Accès et usage aux systèmes intelligents de soutien à l’autonomie des personnes âgées à domicile : besoins et formations

L’Institut national de la statistique et des études économiques décrit une France qui compterait au 1er janvier 2050 plus de 20 millions de personnes de 65 ans ou plus, soit 8,6 millions de plus qu'en 2013. Les enjeux du vieillissement en France sont donc ceux d’un pays qui vieillit, dont l’espérance de vie augmente très significativement, dont la durée de vie avec au moins une incapacité augmente, et qui doit s’adapter à cette évolution démographique, notamment par des innovations sociales, organisationnelles et technologiques. Ce n’est pas seulement le nombre des âgés qui modifie les équilibres intergénérationnels, mais la longévité elle-même. Les conséquences de cette longévité questionnent sur les plans économique, institutionnelle, sanitaire, mais aussi éducatif, principalement pour le soutien à domicile des personnes âgées en situation de perte d’autonomie, plébiscité par 80% des ménages dans le monde. Elle interroge aussi sur la capacité d’accéder, d’accepter, de prendre en main et d’utiliser les nouvelles technologies et systèmes intelligents émergents. Au regard des processus d’accès, d’acceptation et d’usage de l’innovation que constitue un système d’habitat intelligent, la présente thèse s’est posé la question des déterminants de l’accès à un de ces systèmes intelligents de soutien à domicile des personnes âgées en situation de perte d’autonomie. Elle s’inscrit dans le cadre dispositif Philémon d’accompagnement renforcé au domicile pour des personnes âgées de plus de 60 ans pour lesquels la vulnérabilité ne permet pas un soutien à domicile sans une intervention coordonnée des services d’accompagnement et de soins et que nous mettons en œuvre depuis 2019. Le dispositif s’appuie sur des technologies et des services, et met en place un environnement adapté, et connecté autour d’une table de chevet connectée et de différentes aides techniques. Il est installé par un ergothérapeute complété par une prise en charge globale et coordonnée à domicile (accompagnement, soins, télésanté, téléassistance, prévention et maintien du lien social). A partir d’une étude cas multiples basés sur les référentiels d’accès de Lévesque et al. (2013) et d’acceptabilité et d’usage de Chen et Chan (2104), nous présentons le dispositif et les résultats des évaluations. Ces évaluations visent à objectiver les conditions de mise en œuvre et de pérennité et à mesurer les apports (satisfaction des personnes, de leurs proches aidants et aidants professionnels, préservation de l’autonomie des personnes et de leur santé). Les premiers résultats de ces évaluations ont permis la pérennisation et le déploiement de ce dispositif en Centres de Ressources du territoire par le gouvernement Français

State of Art of Telemonitoring in Patients with Diabetes Mellitus, with a Focus on Elderly Patients

Since the beginning of the 1990s, several telemedicine projects and studies focused on type 1 and type 2 diabetes have been developed, including very few elderly diabetic patients. Several of these projects specifically concerned elderly subjects (n = 4). Mainly, these projects and studies show that telemonitoring diabetes results in improved blood glucose control—a significant reduction in HbA1c, improved patient ownership of the disease, greater patient adherence to therapeutic and hygiene-dietary measures, positive impact on comorbidities (hypertension, weight, dyslipidemia), improved quality of life for patients, and at least good patient receptivity and accountability. To date, the magnitude of its effects remains debatable, especially with the variation in patients’ characteristics (e.g., background, ability for self-management, medical condition), sample selection, and approach for treatment of control groups. Over the last 5 years, numerous telemedicine projects based on connected objects and new information and communication technologies (ICT) (elements defining telemedicine 2.0) have emerged or are still under development

EyeSchool: an educational assistive technology for people with disabilities - Passing from single actors to multiple-actor environment

International audienceSince 2005, public policy in France has strongly been encouraging young people with disabilities inclusion within the regular school system. This has found a direct application through technical innovation, intended to help students being more independent within their learning activities. In this context, the purpose of this paper is to underline the manner in which using assistive information and communication technologies may improve the inclusive education for people with disabilities. The case study we present underlines the complexity of the social world into which the use of a precise assistive tool takes it place

ARIA digital anamorphosis : Digital transformation of health and care in airway diseases from research to practice

Digital anamorphosis is used to define a distorted image of health and care that may be viewed correctly using digital tools and strategies. MASK digital anamorphosis represents the process used by MASK to develop the digital transformation of health and care in rhinitis. It strengthens the ARIA change management strategy in the prevention and management of airway disease. The MASK strategy is based on validated digital tools. Using the MASK digital tool and the CARAT online enhanced clinical framework, solutions for practical steps of digital enhancement of care are proposed.Peer reviewe

The reference site collaborative network of the european innovation partnership on active and healthy ageing

