Implantation d’un système de vidéosurveillance intelligente pour détecter les chutes en milieu de vie

Introduction. Le vieillissement de la population est associé à un risque accru de chute menaçant le maintien des aînés à domicile et dans la communauté. Les nombreuses conséquences néfastes des chutes sur la santé de l’aîné (ex : blessures) et sur son indépendance sont réduites lorsque la prise en charge postchute est rapide. Or les proches-aidants intervenant auprès des aînés en cas de chute ne sont pas assez nombreux et sont souvent conduits à l’épuisement en raison du fardeau lié aux soins apportés à l’aîné (Ducharme, 2006; Wolff et al., 2017; World Health Organization, 2015). L’élaboration d’alternatives pour détecter et alerter lors de chutes devient incontournable pour faciliter le maintien à domicile et dans la communauté en sécurité et pour maintenir une qualité de vie (van Hoof, Kort, Rutten, & Duijnstee, 2011). De nombreuses technologies de détection des chutes ont été développées. Cependant elles ont des limites (ex : l’enregistrement de données personnelles) que le système de vidéosurveillance intelligente (VSI) développé par notre équipe tente de compenser. La VSI est composée d’une caméra reliée à un ordinateur, lui-même relié à Internet. Basée sur une analyse informatisée de l’image, la VSI détecte automatiquement la chute et envoie une alerte au répondant choisi (ex : le proche-aidant) sur son cellulaire, son ordinateur ou sa tablette. Elle préserve la vie privée par son fonctionnement en circuit fermé : en absence de chute, les images sont détruites; lors d’une chute, une image de la chute est transmise au répondant, cette image peut être brouillée à la demande de l’aîné. Si l’aîné l’autorise, il est possible d’enregistrer les 30 secondes précédant la chute pour documenter ses causes. Les travaux antérieurs montrent que la VSI a le potentiel de répondre aux besoins des usagers (Lapierre et al., 2016, 2015; Londei et al., 2009; Rougier, St-Arnaud, Rousseau, & Meunier, 2011). Cependant, il importe de valider sa technologie et d’explorer la perception des usagers dans des conditions écologiques (à domicile auprès d’aînés chuteurs) (Atoyebi, Stewart, & Sampson, 2015). But de l’étude. Basé sur le Modèle de compétence expliquant les relations personne- environnement (Rousseau, 2017), cette thèse a pour but d’explorer la faisabilité de l’implantation de la VSI pour détecter les chutes à domicile afin d’améliorer la qualité de vie de l’aîné et diminuer le fardeau du proche-aidant. Méthodologie. La thèse suit un devis de recherche de développement (Contandriopoulos, Champagne, Potvin, Denis, & Boyle, 2005) en quatre étapes. L’étape 1 consistait en deux revues de la portée (Daudt, Van Mossel, & Scott, 2013) traitant respectivement des technologies de détection des chutes et des technologies de gestion de l’errance. Plusieurs banques de données ont été explorées (ex: CINHAL, Medline, Embase). Chaque étape de sélection des études, puis d’extraction et d’analyse des données a été réalisée indépendamment par deux co-auteurs. Leurs résultats ont été comparés et les désaccords ont été résolus par consensus ou par l’intervention d’un tiers. Les données extraites ont été analysées de façon descriptive (Fortin & Gagnon, 2015). L’étape 2 était une étude de cas multiples (Yin, 2014) auprès de six aînées chuteuses vivant seules, concernant l’implantation à domicile d’une version préalable à la VSI, la vidéosurveillance programmable (VSP). La VSP a été installée durant sept nuits chez les participantes pour observer leurs déplacements lors des levés la nuit pour aller à la toilette. Des entrevues semi-structurées ont été réalisées avant puis après l’expérimentation. Les données ont été analysées qualitativement (Miles, Huberman, & Saldana, 2014; Yin, 2014). L’étape 3 était une preuve de concept en deux phases : 1) une étude de simulation en appartement-laboratoire (Contandriopoulos, Champagne, Potvin, Denis, & Boyle, 2005) et 2) un pré-test au domicile de jeunes adultes. La phase 1 impliquait la simulation de scenarios de la vie quotidienne et de scenarios de chutes afin d’estimer la sensibilité, la spécificité, le taux d’erreur et la précision de la VSI. Le pré-test consistait en l’implantation de la VSI à domicile pendant 28 jours afin d’anticiper les difficultés technologiques liées à une implantation prolongée. Pour les deux phases, un journal de bord a été complété afin de documenter le fonctionnement de la VSI puis les données ont été analysées descriptivement. L’étape 4 était une étude de cas multiples (Yin, 2014) auprès de trois dyades aînés/proches-aidants. Les aînés inclus, présentant un risque de chute