The added value of user involvement during the development of a feedback system regarding physical functioning for community-dwelling elderly people

The number of frail elderly people is increasing. Unfortunately, the number of caregivers is not increasing at the same pace, which affects older people, caregivers and healthcare systems. Because of these developments, self-management is becoming more important in healthcare. To support community-dwelling elderly people in their self-management, a system was developed that monitors their physical functioning. This system provides feedback to elderly people and their caregivers regarding physical indicators of frailty. The feedback is provided to elderly people via the screen of a mobile phone. It is important that elderly people understand the content of the feedback and are able to use the mobile phone properly. If not, it is unlikely that the system can support self-management. Many interactive health technologies that have been developed do not fulfil their promises. An important reason for this is that human and other non-technology issues are not sufficiently taken into consideration during the development process

Construct validity of a modified bathroom scale that can measure balance in elderly people

To investigate the construct validity of a bathroom scale measuring balance in elderly people. Cross-sectional study. Participants were recruited via nursing homes and an organization that provides exercise classes for community-dwelling elderly people. Nursing home patients were compared with active community-dwelling elderly people. Eligibility criteria for both groups were: aged 65 years or older and being able to step onto a bathroom scale independently. The balance measurement of the bathroom scale was compared with the following three clinical balance measurements: Performance Oriented Mobility Assessment (POMA), Timed Up and Go (TUG), and Four Test Balance Scale (FTBS). An independent samples t-test was performed to determine whether nursing home patients scored lower on these four balance tests compared with community-dwelling elderly people. Correlations were calculated between the bathroom scale balance scores and those of the clinical balance tests for nursing home patients and community-dwelling elderly people separately. Forty-seven nursing home patients with a mean age of 81 years (SD 6.40) and 54 community-dwelling elderly people with a mean age of 76 years (SD 5.06) participated in the study. The results showed that nursing home patients had significantly lower scores on all four balance tests compared with community-dwelling elderly people. Correlations between the bathroom scale scores and the POMA, TUG, and FTBS in nursing home patients were all significant: .49, -.60, and .63, respectively. These correlations were not significant in active community-dwelling elderly people, -.04, -.42, and .33, respectively. Linear regression analyses showed that the correlations for the bathroom scale and POMA, bathroom scale and TUG, and bathroom scale and FTBS did not differ statistically between nursing home patients and community-dwelling elderly people. These results suggest that the modified bathroom scale is useful for measuring balance in elderly people. However, the added value of this assessment method for clinical practice remains to be demonstrated

Development of a system that provides tailored feedback and advice to elderly people regarding physical functioning

Objective: To collaborate with relevant stakeholders and end-users to develop an innovative and feasible system that monitors physical functioning and provides tailored feedback and advice to community-dwelling elderly people. Main content of paper: Technological innovations can contribute to bridging the gap between demand and supply of care in frail elderly people. The progression of physical functioning in elderly people can be monitored using technology and via the same technology, functioning-related feedback and advice can be provided to the elderly user and care providers. This may support self-management. However, when developing and introducing new technology, it is important that relevant stakeholders and end-users accept the technology and are able to use it. Therefore, a feedback and advisory system was developed in close collaboration with elderly people, engineers, researchers, geriatricians, physiotherapists, and other health care professionals. All these stakeholders provided input during interviews and expert-meetings on issues such as: which physical indicators should be measured, how (often) should they be measured, how should feedback and advice be provided, and how to embed the technology in daily living and in health care? During this iterative process, aspects of the system were adjusted based on the input of all stakeholders. Results: The technological system that was developed consists of three devices; a bathroom scale monitoring weight and balance, a Grip-ball monitoring grip strength and a mobile phone with a built-in accelerometer monitoring physical activity and gait. The information about these physical indicators is sent to the mobile phone via blue-tooth. The users will receive feedback and advice regarding their own physical functioning on the screen of the mobile phone using text messages and/or spoken messages. The tailored advices relate to individually relevant and realistic goals that aim to maintain or improve physical functioning. The mobile phone also sends the information to an online database that is accessible for care professionals. Conclusion: In collaboration with different stakeholders and end-users, an innovative feedback and advisory system was developed for community-dwelling elderly people. The system can also be used by health care professionals to monitor the progression of physical functioning of their clients. By ensuring that all relevant stakeholders and end-users were able to provide their input during the development process, the feasibility and acceptability of the current system have been optimized. This resulted in a unique system that might relief part of the burden that frailty places on elderly people and on health care systems