Seventy four Reference Sites of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) have been recognised by the European Commission in 2016 for their commitment to excellence in investing and scaling up innovative solutions for active and healthy ageing. The Reference Site Collaborative Network (RSCN) brings together the EIP on AHA Reference Sites awarded by the European Commission, and Candidate Reference Sites into a single forum. The overarching goals are to promote cooperation, share and transfer good practice and solutions in the development and scaling up of health and care strategies, policies and service delivery models, while at the same time supporting the action groups in their work. The RSCN aspires to be recognized by the EU Commission as the principal forum and authority representing all EIP on AHA Reference Sites. The RSCN will contribute to achieve the goals of the EIP on AHA by improving health and care outcomes for citizens across Europe, and the development of sustainable economic growth and the creation of jobs

ARIA digital anamorphosis: Digital transformation of health and care in airway diseases from research to practice

Digital anamorphosis is used to define a distorted image of health and care that may be viewed correctly using digital tools and strategies. MASK digital anamorphosis represents the process used by MASK to develop the digital transformation of health and care in rhinitis. It strengthens the ARIA change management strategy in the prevention and management of airway disease. The MASK strategy is based on validated digital tools. Using the MASK digital tool and the CARAT online enhanced clinical framework, solutions for practical steps of digital enhancement of care are proposed

First Test of an Automated Detection Platform to Identify Risk of Decompensation in Elderly Patients

Introduction: We tested the MyPrediTM e-platform which is dedicated to the automated, intelligent detection of situations posing a risk of decompensation in geriatric patients.Objective: The goal was to validate the technological choices, to consolidate the system and to test the robustness of the MyPrediTM e-platform through daily use. Results: The telemedicine solution took 3,552 measurements for a hospitalized patient during her stay, with an average of 237 measurements per day, and issued 32 alerts, with an average of 2 alerts per day. The main risk was heart failure which generated the most alerts (n=13). The platform had 100% sensitivity for all geriatric risks, and had very satisfactory positive and negative predictive values.Conclusion: The present experiment validates the technological choices, the tools and the solutions developed

Current Research and New Perspectives of Telemedicine in Chronic Heart Failure: Narrative Review and Points of Interest for the Clinician

Background: This is a narrative review of both the literature and Internet pertaining to telemedicine projects within the field of heart failure, with special attention placed on remote monitoring of second-generation projects and trials, particularly in France. Results: Since the beginning of the 2000’s, several telemedicine projects and trials focused on chronic heart failure have been developed. The first telemedicine projects (e.g., TEN-HMS, BEAT-HF, Tele-HF, and TIM-HF) primarily investigated telemonitoring or for the older ones, telephone follow-up. Numerous second-generation telemedicine projects have emerged in Europe over the last ten years or are still under development for computer science heart failure, especially in Europe, such as SCAD, OSICAT, E-care, PRADO-INCADO, and TIM-HF2. The E-care telemonitoring project fits within the telemedicine 2.0 framework, based on connected objects, new information and communication technologies (ICT) and Web 2.0 technologies. E-care is the first telemedicine project including artificial intelligence (AI). TIM-HF2 is the first positive prospective randomized study with regards to EBM with positive significant clinical benefit, in terms of unplanned cardiovascular hospital admissions and all-cause deaths. The potential contribution of second-generation telemedicine projects in terms of mortality, morbidity, and number of hospitalizations avoided is currently under study. Their impact in terms of health economics is likewise being investigated, taking into account that the economic and social benefits brought up by telemedicine solutions were previously validated by the original telemedicine projects

Results of the Second Phase of the GER-e-TEC Experiment concerning the Telemonitoring of Elderly Patients Affected by COVID-19 Disease to Detect the Exacerbation of Geriatric Syndromes

Background: Coronavirus disease 2019 (COVID-19) has wreaked health and economic damage globally. This pandemic has created a difficult challenge for global public health. The coronavirus disease 2019 (COVID-19) pandemic has necessitated the use of new technologies and new processes to care for hospitalized patients, including elderly patients. Our team developed a telemonitoring program focused on the prevention of geriatric syndromes, the “GER-e-TEC COVID study”. Methods: This second phase took place during the 3rd wave of the epidemic in France, between 14 December 2020 and 25 February 2021, conducted in the University Hospital of Strasbourg. Results: 30 elderly patients affected by COVID-19 disease were monitored remotely; the mean age was 85.9 years and a male/female ratio of 1.5 to 1.11 (36.7%) died during the experiment. The patients used the telemedicine solution for an average of 27.3 days. 140,260 measurements were taken while monitoring the geriatric syndromes of the entire patient group. 4675 measurements were recorded per patient for geriatric disorders and risks. 319 measurements were recorded per patient per day. The telemedicine solution emitted a total of 1245 alerts while monitoring the geriatric syndromes of the entire patient group. In terms of sensitivity, the results were 100% for all geriatric risks and extremely satisfactory in terms of positive and negative predictive values. Survival analyses showed that gender played no role in the length of the hospital stay, regardless of the reason for the hospitalization (decompensated heart failure (p = 0.45), deterioration of general condition (p = 0.12), but significant for death (p = 0.028)). The analyses revealed that the length of the hospital stay was not affected by the number of alerts. The results concerning the predictive nature of alerts are satisfactory. Conclusions: The MyPredi™ telemedicine system allows for the generation of automatic, non-intrusive alerts when the health of a COVID-19 elderly patient deteriorates due to risks associated with geriatric syndromes