élevé, vivaient seuls à domicile. La VSI était implantée pour deux mois, avec le proche-aidant comme destinataire des alertes. Une entrevue semi-structurée était réalisée, avant, à mi-parcours et après l’expérimentation. Les données ont été analysées qualitativement (Miles, Huberman, & Saldana, 2014; Yin, 2014). Résultats. Les résultats ont abouti à l’adaptation de la VSI pour explorer la faisabilité de son implantation à domicile afin de détecter les chutes graves. L’étape 1 a souligné les lacunes dans la littérature, dont certaines ont été comblées par le projet de thèse (ex : manque d’étude explorant l’implantation de systèmes ambiants dans des domiciles variés). Cette étape a aussi permis d’identifier les façons de bonifier la VSI et sa procédure d’implantation. L’étape 2 a mis en évidence des facteurs pouvant faciliter ou freiner l’implantation de systèmes de caméras à domicile. L’étape 3 a permis de valider la technologie de la VSI dans un environnement similaire à celui de l’aîné et de résoudre les problèmes techniques liés à l’implantation prolongée du système. Enfin, l’étape 4 a permis d’explorer la faisabilité de l’implantation de la VSI au domicile d’aînés chuteurs pendant une période de deux mois. Discussion. Cette recherche de développement a permis d’adapter la VSI pour son implantation grâce à plusieurs étapes de recherche (des revues de la portée, une preuve de concept, étude de cas multiple) puis de montrer la faisabilité de son implantation. Les résultats ont abouti à l’identification de facteurs influençant l’implantation de la VSI à domicile et ont permis d’émettre des recommandations à cet égard. Cette recherche est originale notamment sur trois aspects: 1) l’implication d’une équipe multidisciplinaire, 2) une conception technologique centrée sur l’usager, 3) l’implantation à domicile de la technologie. Même si des défis persistent quant à son implantation à domicile (ex. réduire l’écart de performance du système entre l’appartement-laboratoire et le domicile), cette étude encourage la poursuite du développement de la VSI. Conclusion. Cette thèse visait à répondre à la problématique des chutes des aînés à domicile grâce à l’implantation d’un système de vidéosurveillance intelligente pour alerter automatiquement le proche-aidant. Les résultats de cette recherche de développement, soulignent que la VSI serait une avenue prometteuse pour détecter les chutes graves, alerter le proche et documenter la cause des chutes. Les futures recherches sur l’implantation de technologies similaires devraient impliquer des devis de recherche quantitatifs, avec notamment des profils plus variés de proches-aidants et une implantation plus longue pour démontrer les effets de la VSI. La VSI pourrait ensuite devenir accessible aux aînés afin de soutenir leur maintien à domicile et dans la communauté et soulager le fardeau des proches- aidants.Introduction. Aging is associated with an increased risk of fall, which threatens Aging in Place. The numerous and serious consequences of falls on the older adult’s health and independence are reduced with a quick intervention. Yet the informal caregivers, who often intervene in case of a fall are not numerous enough and are often worn out because of the burden related to the care provided for the older adult (Ducharme, 2006; Wolff et al., 2017; World Health Organization, 2015). The development of alternatives to detect and alert in case of a fall becomes essential to facilitate Aging in Place in safety and to maintain a quality of life (van Hoof, Kort, Rutten, & Duijnstee, 2011). Many fall detection systems have been developed. However, they have limits (eg. the recording of personal data), that the intelligent videomonitoring system (IVS) tries to compensate. The IVS is composed of one camera linked to a computer and to the Internet. Based on the computerized analysis of the images, the IVS automatically detects falls and sends an alert to the chosen recipient (eg. the informal caregiver) on his smartphone, computer or tablet. The IVS preserves privacy with its closed circuit functioning: without a fall, the images are destroyed; in case of a fall, an image of the fall can be sent to the recipient. This image can be blurred at the request of the older adult. The 30 seconds before the fall can be recorded to document its causes, if the older adult authorizes it. Previous studies on the IVS show that the IVS has the potential to answer the users’ needs (Lapierre et al., 2016, 2015; Londei et al., 2009; Rougier, St-Arnaud, Rousseau, & Meunier, 2011). However, it is important to validate its technology and explore users’ perception in ecological conditions (at home with older adults