Ricky Yean's List: Elderly Care Research

• The responses of governments have included initiatives to extend productive working lives and promote self-funded retirement; to promote healthy, active aging; and to encourage more care to be delivered in home and community settings. Technology will be a major enabler of these strategies.
• Innovation will provide greater independence and better access to care in their own homes for the elderly, sufferers of chronic illness, and persons with disability and reduce the incidence of hospital admissions and the length of stay when admissions do occur. Technologies will support families and professional caregivers and are expected to reduce costs.
• governments of many developed countries have taken such diverse measures as deferring retirement, promoting more self-funded retirement, increasing the provision of home care, implementation of public insurance schemes for aged care, providing research grants to academics and technologists working in the field of aged care, and providing more support for family carers.
• Monitors include personal alarms, motion and smoke sensors, and fall detectors. These can be supported by intelligent software that can alert carers or call centers as required. Some monitors keep track of household equipment and how it is being used. This could indicate that a person is no longer cooking for him- or herself or could turn off appliances that have been left on. Sensors are available to turn lights on. They can track and alert for wandering by patients with dementia, and can monitor arrivals and departures of people including the patient or authorized visiting carers.
• Bed pressure sensors can detect when patients leave their bed during the night, and will trigger an alarm if they do not return within a reasonable time. Monitors can record visits to the bathroom and how long the person might spend there as well as any change in physical activity, such as using the stairs. The technology can alert patients to their own levels of physical activity; and it could set goals, prompting patients to undertake more activity to maintain muscle, bone, and mental fitness.
• Sensors on kitchen cupboards, refrigerators and other electric appliances can indicate when the patient is eating and drinking and pass this information to carers. Systems can record patterns of typical behavior over time, note changes, and alert carers when appropriate. Monitoring devices can be more accurate guides to health risks than are patients' own awareness of their symptoms. Devices can monitor important indicators for disease management.
• Broadband, however, will be required for always-on continuous monitoring, especially for image capture and transmission. RFID, Bluetooth, and Wi-Fi technology will allow connectivity of devices around the home and in the community without cabling. Passive RFID tags can absorb enough power from the sensing device to perform simple functions. Devices that are powered electrically can use Ethernet Over Power.
• There are some studies on the effect of information technology applied to health care in Korea. A result of a study conducted in Korea revealed that hospitals that implemented more information technology-related strategies (for example, computerized physician order entry, picture archiving and communication systems [PACS], Enterprise Resource Planning [ERP], billing and medical data transportation by Electronic Data Interchange [EDI] and other similar systems) showed a higher financial performance than those that did not.⁸ Another study examined the effects of a Web-based health information service system for the elderly and revealed that users rated it very useful, relevant, convenient, and efficient for preventing disease and promoting health.⁹ A study revealed that most users were comfortable and satisfied with the telemedicine in primary care.¹⁰
• A smart home is usually embedded with the following technologies: sensor networks, home networks, activity tracking, ambient displays, context-aware memory aids, and location tracking and alert systems.
• Ambient displays include lights or other indicators that provide background information. For example in aged care, the Intel project has a lamp that goes on to show the elderly person when her daughter's family are in their own home; the elderly person then she knows they are there and can call them by telephone if necessary.
• Context-aware memory aids are applications that watch a user's context and proactively suggest information that may be of use, such as prompts or other reminders specific to the person's activity. For example, if someone switches on the coffee machine, a screen might display the steps involved in making a cup of coffee—it is common things like this that people with dementia forget how to do—or reminders to take medication. Sensors that become aware of what a person is doing can reminds the person of where they were up to and what the next step is.
• Important reasons for this are insufficient capital, little knowledge about how to involve the user, lacking ambition to work in a multidisciplinary way, and unprofitable market conditions.
• Thus the challenges we are facing in aging and aged care is the development of user-oriented products, education and training of users for new products and services, internal business organization so that the provider of the product draws on the resources of a multidisciplinary team, and the profitability of market, not the technology.

