Intervention Systems European Perspective

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The scope of this section will mainly focus on activities in Europe in the areas of Intervention Systems. It will look at pilots and programs where the telehealthcare loop is 'closed' back to the patient, that is, data collected is acted upon to provide the patient feedback and coaching on actions he/she can do to promote better wellbeing. Broadly speaking, the following section will look at different application areas of Intervention systems (Obesity, Falls etc) and each section will be further split in to 'Research Programs' and 'Commercial Products'.

In theory any system aimed at preventing an illness or on set of health problems can be defined as an "Intervention System," and to list all such systems would obviously be beyond the scope of this exercise. Instead this section will focus on programs and products that are popular in Europe and will identify 'Gaps' in research and commercialisation, where they exist.

Contents

Clinical Telehealthcare Intervention Pilot Activity

There have been many small scale pilots in Europe in the area of home based clinical telehealthcare. These pilots have usually been concerned with comparing 'usual care' with home based telehealthcare. These home based systems are set up to provide intervention in the event of a medical anomaly e.g. blood pressure too high, glucose levels becoming dangerous etc and most of these commercial systems include a feedback and coaching element for the user. A full treatment of these systems is given in the section European Clinical Telemonitoring Trials and Pilot Activity.

Ambient Assisted Living Intervention Pilot Activity

The area of Ambient Assisted living is one that is basically predicated on the concept of Intervention systems, i.e. the whole idea is to use ambient technologies to provide data to allow intervention before an issue becomes an acute problem. There are many examples of such systems and several pilots have appeared (again though, mainly small scale in nature). A full treatment of these systems is given in the section European Ambient Assistive Living Trials and Pilot Activity.

Obesity Programs

There is a major lack of live pilot infromation around Obesity programs. While the guidelines for avoidance of Obesity are quite clear and have been well publicised globally, there is still a lack of field-data indicating the efficacy of intervention programs and in particular programs that use telehealthcare intervention. More work is required in this space. Some of the pilots that have happened and where the information is published include the following;

Cognitive Training Activity

The section reviews the so called memory-training products aimed at stimulating certain regions of the brain that may be deteriorating as a result of ageing or injury (or cognitive deline conditions). Vendors claim that these products can be used for normally 'well' people also and use can halt natural deterioration of functioning that is characteristic of the ageing process. Applications now include diverse applications such as being used as aids to driving instruction.

  • Commercial Products - Follow this link for a list if EU funded research activity in this area.
  • Not everyone believes their efficacy

The BBC reported in Feb 2009 [1] that the group Which? (an independent consumre review body) stated that there is no evidence that brain training products are any more effective than regularly doing a crossword or surfing the internet. But there is evidence that exercise, a healthy diet and an active social life help keep an agile mind... Which? said.

Falls Prevention

There is a major shortage of information on live Falls Prevention pilots across Europe. The reason for this is unlcear. It may be that pilots have happened and the results have not been published. There seems to be a major trend towards a Web Based 'Guidelines' approach involving multi-diciplinary efforts i.e. social workers, nurses, clinicians, caregivers working together in a community-based approach. These Web based programs appear valueable, however the lack of real 'before and after' data makes it difficult to properly assess their efficiacy. Much more live pilot activity is needed with proper recording and reporting of data. Regarding Falls Prevention using technology devices (such as bed/chair sensors), there is almost no information available, and again this is quite surprising. Also regarding EU-Funded programs on Falls prevention, there is a surprisingly small amount of activity, and where there is activity, results dissemination is quite poor. Some of the material that has been published is detailed as follows; (follow the title links);

Social Connectedness

A recent study by Anderson Analytics (1) set out to find out how different generations were using social networks, which have become increasingly popular across all demographics. As they mature, social networks are slowly taken over by the older generations, sometimes becoming the groups with the largest number of users, replacing the early adopters who are mostly younger. The study showed that different generations in the US and Europe had different preferences when it came to social networks, with younger users preferring MySpace while the older ones predominantly using Facebook. Facebook dominates these age groups, with 90 percent of those above 65 years old and 73 percent of those between 44 and 65 using it.

See pages on Social Connectedness for a full treatment of Online social networks in general, European networks and European academic and research oriented programmes. Note: there are not many 'elder-specific' social networks available. The pattern as shown by the data is that people aged 65 and over tend to use Facebook as the social network of choice.

Robotics

Summary: in 2008 The EU commissioned a study "Road map for application of robotics in medicine and healthcare" [2] on the usage of robotics in healthcare applications in Europe. They also tasked the group with plotting the way forward in a roadmap. Some of the main findings pertinent to the CAPSIL domain are as follows;

The main challenges of producing robotic based intervention systems lies in their complexity, their practicality i.e. how unobtrusive they are and how easily they can be integrated. The market is still very young in this regard. Many products have appeared such as ProVAR [3] and RAID-MASTER [4] but met with limited success.The development of robotised Tele-diagnostic systems is well underway in Europe however there are still not very many commercial applications available on the market (some of these are given below). Robotic-care assistant applications similarly are mainly the domain of research programs although some commercial devices are available. The use of robots for physical rehabilitation therapy has been looked at extensively but again not many commercial platforms are available. Also, the efficacy of these devices still largely unknown. More commercial devices producing larger data sets is needed. Interestingly also no major initiatives have been identified in the sports fitness area. This is surprising considering the focus on Obesity and its co-morbidities. The EU needs to fund more programs particularly in the assisted living space as there are still very little solutions (and even research) available in this space.

Alzheimers Patient Tracking

It has been reported widely that almost two-thirds of people with dementia wander off at some point. Once it happens, it's almost certain to happen again. Also a sobering statistic shows that up to half of wanderers missing for 24 hours are not found alive.

Devices for tracking Alzheimer's patients who are prone to wandering fall in to two categories, namely, 1). Long range systems capable of tracking a person to any distance (in theory anyway), and 2). Short range systems that use RFID type devices for tracking location within a facility boundary such as a hospital or home perimeter. The former systems use GPS or GSM GSM mobile telephone networks and typically operate on a triangulation or Time Difference on Arrival (TDOA) principle, the latter systems use active RFID (battery based) or wi-fi. Both systems involve some form of worn 'wrist-band' type device that may resemble a watch. This device includes a battery that needs to be changed (typically every two years). The science behind tracking people is not very complex and hence there is not a lot of activity in the research space here. Concerns over 'big brother' and privacy do play a part here though and systems such as the VeriChip human implantable tracking device used in the US for tracking patients, have not yet met with approval in Europe. See section on Privacy & Security for more details.

Medication Reminders

Medication reminders are intended to ensure that compliance to a medication regime is as high as possible. Data shows that in the US Typical compliance to a medication regime is around 50%. Typical medication reminder systems include some form of 'pill box' that holds the pre-loaded medication for up to maybe 10 days. It automatically dispenses the medication based on the programmed dosage and frequency (can be performed by the user or a care giver). Also typical of medication reminder systems is a highly programmable 'wrist watch' device that features reminder alarms and vibrating/buzzers.

Some of the popular commercial medication reminder systems in Europe are given at the following link.

References

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