at risk of fall) (Atoyebi, Stewart, & Sampson, 2015). Purpose. Based on the Model of Competence explaining the person-environment interactions (Rousseau, 2017), the study aims to explore the feasibility of the IVS implementation to detect falls at home in order to improve the older adult’s quality of life and decrease the caregiver’s burden. Methodology. The thesis follows a development research design (Contandriopoulos, Champagne, Potvin, Denis, & Boyle, 2005) in four steps. Step 1 was two scoping reviews (Daudt, Van Mossel, & Scott, 2013) on fall detection technology and on wandering management technology respectively. Many databases have been searched (eg. CINHAL, Medline, Embase). Each step of the study selection, data extraction and analysis have been independently realised by two co-authors. Results were compared and disagreements were solved by consensus or by a third part intervention. Extracted data were descriptively analysed (Fortin & Gagnon, 2015). Step 2 was a multiple case study (Yin, 2014) with six older adults living alone with a risk of fall, on the implementation of a previous version of the IVS, the programmable videomonitoring system. The programmable videomonitoring system was installed for seven nights at home to observe participants walk when they went to the bathroom at night. Semi- structured interviews were realised before and after the experiment. Data were qualitatively analysed (Miles, Huberman, & Saldana, 2014). Step 3 was a proof of concept in two phases: 1) a simulation study in an apartment- laboratory (Contandriopoulos, Champagne, Potvin, Denis, & Boyle, 2005) and 2) a pre-test at home with young adults. Phase 1 implied a simulation of daily living scenarios and falls scenarios to estimate the sensitivity, specificity, error rate and accuracy of the IVS. The pre- test consisted in the implementation of the IVS at home for 28 days to anticipate the technological difficulties related to extended implementation. For the two phases, a logbook was completed to document the IVS functioning, then data were descriptively analysed. Step 4 was a multiple case study (Yin, 2014) with three dyads of older adults/caregivers. The included older adults had a high risk of fall and lived alone. The IVS was implemented for a two-month period with the informal caregiver as the alerts recipient. A semi-structured interview was realised before, at mid-term, and after the experiment. Data were qualitatively analysed (Miles, Huberman, & Saldana, 2014). Results. Results encompass the adaptation of the IVS to explore the feasibility of its implementation at home to detect serious falls. Step 1 highlighted the gaps in the literature, some of which were filled by the thesis project (eg. lack of studies exploring the implementation of ambient system in various homes). This step also enabled us to identify ways to improve the IVS and its implementation process. Step 2 highlighted factors facilitating or hindering the implementation of cameras system at home. Step 3 has enabled us to validate the technology in a similar environment to the older adult’s home and to solve technical difficulties related to the prolonged implementation. Finally, step 4 enabled us to explore the feasibility of the implementation of the IVS at older adults’ home for a two-month period. Discussion. This development research enabled us to adapt the IVS for its implementation by means of four research steps (scoping reviews, proof of concept, multiple case study), and then to show the feasibility of its implementation. Results led to the identification of factors influencing the IVS at home and enabled us to make recommendations in this regard. This thesis is original on three aspects: 1) the implication of a multidisciplinary team, 2) a user-based conception, 3) the implementation of the technology at home. Despite the remaining challenges regarding the implementation (eg. the performance discrepancy between the home and the apartment-laboratory), this study encourages the further development of the VSI. Conclusion. This thesis aimed to address the problematic of falls at home thanks to the implementation of the IVS to automatically alert the informal caregiver. Results from this development research highlight that the IVS may be a promising way to detect serious falls, to alert the caregiver and document the falls causes. Future researches should be involving quantitative designs, more specifically with more various profiles of informal caregivers and a longer period of implementation, to demonstrate the IVS outcomes. The IVS could then become accessible to the older adult to support Aging in place and relieve the caregiver’s burden

