Domotics and Cure

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Domotics and Cure Care

• Dr. Ir. Jan A. Van Alsté
• University of Twente
• Biomedical Engineering

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Cure and care

• Cure
• Prevention
• Diagnostics
• Therapy
• Back to normal activities
• Short duration
• High specialised
• High tech

• Care
• Nursing
• Support of vital functions
• Normal activities not always possible
• Often long duration
• Medium specialised
• Low tech

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Relevant trends

• Demographic changes
• More grey demand for cure care
• Less green supply of caretakers
• More colour different life styles
• Slow process time to action
• Reduction of costs
• Horizontal and vertical substitution in medicine

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Care processes

• Distinction between
• Cure and care
• Care and household
• Health and well-being
• Types of care processes
• Short, directed towards recovery
• Chronically ill or functional disorders
• Terminally ill patients

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Demand for care

• Two trends
• Changing epidemiological profile
• People live longer and are longer ill
• Demand for health care is increasing
• Socio-cultural change in needs
• Changing conditions of living
• Information and self-realisation
• Wish to function independently

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Supply of care

• Organisational changes
• Shorter stay in hospital
• More medical interventions at home
• Business Process Redesign continuity of care
• Problems of personnel
• Shortage technology, self management,
  productivity, disability
• New players and roles
• Specific companies, call centres
• Mergers and collaboration
• Improved coherence contents, efficiency

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Focus on end-user (patient)

• Continuity in care processes
• More possibilities to choose
• Less restricted to certain localities
• Home care technology quality of live
• Assistive devices self care, independence
• ICT choice based on information

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Maslows hierarchy of needs

• Physiological food, air, water, sex
• Safety and security
• Belonging to, love, acceptation, affection
• Esteem, competence, approval, recognition
• Esthetical and cognitive needs
• Self realisation

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Universal self care activities(after D.E. Orem)

• Intake of air, water and food
• Excretion
• Balance between activity and rest
• Prevention of threats against human happiness,
  functioning and well-being
• Live in social communities according human
  possibilities, limitations and dignity

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Health related self care activities(after D.E.
Orem)

• Adequate medical care
• Knowledge and insight in health and illness
• Execution of diagnostic, therapeutic or
  rehabilitation activities
• Anticipate troublesome or harmful effect of
  medical interventions
• Changing ones self image
• Learn to live with the consequences of illness

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Trends in society

• Individuality
• Demand in control
• Various target groupsdifferent wants
• People over 50 are more in control
• More market, less government
• Room for innovation and renewal
• Decentralised living, care and healthcare

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Challenges for Domotics

• Independent living
• Activities of Daily Life
• Social contacts
• Entertainment
• Medical treatment

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Challenges for the near future

• New homes
• One level
• Living well-cared
• Adaptation of existing homes
• Points of support of care functions
• Domotics and personal alarm
• Living environment more care oriented

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Consequences of domotics for the organisation of
healthcare

• Security / safety
• Support functions at home
• Quality improvement
• Efficacy
• Efficiency
• Costs government institutions housing
  associations, caretakers
• Personnel

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Possible services and applications

• Level of lighting adapted to biorhythm
• Climate control
• Individual control of freedom to walk around
• Monitoring / Surveillance of activities during
  the night
• Asking for help (by calling)
• Automatic detection of water overflow
• Automatic control of cooking equipment
• Support in independent communication

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Palliative care adds life to days when days
cannot be added to life (Saunders, 1995)

• Symptom and pain relief
• Monitoring
• Support of self support
• Continuity of care
• ADL support
• Communication, social, healthcare
• Workload reduction care providers

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Telemedicine moving data, instead of patient or
healthcare provider

• Tele cure
• Tele consultation
• dermatology
• Tele diagnostics
• monitoring
• Tele communication
• Electronic patient record
• Tele therapy
• psychiatry
• Tele surgery
• robotics

• Tele care
• Tele monitoring
• Tele supervision
• Tele coaching
• Tele communication
• Electronic care record

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Tele plus minus

• Plus (stimuli)
• Longer at home
• Self management
• Master of ones life
• Double
• Increasing singles
• Increasing chronic ill
• Quality of care
• Decreasing costs of care

• Minus (obstructions)
• Contents
• Infrastructure / organisation
• Changes in job care provider and the care chain
• Finances (no stimuli)

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Design for all

• Usable for all groups of users
• Flexible in use
• Simple, intuitive use
• Readable information
• Fault tolerant
• Low physical load
• Accessible

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Feasible technology, not always available(Centre
for Universal design, 1994)

• Electronic lock (strength, coordination,
  authorisation)
• Intercom front door (voice activated)
• GPS for way-finding
• Icy walkway / ramp warning
• Motorized trash removal system
• Motorized window openers
• Adjustable height toilet seat
• Robotic washer / dryer assistance

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Feasible technology

• Indicator to show hot cook top
• Automatic shutoff when pot is removed
• Kitchen shelves, accessible heights
• Potable robot for heavy lifting
• Motorized extending refrigerator shelves
• Remote cook top controls
• Attractive, self-storing transfer device
• Keypad controlled lockout for dangerous areas /
  appliances

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Feasible technology

• Mechanized crib to assist lifting infant
• Raised infant tub at wheelchair height
• Multi-sensory displays and controls for
  appliances
• Central house status display on TV
• Electrical power back-up system
• Voice recognition computer
• Remote health monitoring
• Expanded on line information services

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Home requirements

• Wide rooms, including toilets
• Many power outlets, power rails
• Facilities for care provider
• Workspace, workload (limitations)
• Privacy (day, overnight)
• Easy room separation (privacy)
• Functions to bed instead of person to functions
• Mobile care facilities, limited medical look
• Communication, leisure facilities

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Contradictions when designing equipment

• Invisible versus easy to use
• Foolproof versus adjustable
• Multi-functional versus manageability
• Continuity versus adjustment-preferences
• Self support versus loneliness
• Privacy versus social safety

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Older adults attitude(Demiris et all, 2004)

• Emergency help
• Preventing or detecting falls
• Assisting with visual or hearing impairments
• Improving mobility
• Reducing isolation
• Managing medications
• Monitoring physiological parameters

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Attitude conclusions(Demiris et all, 2004)

• Benefits
• Emergency help
• Prevention and detection of falls
• Monitoring physiological parameters etc.
• Concerns
• User-friendliness of devices
• Lack of human response
• Need for training tailored to older users
• Conclusion
• Overall positive attitude towards devices and
  sensors installed

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Health smart home(Rialle et all, 2002, review)

• HSH systems provide health care services
• Large diversity in needs in home-based patient
  population
• Complex technology needed
• Distributed approach, many hard and software
  techniques
• Wide scope of new information, communication and
  data-acquisition technologies

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Desired properties of technology

• User / patient
• Minimal load / burden
• Simple in use
• Good ergonomics and aesthetics
• Mobility
• Care provider
• Communication with client
• Work processes
• Content and status of profession
• Added value for the organisation

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Communicationcomputer with internet connection

• Care receivers
• Information
• About hospice, illness,
• From doctor, nurse
• Calls / alarms
• Contacts family, friends
• Fellow patients
• Shopping
• Social
• Diary
• Play station

• Care providers
• Work planning
• Patient-record
• Continuity of care
• Consultation
• Communication with colleagues
• Adjusting equipment

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Domotics, ICT and Care

• Less costs of facility management
• Less hours of care supply
• Simpler user processes
• Less costs of communication
• Better functionality and reduction of costs