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• Some apartments are equipped with a monitoring system, known as QuietCare, comprised of lipstick-sized sensors strategically placed around an individual's home to detect potential health problems. "The client decides where they want those placed," Bakkenist says. "[It] could be a refrigerator, could be a bathroom, could be the kitchen."
• The sensors detect heat and motion. Once a baseline of normal behavior is established, any deviations are analyzed and sent remotely to designated computer screens. "And again," Bakkenist says, "the client decides who gets access to the readout of the information."
• "I like knowing that there is that added level of safety with QuietCare, but that it doesn't jeopardize my privacy,"
• Dakim [m]Power presents challenging but entertaining exercises using film clips, pictures, music and narration. Progress is tracked so caregivers can assess the user's cognitive abilities. Simpler exercises are geared toward those with dementia.
  
  Dakim [m]Power is already being used in some assisted living facilities, where it reduces the need for one-on-one cognitive therapy. A home version of the program will be released soon. After all, one of the objectives of using new technologies in eldercare is to allow individuals to stay in their own homes as they age.
• Gaytha explains that a computer screen in the senior's home "shows them messages from their loved ones, pictures, calendar appointments, headline news, nostalgia and triva - all of the socialization aspects."
• "that are unobtrusive, but caregivers can go on line and see the recorded activity from those sensors. [They can] make sure that the grandmother is moving around normally, that the temperature of the house is right; she's not leaving the house in the middle of the night."
• Many of the programs and products demonstrated on Capitol Hill, including [m]Power and the GrandCare system, were developed to meet a personal need, to assist an aging parent.
• "We need to reduce barriers to getting these technologies to market," she says, "to get them into the hands of consumers and to figure out ways to fund them so they are affordable to a broad range of people."

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• A senior parent wants to live in his own home, maintaining his independence, but he has trouble bathing, fixing meals and remembering to take his medications
• And with health-care costs rising by the moment, hospitals are discharging patients earlier than ever, sending them home too ill or too weak to fend for themselves.

• By automatically detecting speech patterns of the elderly, the technology automatically boosts incoming and outgoing audio while simplifying menu structure and increasing font size. 
  

• Enurgi has taken its cue from social networks by creating a service network that connects caregivers with patients and facilitates their business transactions online.
• The site is premised on the notion that it is currently too difficult for the elderly and disabled to find professionals to care for them (or clinicians to find clients who can benefit from their particular skills).
• Professional caregivers can join the site by claiming their identity (with scanned proof of license) from a database of about 1.5 million caregivers, which Enurgi has built up from public records maintained by states across the US.
• Soon, caregivers will also be able to run background checks on themselves using LexisNexis and post the results of those checks on their profiles
• Once ready, these caregivers can then find people in need of their services by searching Enurgi’s pool of registered care recipients.
• Enurgi will then keep track of these relationships, help schedule sessions with its calendaring system, and manage all of the payments that clients send to their caregivers through the website
• Clients can also post reviews of their caregivers that can be viewed by other potential clients. Among Enurgi’s features is a tool that helps care recipients calculate how much money they will have to spend on services given their insurance coverage. Another tool helps caregivers deal with the paperwork of working under contract.

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• Revenues for elder care services in the US are expected to increase 6.6 percent per year to $26.4 billion in 2011.
• Growth will also stem from the rising cost of providing care on a per capita basis.
• Further revenue gains will be restrained by limitations on government reimbursements that have not generally kept pace with the rising cost of providing care, a particular concern because a large number of older adults rely on Medicare and Medicaid to pay for elder care services.
• However, the fastest growth is expected in the home health care segment where gains will be driven by the growing number of older adults who choose to have nursing care brought to them, as well as the increasing use of home- and community-based Medicaid waivers to pay for care away from more expensive institutional settings.
• private insurance is expected to post the strongest gains among payment sources as a greater number of older adults utilize long-term care insurance
• The Medicare program is expected to post the second strongest gains as the eligible population increases. However, gains in Medicare and Medicaid reimbursements are subject to changes in reimbursement rates and payment structures. Out-of-pocket payments continue to be important, particularly in continuing care, assisted living and privately-funded social services.

