East Midlands Research into Ageing Network (EMRAN) Discussion Paper Series

Academic geriatric medicine in Leicester . There has never been a better time to consider joining us. We have recently appointed a Professor in Geriatric Medicine, alongside Tom Robinson in stroke and Victoria Haunton, who has just joined as a Senior Lecturer in Geriatric Medicine. We have fantastic opportunities to support students in their academic pursuits through a well-established intercalated BSc programme, and routes on through such as ACF posts, and a successful track-record in delivering higher degrees leading to ACL post. We collaborate strongly with Health Sciences, including academic primary care. See below for more detail on our existing academic set-up. Leicester Academy for the Study of Ageing We are also collaborating on a grander scale, through a joint academic venture focusing on ageing, the ‘Leicester Academy for the Study of Ageing’ (LASA), which involves the local health service providers (acute and community), De Montfort University; University of Leicester; Leicester City Council; Leicestershire County Council and Leicester Age UK. Professors Jayne Brown and Simon Conroy jointly Chair LASA and have recently been joined by two further Chairs, Professors Kay de Vries and Bertha Ochieng. Karen Harrison Dening has also recently been appointed an Honorary Chair. LASA aims to improve outcomes for older people and those that care for them that takes a person-centred, whole system perspective. Our research will take a global perspective, but will seek to maximise benefits for the people of Leicester, Leicestershire and Rutland, including building capacity. We are undertaking applied, translational, interdisciplinary research, focused on older people, which will deliver research outcomes that address domains from: physical/medical; functional ability, cognitive/psychological; social or environmental factors. LASA also seeks to support commissioners and providers alike for advice on how to improve care for older people, whether by research, education or service delivery. Examples of recent research projects include: ‘Local History Café’ project specifically undertaking an evaluation on loneliness and social isolation; ‘Better Visits’ project focused on improving visiting for family members of people with dementia resident in care homes; and a study on health issues for older LGBT people in Leicester. Clinical Geriatric Medicine in Leicester We have developed a service which recognises the complexity of managing frail older people at the interface (acute care, emergency care and links with community services). There are presently 17 consultant geriatricians supported by existing multidisciplinary teams, including the largest complement of Advance Nurse Practitioners in the country. Together we deliver Comprehensive Geriatric Assessment to frail older people with urgent care needs in acute and community settings. The acute and emergency frailty units – Leicester Royal Infirmary This development aims at delivering Comprehensive Geriatric Assessment to frail older people in the acute setting. Patients are screened for frailty in the Emergency Department and then undergo a multidisciplinary assessment including a consultant geriatrician, before being triaged to the most appropriate setting. This might include admission to in-patient care in the acute or community setting, intermediate care (residential or home based), or occasionally other specialist care (e.g. cardiorespiratory). Our new emergency department is the county’s first frail friendly build and includes fantastic facilities aimed at promoting early recovering and reducing the risk of hospital associated harms. There is also a daily liaison service jointly run with the psychogeriatricians (FOPAL); we have been examining geriatric outreach to oncology and surgery as part of an NIHR funded study. We are home to the Acute Frailty Network, and those interested in service developments at the national scale would be welcome to get involved. Orthogeriatrics There are now dedicated hip fracture wards and joint care with anaesthetists, orthopaedic surgeons and geriatricians. There are also consultants in metabolic bone disease that run clinics. Community work Community work will consist of reviewing patients in clinic who have been triaged to return to the community setting following an acute assessment described above. Additionally, primary care colleagues refer to outpatients for sub-acute reviews. You will work closely with local GPs with support from consultants to deliver post-acute, subacute, intermediate and rehabilitation care services. Stroke Medicine 24/7 thrombolysis and TIA services. The latter is considered one of the best in the UK and along with the high standard of vascular surgery locally means one of the best performances regarding carotid intervention

Non-Invasive Ambient Intelligence in Real Life: Dealing with Noisy Patterns to Help Older People

This paper aims to contribute to the field of ambient intelligence from the perspective of real environments, where noise levels in datasets are significant, by showing how machine learning techniques can contribute to the knowledge creation, by promoting software sensors. The created knowledge can be actionable to develop features helping to deal with problems related to minimally labelled datasets. A case study is presented and analysed, looking to infer high-level rules, which can help to anticipate abnormal activities, and potential benefits of the integration of these technologies are discussed in this context. The contribution also aims to analyse the usage of the models for the transfer of knowledge when different sensors with different settings contribute to the noise levels. Finally, based on the authors’ experience, a framework proposal for creating valuable and aggregated knowledge is depicted.This research was partially funded by Fundación Tecnalia Research & Innovation, and J.O.-M. also wants to recognise the support obtained from the EU RFCS program through project number 793505 ‘4.0 Lean system integrating workers and processes (WISEST)’ and from the grant PRX18/00036 given by the Spanish Secretaría de Estado de Universidades, Investigación, Desarrollo e Innovación del Ministerio de Ciencia, Innovación y Universidades

