Dem@Care: a proposed system for the home-based ambient monitoring and enablement of older adults with dementia.

With an ageing population comes an anticipated leap in the numbers of individuals with dementia, and it is advisable both from an economic and community perspective to maintain home-based care for individuals with dementia for as long as possible. Ambient assistive and sensor technologies comprise a key contribution towards helping the person with dementia maintain independence in their community, by supporting their health, lifestyle, and safety, in an unobtrusive manner. Ambient technologies can be used to assess the status of the individual with dementia, and also to enable their independent home-based living for as long as possible. Methodology Dem@Care is an FP7 funded initiative, which aims to provide multi-parametric remote monitoring and enablement for persons with dementia living in the community. We here describe the goals of Dem@Care, as well as the principles behind its design, and early identified issues with deployment. Results We report relevant guiding principles from the literature, as well as principles arising from the team’s own clinical expertise. These principles include user-centred design, individualisation, involving the caregiver, and the prioritising of unobtrusive monitoring. Our goals include the successful enhancement of the quality of life of individuals with dementia, and the efficient and unobtrusive design of technological sensor-based systems in the home. We outline our plans to date to deploy the complete Dem@Care in the homes of community-dwelling older adults with dementia. An emphasis throughout is maintained on the individualised, ‘toolbox’ nature of the system, since we are aware that one size does not fit all for dementia. Conclusions The current proposal introduces the Dem@Care project, as a system for remote management and enablement of persons with dementia. We anticipate valuable insights pertaining to dementia care arising from this multidisciplinary initiative

Designing for and with vulnerable people: The Dem@Care "toolbox" approach

We describe the challenge set to us within the Dem@Care project, of designing a multi-component system to support safety, enablement, and diagnosis for older adults with dementia. Specifically we discuss the system as it relates to home-based enablement. Person-centred care is the gold standard in dementia care, which we incorporate into technology design by engaging in a user-led, participatory approach. The result of our considerations is the Dem@Care “toolbox”, a solution which addresses the challenge of providing home-based, person-centred care and enablement for older adults with dementia, utilising sensor technologies. The current text describes the toolbox and the terms of its future deployment

Review of the current status of research on smart homes and other domestic assistive technologies in support of the TAHI trials

The study provides an overview of developments in smart home technology and its use in the assistive technology sector. It includes an extensive literature review and detailed descriptions of current smart home installations in the UK and Europe. The report highlights the complexity of providing products and services in this area, and the relative immaturity of smart home technology in this sector. Many of the available products have emerged from office automation technologies developed for use in building control applications or from small niche markets in the assistive sector. Smart home developments have also concentrated on home control applications, but larger potential markets are also now being identified in other areas. Many of the trials described use technology to improve the safety and security of older and disabled people, concentrating more on the monitoring rather than home environment control. The report also demonstrates the practical difficulties faced in developing services in this sector. For many organisations these have been exploratory first steps in the use of technology to support care, and this lack of experience is reflected in common difficulties in specification and installation of equipment especially when retrofitting installations into buildings. Many developments have suffered from the lack of relevant experience of electrical and other contractors, so that it has proved difficult for organisations to identify both suppliers of equipment and people with the skills to install the technology. In the majority of cases there has been no formal evaluation of the developments, and it is therefore difficult to obtain evidence of the costs and benefits of using such technology to provide care and support independent living

Night optimised care technology for users needing assisted lifestyles

There is growing interest in the development of ambient assisted living services to increase the quality of life of the increasing proportion of the older population. We report on the Night Optimised Care Technology for UseRs Needing Assisted Lifestyles project, which provides specialised night time support to people at early stages of dementia. This article explains the technical infrastructure, the intelligent software behind the decision-making driving the system, the software development process followed, the interfaces used to interact with the user, and the findings and lessons of our user-centred approach

Night optimised care technology for users needing assisted lifestyles

There is growing interest in the development of ambient assisted living services to increase the quality of life of the increasing proportion of the older population. We report on the Night Optimised Care Technology for UseRs Needing Assisted Lifestyles project, which provides specialised night time support to people at early stages of dementia. This article explains the technical infrastructure, the intelligent software behind the decision-making driving the system, the software development process followed, the interfaces used to interact with the user, and the findings and lessons of our user-centred approach

The clinical utility of the electronic toilet-top bidet for Australian nursing home residents and staff

Inability to self-toilet has negative outcomes for older people, including risk of admission to residential care. In residential care, toileting is the most frequent task undertaken by staff and may provoke distress, particularly for people with dementia. This work comprises an iterative, mixed methods investigation of the feasibility and clinical utility of the wash-and-dry toilet-top bidet for older dependent people, staff and family carers. A literature review and three exploratory studies were conducted. First, interviews with five family carers found the bidet acceptable if it met physical and symbolic needs. Ongoing use was mediated by environmental constraints, cleaning ability, reactions of the older person, and quality of interactions with health professionals. Carers reported it cleaned reliably, reduced incontinence and helped ‘normalise’ familial relationships. Second, a single-arm study in a dementia aged care home (ACH) found bidets were feasible and acceptable for residents and staff, were reliable, and cleaned effectively. Staff workload and facility expenditure on incontinence products decreased. Third, a non-randomised, controlled pilot study in two ACHs (n= 49 residents, 73 staff) found bidets were acceptable, reduced staff workload, improved resident behaviour during toileting and lowered rates of constipation. No changes were found in incontinence associated dermatitis or odour. Residents in the bidet condition were more likely to have a clear case of bacteriurea or a probable urinary tract infection, however higher rates of faecal incontinence at baseline may have mediated this result. The studies have ecological validity and bidet technology shows promise for improving dignity and ease of toileting. These studies have contributed to a more nuanced understanding of factors that influence uptake and ongoing use of assistive technologies in aged care settings, and development of measures also provides a basis for future confirmatory studies