Older women's perceptions of a programmable video monitoring system at home : a pilot study

Introduction：　Developing technologies to help older adults to age in place is paramount in coping with health challenges related to the ageing population. Camera-based technologies are efficient for home monitoring; however, few studies exist of users’ perceptions of these technologies. To monitor night walks and the person-environment interaction, a programmable video monitoring system (VS) was implemented at home. This study explores users’ perceptions of this VS. Methods：　For this multiple case study, six older women were recruited according to these criteria: (1) ≥65 years old; (2) ≥ one fall within the last 12 months; (3) woke up at night to go to the toilet; (4) lived alone. The VS was implemented for seven nights. Perceptions were explored with semi-structured interviews before and after the experiment. Data were analysed qualitatively following a cross-case method. Results Participants had positive opinions of the VS before the implementation; they appreciated three features: (1) the programmable movement detection during chosen time slots, respecting privacy; (2) the LED indicating the recording; (3) the small cameras. After the experiment, participants reported positive experiences, though some expressed some discomfort. During the experiment, participants’ perceptions changed because they got used to the system. Conclusion：　Older women’s favourable opinion of programmable VS supports the use of ambient technologies to facilitate ageing in place. Future research should involve larger samples to confirm the possibility of using programmable VS with community-dwelling older adults

Impact of the COVID-19 pandemic on older adults: rapid review

Background: The COVID-19 pandemic has drastically changed the lives of countless members of the general population. Older adults are known to experience loneliness, age discrimination, and excessive worry. It is therefore reasonable to anticipate that they would experience greater negative outcomes related to the COVID-19 pandemic given their increased isolation and risk for complications than younger adults. Objective: This study aims to synthesize the existing research on the impact of the COVID-19 pandemic, and associated isolation and protective measures, on older adults. The secondary objective is to investigate the impact of the COVID-19 pandemic, and associated isolation and protective measures, on older adults with Alzheimer disease and related dementias. Methods: A rapid review of the published literature was conducted on October 6, 2020, through a search of 6 online databases to synthesize results from published original studies regarding the impact of the COVID-19 pandemic on older adults. The Human Development Model conceptual framework–Disability Creation Process was used to describe and understand interactions between personal factors, environmental factors, and life habits. Methods and results are reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses Statement. Results: A total of 135 records were included from the initial search strategy of 13,452 individual studies. Of these, 113 (83.7%) studies were determined to be of level 4 according to the levels of evidence classification by the Centre for Evidence-Based Medicine. The presence of psychological symptoms, exacerbation of ageism, and physical deterioration of aged populations were reported in the included studies. Decreased social life and fewer in-person social interactions reported during the COVID-19 pandemic were occasionally associated with reduced quality of life and increased depression. Difficulties accessing services, sleep disturbances, and a reduction of physical activity were also noted. Conclusions: Our results highlight the need for adequate isolation and protective measures. Older adults represent a heterogeneous group, which could explain the contradictory results found in the literature. Individual, organizational, and institutional strategies should be established to ensure that older adults are able to maintain social contacts, preserve family ties, and maintain the ability to give or receive help during the current pandemic. Future studies should focus on specific consequences and needs of more at-risk older adults to ensure their inclusion, both in public health recommendations and considerations made by policy makers

Perceptions and needs regarding technologies in nursing homes : an exploratory study

Two of the most salient problems in nursing homes are the responsive behaviours and falls of older people living with Alzheimer’s disease and related disorders. Intelligent videomonitoring and mobile applications are potential technologies that may help prevent and manage these problems. However, evidence for the needs for technologies in nursing homes is scarce. This study aimed to explore the perceptions and needs of care managers, and of formal and family caregivers in nursing homes regarding these potential technologies. With an exploratory qualitative design based on Rogers’ diffusion of innovation theory, individual interviews and a content analysis were conducted. Results show that the potential users of these technologies consider them relevant in nursing homes. The characteristics that would make these technologies useful in nursing homes are described. These results could be used to develop useful technologies to improve the quality of clinical practice in nursing homes