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• Over 3.4 million seniors to be   using these devices by 2012
• A new projection says   that by 2012 more than 3.4 million senior citizens in the U.S. will be   using networked sensor applications to monitor and improve their health.
• One company active in this area, Living   Independently Group, says that in this last quarter of 2007, it will   install approximately 1,500 new QuietCare systems in U.S. senior   communities. QuietCare senors learn the pattern of activity in a home or   room and alerts monitors if there is a change in these patterns. (See   more below).
• the total U.S. digital home health market   will grow at an average annual rate of 36 percent and turn into a $2.1   billion industry by 2010.
• by Parks Associates highlights   major technology trends for sensors including ECG electrodes, blood   glucose sensors, SpO2 sensors, respiratory rate sensors, activity   sensors, and emerging Body Sensor Network (BSN) applications.
• "The industry will grow even faster if consumers,   government Medicare and Medicaid programs, long-term care insurance   underwriters, and retiree health benefit insurers all chip in to finance   these new technologies."

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• It has been stated that “Smart home technology will be helpful only if it is tailored to meet the individual needs of each patient” (Cheek 2005). This currently creates a problem because many of the interfaces designed for home automation “are not designed to take functional limitations, associated with age, into consideration” (Cheek 2005). Another problem that has been presented involves making the system user-friendly for the elderly who often have difficult operating electronic devices. The cost of the systems has also present a challenge, because although the systems would be cheaper than the costs of a long-term health care facility, the U.S. government currently provides no assistance to seniors who choose to install these systems (in some countries as Spain the Dependency Law includes this assistance).

• The U.S.'s senior and baby boomer populations are not currently receptive to in-home health monitoring, according to Parks Associates' Delivering Quality Healthcare to the Digital Home, which reports that two-thirds from both populations see little to no value in these services.
• Of the one-fifth who find the service valuable, 60% would still not spend extra money, either out-of-pocket or in higher healthcare premiums, for in-home health monitoring. Only 20% would accept a moderate increase in health insurance premiums, and another 16-20% would be willing to pay out-of-pocket for it.
• "Low interest in this service among the grey-power generation and the baby boomers stems from multiple reasons, including the fact that the service is a novelty to many senior citizens, who are typically slow to adopt new technologies in the first place," said Harry Wang, research analyst at Parks Associates. "The seemingly complex applications inhibit adoption."
• Over time, the industry will receive another boost once the cost-saving benefits of home care monitoring services are clearly documented and recognized by insurers.
• "The industry, which is composed of many small, private companies, is suffering from a lack of consumer understanding and poor reimbursement mechanisms in the private and public sectors,"
• "This situation will be improved once influential constituents, such as the U.S. government, large employer groups and health plans, and IT giants, make a concerted effort to remove those speed bumps."

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• Instead of presenting basic risk-stratified "exceptions"   or "alerts" for nurse management based on experience,   Cardiocom nurses follow a structured, stepwise process of rules-based   clinical triage.
• The OMNIVISOR™ patient management system enables clinical   staff to manage patients "by exception".

• AGIS makes money from advertising, partnerships, and sponsorships.

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  AGIS Network facilitates the exchange of eldercare information, solutions, and services to help individuals, employers, agencies, and service providers meet eldercare challenges. Since 1998, AGIS Network (formerly AssistGuide) has been providing technology-driven resources for the aging and disability communities.

• The advertisers on Eons include Humana health care insurance, Fidelity Investments and the pharmacy chain CVS. Lee Goss, president and chief operating officer of Eons Inc., which received backing from the venture capital firms Sequoia Capital and General Catalyst, said that the sites aimed at an older audience may not grow as quickly as MySpace, but could have longevity.

