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

What matters to older people with assisted living needs? A phenomenological analysis of the use and non-use of telehealth and telecare

Telehealth and telecare research has been dominated by efficacy trials. The field lacks a sophisticated theorisation of [a] what matters to older people with assisted living needs; [b] how illness affects people's capacity to use technologies; and [c] the materiality of assistive technologies. We sought to develop a phenomenologically and socio-materially informed theoretical model of assistive technology use. Forty people aged 60–98 (recruited via NHS, social care and third sector) were visited at home several times in 2011–13. Using ethnographic methods, we built a detailed picture of participants' lives, illness experiences and use (or non-use) of technologies. Data were analysed phenomenologically, drawing on the work of Heidegger, and contextualised using a structuration approach with reference to Bourdieu's notions of habitus and field. We found that participants' needs were diverse and unique. Each had multiple, mutually reinforcing impairments (e.g. tremor and visual loss and stiff hands) that were steadily worsening, culturally framed and bound up with the prospect of decline and death. They managed these conditions subjectively and experientially, appropriating or adapting technologies so as to enhance their capacity to sense and act on their world. Installed assistive technologies met few participants' needs; some devices had been abandoned and a few deliberately disabled. Successful technology arrangements were often characterised by ‘bricolage’ (pragmatic customisation, combining new with legacy devices) by the participant or someone who knew and cared about them. With few exceptions, the current generation of so-called ‘assisted living technologies’ does not assist people to live with illness. To overcome this irony, technology providers need to move beyond the goal of representing technology users informationally (e.g. as biometric data) to providing flexible components from which individuals and their carers can ‘think with things’ to improve the situated, lived experience of multi-morbidity. A radical revision of assistive technology design policy may be needed

On the Integration of Adaptive and Interactive Robotic Smart Spaces

© 2015 Mauro Dragone et al.. This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License. (CC BY-NC-ND 3.0)Enabling robots to seamlessly operate as part of smart spaces is an important and extended challenge for robotics R&D and a key enabler for a range of advanced robotic applications, such as AmbientAssisted Living (AAL) and home automation. The integration of these technologies is currently being pursued from two largely distinct view-points: On the one hand, people-centred initiatives focus on improving the user’s acceptance by tackling human-robot interaction (HRI) issues, often adopting a social robotic approach, and by giving to the designer and - in a limited degree – to the final user(s), control on personalization and product customisation features. On the other hand, technologically-driven initiatives are building impersonal but intelligent systems that are able to pro-actively and autonomously adapt their operations to fit changing requirements and evolving users’ needs,but which largely ignore and do not leverage human-robot interaction and may thus lead to poor user experience and user acceptance. In order to inform the development of a new generation of smart robotic spaces, this paper analyses and compares different research strands with a view to proposing possible integrated solutions with both advanced HRI and online adaptation capabilities.Peer reviewe

Rehabilitation robot cell for multimodal standing-up motion augmentation

The paper presents a robot cell for multimodal standing-up motion augmentation. The robot cell is aimed at augmenting the standing-up capabilities of impaired or paraplegic subjects. The setup incorporates the rehabilitation robot device, functional electrical stimulation system, measurement instrumentation and cognitive feedback system. For controlling the standing-up process a novel approach was developed integrating the voluntary activity of a person in the control scheme of the rehabilitation robot. The simulation results demonstrate the possibility of “patient-driven” robot-assisted standing-up training. Moreover, to extend the system capabilities, the audio cognitive feedback is aimed to guide the subject throughout rising. For the feedback generation a granular synthesis method is utilized displaying high-dimensional, dynamic data. The principle of operation and example sonification in standing-up are presented. In this manner, by integrating the cognitive feedback and “patient-driven” actuation systems, an effective motion augmentation system is proposed in which the motion coordination is under the voluntary control of the user

The nature of care giving in a community sample of people with multiple sclerosis