Conditions and ethical challenges that could influence the implementation of technologies in nursing homes : a qualitative study

Aim: To explore the conditions that may influence the implementation of an interactive mobile application (app) and an intelligent videomonitoring system (IVS) in nursing homes (NHs) and the ethical challenges of their use. Background: There is a lack of knowledge about implementing technologies in NHs and the ethical challenges that might arise. In past studies, nursing care teams expressed the need for technologies offering clinical support. Technologies like an IVS and an app could prove useful in NHs to prevent and manage falls and responsive behaviours. Design: An exploratory qualitative study was conducted with care managers, family caregivers, and formal caregivers in five NHs. Methods: Each participant was shown a presentation of a potential app and a short video on an IVS. It was followed by an individual semi-structured interview. A conventional content analysis was performed. Findings: Potential users found it would be possible to implement these technologies in NHs even if resistance could be expected. To facilitate adoption and achieve clinical benefits, the implementation of technologies should be pilot-tested, and coaching activities should be planned. Ethical risks were considered already present in NHs even without technologies, for example, risks to privacy. Strategies were proposed, for instance, to adapt the code of ethics and procedures. Some potential prejudices about the interest and abilities of older staff, nurses’ aides, and family caregivers to use technology were identified. Conclusions: Through rigorous and ethical implementation, technologies supporting clinical care processes could benefit older people living in NHs, as well as their relatives and the staff. Implications for practice: Various strategies are proposed to successfully implement technologies. Effort should be made to avoid prejudices during implementation, and procedures should be adapted to mitigate possible ethical challenges

Exergame-Assisted Rehabilitation for Preventing Falls in Older Adults at Risk: A Systematic Review and Meta-Analysis

International audienceIntroduction: Exergaming is increasingly employed in rehabilitation for older adults. However, their effects on fall rate and fall risk remain unclear. Methods: We conducted a systematic review and meta-analysis that included randomized controlled trials (RCTs) comparing exergame-assisted rehabilitation with control groups, published in French or English, from Web of Science, CINHAL, Embase, Medline, and CENTRAL (last search in June 2021). Two reviewers independently assessed the studies. Risk of bias was assessed using RoB2, PEDRO scale, and the GRADE system. The outcomes of interest were (a) fall rate, (b) risk of falling, measured by the Short Physical Performance Battery (SPPB), Timed Up and Go (TUG), One-Leg Stance, or Berg Balance Scale (BBS), (c) fear of falling, measured with the Fall Efficacy Scale (FES-I) or the Activities-specific Balance Confidence (ABC) score. Data were pooled and mean differences (MDs) between exergame and control groups were calculated using a random-effects model. Results: Twenty-seven RCTs were included (1,415 participants, including 63.9% of women, with mean age ranging from 65 to 85.2 years old). Exergame-assisted interventions were associated with a reduction in the incidence of falls (4 studies, 316 participants, MD = −0.91 falls per person per year; 95% CI: −1.65 to −0.17, p = 0.02, moderate quality). Regarding fall risk (20 studies included, low-quality evidence), SPPB did not change (MD = 0.74; 95% CI: −0.12 to 1.60, p = 0.09), but all other scores were improved: BBS (MD = 2.85; 95% CI: 1.27 to −4.43, p = 0.0004), TUG (MD = −1.46; 95% CI: −2.21 to −0.71, p = 0.0001) and One-Leg Stance (MD = 7.09; 95% CI: 4.21 to 9.98, p < 0.00001). Fear of falling scores (FES-I and ABC) showed no difference. Conclusion: There is moderate-quality evidence of a reduction in the fall rate with exergame-assisted rehabilitation and low-quality evidence suggesting a mild reduction in the risk of falling. Statistically significant benefits from exergame-assisted rehabilitation did not achieve clinically meaningful changes in risk of falling assessments

The effects of a strong desire to void on gait for incontinent and continent older community-dwelling women at risk of falls

