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Emma 3: Our thoughts about Emma


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Emma 3: Our thoughts about Emma

  1. 1. Meeting Emma’s needs Some of our own thoughts
  2. 2. Emma’s family have attempted to increase her safety in two ways: •  They have placed her bed by the connecting wall to the main building, so that she can summon help if needed by knocking on the wall. •  They have obtained a pendant alarm system through Social Services, in case they are not within earshot. In the UK, Age Concern provide the most popular non-statutory service of this form; Aid-Call. Current methods
  3. 3. The Aid-Call pendant alarm system
  4. 4. Problems with the current strategies While banging on the wall is the simplest way to summon help, it depends on Emma being near to a wall, and on the family being in the building. Like many other people, Emma tends to take her alarm off regularly, and then forgets to put it on. Although the pendant alarm is shower-proof, Emma took it off when getting into the bath – and was then unable to reach it when she fell.
  5. 5. Building on the current strategies Helping Emma summon help from her family
  6. 6. Pull-cord alarm systems A pull-cord alarm overcomes problem of taking pendant off. Two main types: • Self-contained unit – siren and flashing LED to alert those nearby. • Radio unit – sends signal to a remotely based alarm, and/or to a call centre. • Often provided as an optional extra with pendant alarms. Click here for further details
  7. 7. Improving monitoring from the main house Rather than relying on Emma being able to knock on the wall, her family could install one or more intercom units within the home. Although they only need one unit themselves, a unit would need to be installed in each room in Emma’s flat to be fully effective. Click here for further details
  8. 8. Telecare-enabled bath-lift This would overcome the problems of Emma taking off her pendant when using the bath. However, it may encourage her to use the bath without assistance. Would replacement of the bath with a level-access shower be better? Click here for further details
  9. 9. Reducing the risk of falls
  10. 10. Mobility equipment Our first thought with regard to Emma’s increasingly unsteady gait was that she would benefit from an assessment for mobility equipment (e.g. a walking frame). However, there are also disadvantages with this option (click here for some common examples). Many people overcome this in part by fixing rails to the walls – but furniture may make this impractical. Would it be possible to combine electronic reminder technology (as discussed with Brian in Unit 2) with mobility equipment?
  11. 11. Fall management Tunstall Healthcare recommend three main elements to an effective care package for falls management: • A bed occupancy sensor • Sometimes coupled with a chair occupancy sensor • A fall detector • A Passive Infra-Red (PIR) movement detector
  12. 12. Occupancy sensors Switches on lights and/or alerts others when a person has left their bed/chair. A delay can be set to the alert (e.g. to allow Emma to get up at night to go to the bathroom without waking her family; but notifying them if she does not return after a certain time). A recorded message can be used to remind the user about basic safety (e.g. to use walking frame).
  13. 13. Fall detectors Worn on a belt or waist-pouch. Sensitive to both impact and angle. Will give a soft buzzing first, to give the user the opportunity to re-set the unit before sending an alarm. • Will Emma remember to wear it? • Will Emma remember what the warning buzzer means?
  14. 14. Room sensors PIR movement detectors can be set to alert others if no movement is detected within a room over a defined period of time. This may not be suitable if Emma is only using one room. Household sensors could be used to help keep her safe, e.g; •  Flood detectors could be used in case Emma leaves a tap running •  Gas detector should she leave a gas appliance on.
  15. 15. Developing on the idea of occupancy sensors
  16. 16. Developing on the idea of occupancy sensors The SenseBulb • Working prototypes by Girton Labs. • Bulb fits into standard LED light sockets. • Uses technology from heat-seeking missiles (now low-cost!) to detect heat, movement, and much more (see here). • Can send a wide variety of alert messages to a mobile phone. • Planned cost £20 per bulb.
  17. 17. Monitoring Emma’s behaviour
  18. 18. Activity patterns Emma’s family suspect that she is becoming active at night, rather than in the daytime; and are worried, too, that she may not be eating properly. Emma, however, consistently says that their concerns are unfounded. It would be helpful to develop an ongoing record of her activity patterns.