• Virtual operators are projected to have approximately 150 million subscribers by 2012, which would translate into nearly $30 billion in services revenue, according to Pyramid Research, which notes in a recent report that the global MVNO subscriber base grew by 24 percent last year to 84 million users.
• Growth also is forecast in a 2006 report from Ovum, which predicts MVNO customer share of all wireless customers is expected to increase to 9.9 percent by 2009, with revenues expected to reach $8.8 billion by then.

• Today, baby boomers make up the Web's largest constituency, accounting for fully one-third of the 195.3 million Web users in the U.S., according to JupiterResearch. They also spend more money on online shopping than your average Web user. Advertisers understand that, and targeted boomers with close to $5 billion in ads last year, according to Jupiter, out of a total $13 billion spent in Web advertising. 
  
• Eons.com is part of that, and so is the all-powerful AARP, which plans to add MySpace.com-like features to its Web site in the first quarter of 2007, says Hugh Delehanty, editor-in-chief of AARP publications. The site will let people create their own home pages and form interest groups, focused on hobbies like gardening or taking care of elderly parents.
• So what does this generation really care about? According to Jupiter, they're most interested in investing, finance, and health. Self-help and advice columns are also popular on the new boomer-centric Web sites, which tend to take an upbeat view of the whole aging process.
• Customers pay between $24.95 and $84.95 a year for the service, depending on how much storage they require. A note on the WebBiographies site points out that "charges end when you pass away"—but the site promises to preserve your biographies for posterity.
• There are some encouraging signs: AARP says its Web site saw its ad revenues rise 23% last year.

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• The first of the baby boomers turns 60 this year. And that means some 78 million people, born between 1946 and 1964 present a $480 billion industry for entrepreneurs to profit from by developing new products and services targeted to them.
• Eighteen percent of people 55 and over are online, Rashtchy said, as are 20 percent of 45-to-54-year-olds. Boomers are the largest group at 38 percent.

• June 19, 2007) - Posit Science Corporation, the brain health and fitness company, announced that it has turned a profit and plans to share the wealth through a new foundation.
• Posit Science became profitable in January, just 18 months after introducing its first program, and has remained profitable since then.

• And based on this knowledge, Americans have begun to generate another industry: the brain fitness industry. It is already worth $225 million in the US and growing fast.
• The brain fitness industry is already worth $225 million in the US and growing very fast
   
    The first brain fitness company was Scientific Learning, set up in 1999. Now there are around 20 such companies in the world
  
• Worldwide, the major event for this industry was the launch of Nintendo’s video game Brain Age in May 2005. Over 24 million people have bought this game. According to the San Francisco-based market research company SharpBrains, there exist around 20 brain fitness companies around the world. SharpBrains itself is a product of this new phenomenon. It puts the US market at $225 million in 2007, up from only $100 million in 2005. The world market is around $700 million, most of it from Brain Age.
• SharpBrains divides the brain fitness industry into four categories. The first is the education segment, and consists of products for children with special needs. The second is cons- umer and gaming. It did not exist in 2005, but was worth $80 million in the US in 2007. This segment consists of Nintendo and companies such as Cogmed, Posit Science and Lumos Labs, all of which have managed to raise venture capital. The third segment, healthcare, develops products to treat patients with brain diseases such as Alzheimer’s and Mild Cognitive Impairment (MCI). This segment is worth $65 million. One company in this field, California-based Dakim, raised $10.6 million in February this year. The fourth segment is corporate wellness, military and sports. It is worth $20 million.

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• Going forward, Eons will focus on the community-building and social-networking aspects of the site, found mainly in its people section, which among other things hosts a collection of blogs and user groups dedicated to topics like games, romance, health, and investing. While Eons as a whole has been struggling, “The community is thriving,” our source says.