Aims The fall rate in urgency urinary incontinence (UUI) and mixed UI (MUI) older women is higher when compared with that of continent women. One hypothesis is that a strong desire to void (SDV) could alter gait parameters and therefore increase the risk of falls. The aim of this study was to investigate and compare the effect of SDV on gait parameters in UUI/MUI and continent older women who experienced falls. The secondary aim was to determine the relationship between UI severity and gait parameters in incontinent women. Methods A quasi-experimental pilot study was conducted with two groups of healthy community-dwelling women who experienced at least one fall in the last year: continent (n = 17; age: 74.1 ± 4.3) and UUI/MUI (n = 15; age: 73.5 ± 5.9). We recorded, analyzed, and compared spatiotemporal gait parameters for participants in each group with both SDV and no desire to void condition. Results A pattern of reduced velocity (P = 0.05) and stride width (P = 0.02) was observed in both groups with SDV. Incontinence severity was correlated with reduced velocity (rs = −0.63, P = 0.01), increased stance time (rs= 0.65, P = .01) and stance time variability (rs = 0.65, P = .01) in no desire to void condition and with reduced velocity (rs = −0.56, P = .03) and increased stride length variability (rs = 0.54, P = .04) in SDV condition. Conclusions SDV reduced gait velocity and stride width regardless of continence status in older women at risk of falls. Further, UI severity in the UUI/MUI women was correlated to reduced gait velocity and increased variability. Our findings could explain the higher fall rate in this population

Effects of a Rehabilitation Program Using a Patient-Personalized Exergame on Fear of Falling and Risk of Falls in Vulnerable Older Adults: Protocol for a Randomized Controlled Group Study

International audienceBackground Older adults often experience physical, sensory, and cognitive decline. Therefore, they have a high risk of falls, which leads to severe health and psychological consequences and can induce fear of falling. Rehabilitation programs using exergames to prevent falls are being increasingly studied. Medimoov is a movement-based patient-personalized exergame for rehabilitation in older adults. A preliminary study showed that its use may influence functional ability and motivation. Most existing studies that evaluate the use of exergames do not involve an appropriate control group and do not focus on patient-personalized exergames. Objective This study aims to evaluate the effects of Medimoov on risk of falls and fear of falling in older adults compared with standard psychomotor rehabilitation. Methods This is a serial, comparative, randomized controlled group study. Both groups (n=25 in each) will receive psychomotor rehabilitation care. However, the methods of delivery will be different; one group will be exposed to the Medimoov exergame platform, and the other only to traditional means of psychomotor rehabilitation. The selection criteria will be (1) age of 65 years or older, (2) ability to answer a questionnaire, (3) ability to stand in a bipedal position for at least 1 minute, (4) score of 13 or greater on the Short Fall Efficacy Scale, and (5) stable medical condition. An evaluation will be made prior to starting the intervention, after 4 weeks of intervention, and at the end of the intervention (after 8 weeks), and it will focus on (1) risk of falls, (2) fear of falling, and (3) cognitive evaluations. Physical activity outside the session will also be assessed by actimetry. The outcome assessment will be performed according to intention-to-treat analysis. Results The protocol (2019-11-22) has been approved by the Comité de Protection des Personnes Nord-Ouest I–Université de Rouen (2019-A00395-52), which is part of the French national ethical committee. The study received funding in February 2020. As of October 2020 (submission date), and due to the context of the COVID-19 pandemic, a total of 10 participants out of 50 had been enrolled in the study. The projected date for the end of the data collection is December 2021. Data analyses have not been started yet, and publication of the results is expected for Spring 2022. Conclusions The effects of psychomotor rehabilitation using the Medimoov exergame platform on the risk and fear of falls will be evaluated. This pilot study will be the basis for larger trials. Trial Registration ClinicalTrials.gov NCT04134988; https://clinicaltrials.gov/ct2/show/NCT04134988 International Registered Report Identifier (IRRID) DERR1-10.2196/2466

Design

To address the research question we will conducted a scoping review, based the on process outlined by Levac et al.’s ( 2010), which is a modification of Arksey and O’Malley’s (2005) framework for scoping review. We will report the findings according to scoping review extension of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (Liberati et al., 2009)