  19. 19. Just Checking Site:
  20. 20. The Just Checking system • Small, wireless sensors in the key rooms of the house are triggered as a person moves around their home. • Data from the sensors are gathered by the controller, a small box, and sent via an integral mobile phone to the Just Checking web- server. • Family members and professionals can log on to the password protected Just Checking website, to view the chart of the activity. • They can see when a person: • got up and went to bed, and whether he/she had a disturbed night; • visited the kitchen to prepare meals or drinks; • left the dwelling and for how long; • how they are responding to care that has been put in place.
  21. 21. Monitoring in residential care If Emma eventually moves out of her current home into residential care, it would still be invaluable to monitor Emma, to determine what level of support she would need. Amongst other systems fulfilling this need, the MyAmego system strives to give residents a degree of independence, and enhance quality of life. MyAmego provides information and reporting on: • Mobility and well-being including historical comparisons; • At risk areas or “Safe Zone” alerting; • Generic risk analysis; risk parameters and alarm settings individually set by service user; • Reporting on system activity, mobility and risk analysis including historical reporting and comparison.
  22. 22. Leaving the home
  23. 23. Wandering or walking? On at least one occasion recently, Emma has left her home. A neighbour found her outside, saying that she was going shopping. Her family see this as evidence that she is becoming more confused – but would they worry if somebody else said they were going shopping? How do we minimise risk, whilst at the same time encouraging exercise and independence?
  24. 24. Preventing Emma from leaving home alone The family’s first thought was to lock all doors except those leading into the main house. This ensures that they are always aware if Emma wants to go out. However, is arguably unethical; and may be a fire hazard. A similar strategy is to install handles designed to confound Emma’s attempts to open the front door. “Invisible” cupboard handles are similarly used in some settings.
  25. 25. Hazard warnings A visual reminder may act to deter Emma from leaving the flat without telling anyone. The Voice Alert Door Banner (right) will trigger an audible alarm or a pre-recorded message asking Emma to return.
  26. 26. Using sensors on doors Can be used to alert carers or a call centre that a person has left the building, e.g. SeN-Cit. Other sensors can be time oriented and will play a message to remind the person not to open the door, perhaps at nighttime.
  27. 27. Tracking? View video on YouTube
  28. 28. Helping Emma wander? Researchers are currently investigating the possibility of using technology already available to support people with dementia who want to be able to leave their homes alone. For example • GPS technology could be used as a back up in case of getting lost (e.g. GPS watch; GPS mobile phone; GPS shoes). • A “talking walking frame/stick” could be used to remind a person where they are going? (Perhaps building on existing assistive mobility devices such as this one).
  29. 29. Current developments in improving safety at home for people with dementia
  30. 30. Wearing a monitor? Halo Monitoring launched the MyHalo clip in the US but this has since been discontinued. However, this is a good example of new monitors that are used directly next to the skin, e.g. Smart clothing. Some prototypes are able monitor: • Falls • Heart rate and heart rate variability • Skin temperature • Activity levels and calorie expenditure • Sleep/wake patterns
  31. 31. Smart Homes Increasingly, there are moves to integrate the various assistive technologies available for people with dementia into a Smart Home. A Smart Home is “A dwelling incorporating a communications network that connects the key electrical appliances and services, and allows them to be remotely controlled, monitored or accessed.” King, 2003:2 • See this link for a paper on using Smart Homes for monitoring elderly dementia sufferers.
  32. 32. An integrated solution? The Cognow Project  
  33. 33. Ethical Considerations
  34. 34. What is too far … •  Some of the suggestions raise considerable ethical questions around what constitutes as a health and safety measure, to something which is compromising Emma’s free will and independence (see Mental Capacity Act, 2005) •  For example: •  When found by the neighbour, who is to say she wasn’t just going shopping? •  Would the door sensors prevent Emma from leaving the house in an emergency? •  Does the video monitor infringe on Emma’s privacy? Or the GPS tracker? •  Has Emma been bathing by herself because she feels embarrassed to bathe in front of her daughter in law? •  Even if Emma has agreed/disagreed with any of these AT’s does she have the capacity to make an informed decision?
  35. 35. Future Considerations … Unfortunately, Emma’s health deteriorates to the point that she requires end of life palliative care. •  What AT are you aware of that might make Emma more comfortable and retain as much independence as possible? •  How might AT be used to keep family and friends informed of how she is doing? •  Could AT be used in any other way to support Emma and her friends and family in dealing with her deteriorating health?