Detmold Conference Week 2017

Since 2000 (in the beginning 21st Century) climate change and globalisation have influenced the actual world and all societies tremendously and the have also affected the way we are building. Safety and security requirements are increasing and are consequently influencing the design of the building envelope. ‘Resilience’ describes the function and ability of buildings and their facades to to recover from or adjust easily to change. “Resilience” addresses the impacts of climate change and globalization and of safety and security requirements on the building envelope. The first edition of the Detmold Conference Week 2017 connects education and research, scholars and professionals in different events and formats: a master workshop and two conferences will discuss the approaches of resilient design and construction for buildings and facades. The direct way to specific stresses forced by water, wind, fire, explosion or earthquake but also in an indirect way seen as a general ability of adaptivity to different changes will be discussed at the facade2017 conference on Friday 24th November 2017 from different academic and professional perspectives. The 1st RMB Conference on Thursday 23rd November 2017 is organized by the consortium of the ERASMUS+ project “RMB: Reuse of Modernist Buildings. Design Tools for Sustainable Transformations”. There representatives of the consortium as well as international guest will debate in particular issues of Resilience of Modern Movement Buildings and Neighborhoods. During the conference we will discuss new design and educational concepts for the reuse of modern postwar buildings for housing and other purposes – resilience through reuse. Scholars, PhD and master students present and discuss selected papers and posters

Broadening Responsibilities: Consideration Of The Potential To Broaden The Role Of Uniformed Fire Service Employees

What is this report about? This report, commissioned by the National Joint Council for Local Authority Fire and Rescue Services (NJC), aims to identify what impact, if any, firefighters can have on the delivery of emergency medical response and wider community health interventions in the UK. What are the overall conclusions? Appropriately trained and equipped firefighters co-responding1 to targeted, specific time critical medical events, such as cardiac arrest, can improve patient survival rates. The data also indicate that there is support from fire service staff – and a potential need from members of the public, particularly the elderly, isolated or vulnerable – to expand ‘wider work’. This includes winter warmth assessments, Safe and Well checks, community defibrillator training and client referrals when staff believe someone may have dementia, are vulnerable or even, for example, have substance dependencies such as an alcohol addiction. However, there is currently insufficient data to estimate the net benefit of this work

The person, interactions and environment programme to improve care of people with dementia in hospital: a multisite study

Background: Improving care of people with dementia on acute hospital wards is a policy priority. Person-centred care is a marker of care quality; delivering such care is a goal for service improvement. Objectives: PIE (Person: Interaction; Environment) comprises an observation tool and systematic approach to implement and embed a person-centred approach in routine care for hospitalised patients with dementia. The study aims were to: evaluate PIE as a method to improve the care of older people with dementia on acute hospital wards; and develop insight into what person-centred care might look like in practice in this setting. Methods: We performed a longitudinal comparative case study design in ten purposively selected wards in five Trusts in three English regions; alongside an embedded process evaluation. Data was collected from multiple sources: staff, patients, relatives, organisational aggregate information and documents. Mixed methods were employed: ethnographic observation; interviews and questionnaires; patient case studies (patient observation and conversations ‘in the moment’, interviews with relatives and case records), patient and ward aggregate data. Data was synthesised to create individual case studies of PIE implementation and outcomes in context of ward structure, organisation, patient profile and process of care delivery. Cross case comparison facilitated a descriptive and explanatory account of PIE implementation in context, the pattern of variation, what shaped it and the consequences flowing from it. Quantitative data was analysed using simple descriptive statistics. Qualitative data analysis employed grounded theory methods. Results: The study furthered understanding of dimensions of care quality for older people with dementia on acute hospital wards and the environmental, organisational and cultural factors that shaped delivery. Only two wards fully implemented PIE, sustaining and embedding change over 18 months. The remaining wards either did not install PIE (‘non-implementers’); or were ‘partial implementers’. The interaction between micro-level contextual factors (aspects of leadership (drivers, facilitators, team, networks), fit with strategic initiatives and salience with valued goals) and miso and macro level organisational factors, were the main barriers to PIE adoption. Where implemented, evidence suggests that the programme directly affected improvement in ward practice with positive impact on the experience of patients and caregivers, although the heterogeneity of need and severity of impairment meant that some of the more visible changes did not affect everyone equally. Limitations: Although PIE has potential to improve the care of people with dementia when implemented, findings are indicative only: data on clinical outcomes was not systematically collected; and PIE was not adopted on most study wards. Research implications: Further research is required to identify more precisely the skill-mix and resources necessary to provide person-focused care to hospitalised people with dementia, across the spectrum of need, including those with moderate and severe impairment. Implementing innovations to change practices in complex organisations requires more in-depth understanding of contextual factors that impact the capacity of organisations to absorb and embed new practices