Purpose: The provision of informal care plays a crucial role in supporting those with long term illness such as MS to stay in the community, but there is no recent United Kingdom (UK) research into the nature of this care provision and how it interacts with professional community care. The aim of this study was to investigate the nature of informal and professional care in a community population of people with MS living in the UK from the perspectives of people with MS. Method: Data on the Standard Day Dependency Record (SDDR), Barthel Index, a measure of disability, and SF-36 were collected from a community sample of volunteers with MS from a postal questionnaire and visits from researchers. Results: The response rate was 61%, (n = 169). Respondents in this study were most likely to be assisted by family rather than health or social service professionals and the help was considered essential for approximately 70% of individuals. Only 15% of respondents in this survey received visits from a professional in the preceding 24 h. There was a subgroup who considered help to be significantly more essential and who required assistance on more occasions by the SDDR (t = 13.01, df = 622, p < 0.001, t = 10.38, df = 36.4, p < 0.001). Other subgroups were also identified who may be in need of support from professionals but who were not receiving it. Conclusions: There are reports of considerable amounts of care being provided by families to people with MS who may not be receiving the support required from professional caregivers. Further work needs to establish which groups need assistance and what form this assistance should take

Sowing in the autumn season : exploring benefits of green care farms for dementia patients

In the Netherlands an increasing number of farms combine agricultural production with care services for people with care needs. It is generally believed that these green care farms (GCFs) have beneficial effects on the health status of a diversity of target groups. At present, empirical studies testing this hypothesis are scarce. The main objective of the studies described in this thesis was to gain insight into the potential benefits of day care at GCFs for community‐dwelling older dementia patients. Day care at GCFs was therefore compared with day care at regular day care facilities (RDCFs). In view of the differences between both day care types regarding the day care setting and day care program it was hypothesized that they would differ in their effects on the health status of dementia patients. In two cross‐sectional studies it was tested to what extent the day program of dementia patients at GCFs differed from those at RDCFs. It appeared that at GCFs, dementia patients were (physically) more active, participated in more diverse activities, were more outdoors, and had more opportunities to perform activities in smaller groups than those at RDCFs. It was tested whether these differences resulted into different effects for five domains of health: dietary intake, cognition, emotional well‐being, behaviour, and functional performance. In a comparative cross‐sectional study dietary intake of dementia patients attending day care at GCFs or RDCFs was recorded both at home and during their time at the day care facility. The study showed that dementia patients attending day care at GCFs had significantly higher intakes of energy, carbohydrate, and fluid than their counterparts attending day care at RDCFs. In a cohort study, rates of change during 1 year in cognitive functioning, emotional well‐being, behavioural symptoms, and functional performance were compared between dementia patients attending day care at GCFs and RDCFs. Functioning in these domains remained rather stable and no differences were observed between subjects from GCFs and RDCFs. In the cohort study, also caregiver burden of family caregivers of these dementia patients was assessed. Caregivers’ quality of life, emotional distress, and feelings of competence remained rather stable in family caregivers of dementia patients from both day care settings. In conclusion, the present work has shown that GCFs exceeded RDCFs in offering older dementia patients a diverse day program and in stimulating their dietary intake. The latter may result into a better preserved nutritional status in dementia patients attending day care at GCFs than in those attending day care at RDCFs. GCFs and RDCFs were equally effective in preventing significant decrease of cognitive functioning, emotional well‐being, and functional performance and in preventing significant increase of the number of behavioural symptoms. Both day care types further prevented significant increase of caregiver burden. Day care at GCFs is a new and valuable addition to the present care modalities for community‐dwelling older dementia patients and their caregiver

Application of Smartphone Technology in the Management and Treatment of Mental Illnesses

