Technical and Non-Technical Barriers to Independent Living
From Capsil Wiki
Contents |
Barriers to Independent Living for Ambulatory Elders
When speaking about the need for some form of assistive living capabilities for older people, healthcare professionals refer to the ability or inability of the person to perform the Activities for Daily Living (ADLs). These are: •Bathing •Dressing and undressing •Eating •Transferring from bed to chair, and back •Voluntarily control urinary and faecal discharge •Using the toilet •Walking (not bedridden) Several ‘checklist’ type methods are used to determine the persons need for assistive living including the Instrumental Activities of Daily Living Scale (IADL) [1]. The ideal scenario is that the assistive living can be performed from the elders own home as this has the effect of preserving personal dignity and pride (which leads to a better health outcome), however sometimes this is just not possible as there are barriers that prevent this from happening. Some of these are within the control of the person (and their caregivers) and some are not. The following section summarises the various factors that can limit this independence;
Social Barriers to Independent Living
The starting point for this discussion will be the physical and behavioural issues that may require the elderly person to seek out assistive living or some form of daily living support in the first place. The most common issues can be broken down as follows:
- Medical Conditions - Medical conditions that may mitigitate against a person availing of these advances. Examples include lack of mobility and chronic diseases.
- Behavioural Issues - Issues such as mental illnesses and cognitive decline still operate in the classical doctor/patient face to face model. These conditions may mean it is unsafe for a person to live alone.
- Lack of Social Network - As people age, their social network may decline and thus there may not be a network of family and friends to provide care support.
- Lack of Caregiver Support - People may not have family members that can commit to caregiver support. Also the role reversal for parent/child can be awkward for parents to yield to and may not be willing to give up their role as head of teh family.
- Cost of Independent Living Solutions - Cost of retrofitting the house/facility, purchasing the technology and installing may be prohibitive. A leading provider of this type of service in Ireland quotes that this retrofitting can run from around €10k-€35k.
- Environmental Factors - The most common hazards found in households include loose rugs, trip hazards, animal hair, cigarette smoke, excessive dust and mould/dampness.
Other Barriers to Independent Living
- Perception and Apprehension Issues - There exists a ‘digital divide’ between people aged 38 to 59 and people over 60 years of age in their attitude and confidence using technology. This is a statement that not only applies to the field of healthcare but to technology in general.
- Privacy & Security - Home healthcare monitoring poses some fundamental problems in terms of security and privacy balanced with safe and effective healthcare. In reality these are two opposing ideas and the more effective the home healthcare package, the more threat to privacy that exists. A major issue that comes up in this context is that of trust. “How do I know that others are not viewing my healthcare data without my explicit permission?”. See Capsil section on Privacy & Security for a full treatment of this topic.
- Policy Issues - A major issue in the uptake of home healthcare monitoring is that of policy variation between country, state and even sometimes at county level. Say for example a person is being monitored in France and the clinician resides in Germany; then the question arises – “which country’s law is responsible for the integrity of the consultation (accurate, secure, private etc)? Where is the accountability and where is the enforcement if this contract is breached? “.According to OAT [2] “A patient in Oregon could not be treated remotely by a New York doctor, even if that physician were the country’s foremost expert on the patient’s disease.” “This is detrimental to the patient’s health because the individual might not receive the best care possible”, and according to Intel’s Eric Dishman, “it hinders telemedicine”. A full treatment on Policy relating to telehealthcare and independent living is given in the Government Policy section.
- Cost and Reimbursement Issues - A recent Accenture report [3] noted that “Cost and complexity continue to hold back the development and adoption of converged digital home solutions”. A full treatment on Cost and Reimbursement relating to telehealthcare and independent living is given in the Government Policy section.
- Personal Health Records - The use of electronic medical records has been discussed extensively for years now, with little real traction and few if any real examples of adoption on a large scale. Personal Health Records are proposed as an important tool for the gathering, collation and archiving of personal health information gathered from the home. A major attraction of the Personal Health Record is that it cedes control back to the patient (from the network or the administrator, clinician etc). A March 2009 [4] report identified renewed interest in Personal Health Records and noted the positive effect on privacy, cost and security concerns. Availability of Personal Health Records (such as Google Health) will be important factors in assisting the uptake of these new technologies in the home setting. A full treatment of Personal Health Records is given in the Digital Health Records section.
- Broadband Proliferation - Broadband access technology of whatever type (DSL, WiMAX, Satellite etc) is a key enabler technology for home healthcare monitoring, particularly if personal health records are to be employed. Issues of coverage, cost and speed (actual versus advertised) are important here. A full treatment of Broadband connectivity technologies and related issues are given in the Connectivity section.
References
- ↑ 1.M.P. LAWTON & E.M. BRODY. Instrumental Activities of Daily Living Scale (IADL). http://www.abramsoncenter.org/PRI/documents/IADL.pdf
- ↑ Kumekawa, Joanne K. (September 30, 2001) “Health Information Privacy Protection: Crisis or Common Sense?" Online Journal of Issues in Nursing. Vol. #6 No. #3, Manuscript 2 http://www.nursingworld.org/ojin/topic16/tpc16_2.htm
- ↑ http://digitalforum.accenture.com/DigitalForum/Global/ViewByTopic/NewMediaTechnologies/0705_digital_home_study.htm
- ↑ http://www.bio-medicine.org/medicine-news-1/Barriers-to-adoption-of-electronic-personal-health-records-outlined-39063-1/
- Back to Home and Mobile Systems Main page
- Back to Main Page