Overcoming barriers and increasing independence: service robots for elderly and disabled people

This paper discusses the potential for service robots to overcome barriers and increase independence of elderly and disabled people. It includes a brief overview of the existing uses of service robots by disabled and elderly people and advances in technology which will make new uses possible and provides suggestions for some of these new applications. The paper also considers the design and other conditions to be met for user acceptance. It also discusses the complementarity of assistive service robots and personal assistance and considers the types of applications and users for which service robots are and are not suitable

Monitoring and detection of agitation in dementia: towards real-time and big-data solutions

The changing demographic profile of the population has potentially challenging social, geopolitical, and financial consequences for individuals, families, the wider society, and governments globally. The demographic change will result in a rapidly growing elderly population with healthcare implications which importantly include Alzheimer type conditions (a leading cause of dementia). Dementia requires long term care to manage the negative behavioral symptoms which are primarily exhibited in terms of agitation and aggression as the condition develops. This paper considers the nature of dementia along with the issues and challenges implicit in its management. The Behavioral and Psychological Symptoms of Dementia (BPSD) are introduced with factors (precursors) to the onset of agitation and aggression. Independent living is considered, health monitoring and implementation in context-aware decision-support systems is discussed with consideration of data analytics. Implicit in health monitoring are technical and ethical constraints, we briefly consider these constraints with the ability to generalize to a range of medical conditions. We postulate that health monitoring offers exciting potential opportunities however the challenges lie in the effective realization of independent assisted living while meeting the ethical challenges, achieving this remains an open research question remains.Peer ReviewedPostprint (author's final draft

Central monitoring system for ambient assisted living

Smart homes for aged care enable the elderly to stay in their own homes longer. By means of various types of ambient and wearable sensors information is gathered on people living in smart homes for aged care. This information is then processed to determine the activities of daily living (ADL) and provide vital information to carers. Many examples of smart homes for aged care can be found in literature, however, little or no evidence can be found with respect to interoperability of various sensors and devices along with associated functions. One key element with respect to interoperability is the central monitoring system in a smart home. This thesis analyses and presents key functions and requirements of a central monitoring system. The outcomes of this thesis may benefit developers of smart homes for aged care

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

RFID Localisation For Internet Of Things Smart Homes: A Survey

The Internet of Things (IoT) enables numerous business opportunities in fields as diverse as e-health, smart cities, smart homes, among many others. The IoT incorporates multiple long-range, short-range, and personal area wireless networks and technologies into the designs of IoT applications. Localisation in indoor positioning systems plays an important role in the IoT. Location Based IoT applications range from tracking objects and people in real-time, assets management, agriculture, assisted monitoring technologies for healthcare, and smart homes, to name a few. Radio Frequency based systems for indoor positioning such as Radio Frequency Identification (RFID) is a key enabler technology for the IoT due to its costeffective, high readability rates, automatic identification and, importantly, its energy efficiency characteristic. This paper reviews the state-of-the-art RFID technologies in IoT Smart Homes applications. It presents several comparable studies of RFID based projects in smart homes and discusses the applications, techniques, algorithms, and challenges of adopting RFID technologies in IoT smart home systems.Comment: 18 pages, 2 figures, 3 table

Medical data processing and analysis for remote health and activities monitoring

Recent developments in sensor technology, wearable computing, Internet of Things (IoT), and wireless communication have given rise to research in ubiquitous healthcare and remote monitoring of human\u2019s health and activities. Health monitoring systems involve processing and analysis of data retrieved from smartphones, smart watches, smart bracelets, as well as various sensors and wearable devices. Such systems enable continuous monitoring of patients psychological and health conditions by sensing and transmitting measurements such as heart rate, electrocardiogram, body temperature, respiratory rate, chest sounds, or blood pressure. Pervasive healthcare, as a relevant application domain in this context, aims at revolutionizing the delivery of medical services through a medical assistive environment and facilitates the independent living of patients. In this chapter, we discuss (1) data collection, fusion, ownership and privacy issues; (2) models, technologies and solutions for medical data processing and analysis; (3) big medical data analytics for remote health monitoring; (4) research challenges and opportunities in medical data analytics; (5) examples of case studies and practical solutions

The Smart Home Services Diffusion Process: A System Dynamics Model

The application of smart technologies for domestic environment has been around for a while. But the market diffusion of such products and services has not seen yet a significant growth. This paper seeks to provide an overview of the most important factors that influence the diffusion process of smart home services via literature and a case study. These factors compose a System Dynamics model showing the diffusion dynamics of three main smart home services (Heating, Monitoring, Assisted Living)