Abstract: Background: Mental illness continues to be a significant Public Health problem and the innovative use of technology to improve the treatment of mental illnesses holds great public health relevance. Over the past decade telecommunications technology has been used to increase access to and improve the quality of mental health care. There is current evidence that the use of landline and cellular telephones, computer-assisted therapy, and videoconferencing can be effective in improving treatment outcomes. Smartphones, as the newest development in communications technology, offer a new opportunity to improve mental health care through their versatile nature to perform a variety of functions. Methods: A critical literature review was performed to examine the potential of smartphones to increase access to mental health care, reduce barriers to care, and improve patient treatment outcomes. The review was performed by searching several electronic databases using a combination of keywords related to smartphones and mental health interventions using mobile devices. Literature concerning the use of cell phones, handheld computers, and smartphones to improve access to mental health care and improve treatment outcomes was identified.Results: The majority of studies identified were feasibility and pilot studies on patients with a variety of diagnosed mental illnesses using cell phones and PDAs. Authors report that most study participants, with some exceptions, were capable of using a mobile device and found them acceptable to use. Few studies extensively measured treatment outcomes and instead reported preliminary results and presented case illustrations. Studies which used smartphones successfully used them collect data on patients and deliver multimedia interventions. Discussion: The current literature offers encouraging evidence for the use of smartphones to improve mental health care but also reflects the lack of research conducted using smartphones. Studies which examine care provider use of smartphones to improve care is encouraging but has limited generalizability to mental health care. The feasibility of patient use of smartphones is also encouraging, but questions remain about feasibility in some sub-populations, particularly schizophrenia patients. Pilot testing of mobile devices and applications can greatly increase the feasibility of using smartphones in mental health care. Patients who are unfamiliar with smartphones will likely need initial training and support in their use. Conclusion: The literature identified several ways in which smartphones can increase access to care, reduce barriers, and improve treatment outcomes. Study results were encouraging but scientifically weak. Future studies are needed replicating results of studies using cell phones and PDAs on smartphones. Larger and higher quality studies are needed to examine the feasibility, efficacy, and cost-effectiveness of smartphones to deliver multiple component interventions that improve access to mental health care and improve treatment outcomes

Educating Caregivers in Assisted Living Facilities (ALFS) Who Care for People with Dementia

It is estimated that approximately 40-71% of residents living within assisted living facilities (ALFs) have a form of dementia or other cognitive impairment (Harris- Kojetin et al., 2016; Zimmerman, Sloana, & Reed, 2014). There is also evidence that suggests that caregivers working within ALFs have inadequate knowledge on how to care for a resident diagnosed with dementia (Hughes, Bagley, Reilly, Burns, & Challis, 2008; McKenzie, Teri, Pike, LaFazia, & Van Leynseele, 2012; Sharpp, Kayser-Jones, & Young, 2012; Zimmerman et al., 2014). The authors of this scholarly project created an instructional manual that can be used to train caregivers within ALFs to address the current gap in their knowledge. Methodology: The authors used the information gained from the literature review, information gathered through collaboration with faculty at the University of North Dakota’s Occupational Therapy Program, and information gathered after researching topics related to dementia to create the product. Product: The instructional manual was created using Knowles Andragogy Adult Learning Model (Knowles, Holton, & Swanson, 2012). The introduction to the manual includes information on how to apply the adult learning model throughout the educational sessions. The educational materials include three 2-hour PowerPoint slide shows that include information on what dementia is, how dementia impacts a resident’s life, an overview of the Cognitive Disabilities Reconsidered Model (CDRM) by Levy and Burns (2011), and different strategies the caregivers can use at each level of the CDRM to better care for residents diagnosed with dementia. The manual also includes an evaluation of learners’ knowledge by using a pre-test and post-test design. Finally, a small handout was created that contains important concepts that were discussed in the instructional materials so the learners can reference the information later if needed. It is intended for the instructional manual to be utilized by an occupational therapist who understands how to apply the adult learning theory and has adequate knowledge with the CDRM. The education material can be used to meet the continuing educational requirements within the state of Wyoming for ALF caregivers

Project:Filter - using applied games to engage secondary schoolchildren with public policy

Applied games present a twenty-first-century method of consuming information for a specific purpose beyond pure entertainment. Objectives such as awareness and engagement are often used as intended outcomes of applied games in alignment with strategic, organizational, or commercial purposes. Applied games were highlighted as an engagement-based outcome to explore noPILLS, a pan-European policy research project which presented policy pointers and suggested methods of interventions for reducing micropollution within the wastewater treatment process. This paper provides an assessment of a video game which was developed for the purpose of public engagement with policy-based research. The video game, Project:Filter, was developed as a means of communicating noPILLS to secondary school children in Scotland as part of a classroom-based activity. Knowledge development and engagement were identified using Interpretative Phenomenological Analysis to evidence topical awareness, depth of understanding, and suggested methods of intervention. Analysis of observations also provided insights into challenges surrounding logistics, pedagogy, social interactions, learning, and gender as contributing factors to the schoolchildren’s experiences of Project:Filter. The intention of this paper is two-fold: firstly, to provide an example of developing video games from policy-based research; and secondly, to suggest methods of phenomenological assessment for identifying play-based engagement