thesis investigates these support needs of informal caregivers in Switzerland, and delineates ethical challenges in the care for people with ALS. The first chapter introduces the topics of amyotrophic lateral sclerosis, palliative and multidisciplinary care, and informal caregiving for people with ALS. Subsequently, the second chapter lays out the research questions and objectives, methods, and methodology used in this thesis. Chapters three to ten form the results section of this cumulative thesis, whereby I first present an overview of needs of informal caregivers of people with ALS during the disease course in the form of a systematic review using narrative synthesis. In addition to this corpus of evidence, the fourth chapter provides an overview of supportive needs of informal caregivers in Switzerland using a thematic analysis of interview data from both informal and professional caregivers. The chapter outlines several unmet needs of informal caregivers such as administrative burden, advance care planning early in the context of ALS, and underlines the importance of social support, be it in peer-groups or community care. Complementing this largely descriptive research, the fifth chapter provides a grounded theory-based approach to understand informal caregiving during the disease and caregiving progression of ALS. Informal caregiving is understood as an upholding a steady state among different activities which informal caregivers perform. This process of holding the balance is the organizing element to four secondary categories which could disrupt or facilitate a balance. The systematic review found a lacuna of research on bereavement needs of informal caregivers. Hence, the sixth chapter provides a thematic analysis of the experiences of bereavement of informal caregivers. However, before the death of people with ALS, they have to make decisions regarding their end-of-life circumstances. The seventh chapter discusses end-of-life decisions via brain-computer-interfaces for people with ALS. The eight chapter outlines informal caregiving at the end-of-life in home care in a general manner. The ninth chapter discusses the conceptualisation of hopelessness of people from ALS, arguing that in the context of ALS, hopelessness is often conceptualized incorrectly. The tenth chapter identifies unfair conditions in the provision of assistive technologies and devices in ALS that arise because of a gap in the transition from disability insurance to old-age and survivors’ insurance in Switzerland. The thesis concludes with a critical discussion and contextualization of the present research

Case Management Program For Frail Elders Manual, August 2008

The purpose of this manual is to guide operation of the Case Management Program for Frail Elders. After Background, Program Administration, Definitions, Consumer Eligibility, and Program Standards, the order follows the flow of a consumer entering the pro-gram from referral through ongoing case activities. The manual is written assuming the reader is the Case Manager. The effective date will appear in the bottom left hand corner of each page. This manual will be updated as needed via Iowa Aging Program Instructions (IAPI). This manual is used in conjunction with the Department of Human Services’ manuals which provide more detail about policies and procedures within the Medicaid elderly waiver program