High-Tech Assistance, Economic Crisis

and Longevity

Roberto BernabeiPresident

Longevity determinants

Adult

socio-economic

status

CAD

Hypertension

Dementia

Diabetes

Depression

Osteoarthritis

Frailty

Adverse outcomes

Disability

Morbidity

Hospitalization

Premature Death

Prevention

Accessibility

medical/social services

Social interaction and

support

Increasing age

Environment

Smoking

Nutrition

Exercise

Other

Growth in utero

Genetic APO-E

Childhood

socio-economic

status

Early Life

Experience

Education

“personal” resources,

personality, etc.

(Adapted from Ben-Shlomo, 2002)

Elderly at home GP

Frail Elderly at

homeGP

Community services,

care giver, other…

SINGLE ENTRY

POINT CGA1

Frail Elderly at

home

Community services,

care giver, other…

SINGLE ENTRY POINT

CGA1

GEU (Geriatrician, GP,

Case Manager, SW,

PT, OT) CGA 2

Community Services

Health/Social Nursing

Home

GP

Frail Elderly at

homeGP

Community services,

care giver, other…

SINGLE ENTRY POINT

CGA1

GEU (Geriatrician, GP,

Case Manager, SW,

PT, OT) CGA 2

Community Services

Health/Social Nursing

Home

ER

Silver Code

CGA 1

Frail Elderly at

homeGP

ER

Silver Code

CGA 1

Community services,

care giver, other…

SINGLE ENTRY POINT

CGA1

GEU (Geriatrician, GP,

Case Manager, SW,

PT, OT) CGA 2

Community Services

Health/Social Nursing

Home

Hospital

Internal Medicine and

Geriatric Department

Internal Medicine Unit

Geriatric Unit

Frail Elderly at

homeGP

ER

Silver Code

CGA 1

Community services,

care giver, other…

SINGLE ENTRY POINT

CGA1

GEU (Geriatrician, GP,

Case Manager, SW,

PT, OT) CGA 2

Community Services

Health/Social Nursing

Home

Hospital

Internal Medicine and

Geriatric Department

Internal Medicine Unit

Geriatric Unit

Frail Elderly at

homeGP

Protected

discharge

ER

Silver Code

CGA 1

Hospital

Internal Medicine and

Geriatric Department

Internal Medicine Unit

Geriatric Unit

Community services,

care giver, other…

SINGLE ENTRY POINT

CGA1

GEU (Geriatrician, GP,

Case Manager, SW,

PT, OT) CGA 2

Community Services

Health/Social Nursing

Home

Hospice

Rehabilitation

Post-acute care

Home Care

Frail Elderly at

homeGP

Protected

discharge

ER

Silver Code

CGA 1

Community services,

care giver, other…

SINGLE ENTRY POINT

CGA1

GEU (Geriatrician, GP,

Case Manager, SW,

PT, OT) CGA 2

Hospital

Internal Medicine and

Geriatric Department

Internal Medicine Unit

Geriatric Unit Community Services

Health/Social Nursing

Home

Hospice

Rehabilitation

Post-acute care

Home Care

Telemedicine

Impact of telemonitoring at home on the management of elderly patients with congestive heart failure. Journal of Telemedicine and Telecare 2008; 14: 300–305.

Antonicelli R., et all

The effects of home telemonitoring in elderly patients with congestive

heart failure (CHF) on mortality and rate of hospitalization, compliance

with treatment, quality of life and costs of CHF management, by

comparison with a group receiving usual care

Home telemonitoring was associated with improvements in the

composite endpoint of mortality and rate of hospitalizations (P=0.006)

and a better compliance with therapy

11

Hub-Spoke Model

Hospital

Hospital LTC / Nursing home

Health and

Social Services

Local Health Unit

Central system

The set of methodological tools, technologies and artifacts that

support independent living of elderly people

Techno-Care

12

TE

CH

NO

CA

RE

External Environment Control

Humidity Control

Air Conditioning Heating System Lighting Control/ Switches

Door/Windows Opening

Elevators

Access control systems

Tools for disabled people

Multimedia Devices

Internet/e-mailing

INTEGRATION PLATFORM

Mobile Phone

Controlled Accesses

Call Center

Video Surveillance

Alarm Systems(Gas, Fire, Water,

Smoke, CO2 detectors)

Water

Electric power

Gas

Fall detection

Assistive Robotics

Tools/Devices for personal use and household

Remote health monitoring/ Telecare/Telemedicine

Mobile Phone

Computers

COMFORT/WELLNESS

HOMEAUTOMATION

HOUSEHOLD APPLIANCE NETWORK

COMMUNICATION/ENTERTAINMENT

REMOTECONTROL

SECURITY/SAFETY

MANAGEMENTOF ENERGY

SYSTEMS

AMBIENT ASSISTED

LIVING

TELEHEALTH

Memory support systems

Monitoring vital parameters

Computers

HR

SpO2

BP (systolic, diastolic)

HGB

Hct

CO/SV/SVV/CI (Cardiac Output ,

Stroke Volume, Stroke Volume Variation, CardiacIndex)

PCO2, PO2

PH

RBC

BV

MAP

A technocare model

o GP / Specialist

o Hospital Specialist

Settles a workgroup to define actors to be involved in the service on the basis of shared

criteria1

Public Institution

Clinician

Patient

o LHU

o Hospital

o Region

2

o Chronic complex patient

Call Center

• “Go live” at first patient/clinician

enrollment. Main activities:

o Training on service /system/devices utilization.

o Patient empowerment and

coaching/educational programs.

o Management of technical issues

o Triage within Service Protocol procedures

Selects eligible patients according

to the Service Protocol

3

Come si attiva il servizio e chi sono i principali

attori

o Medico Curante (es. MMG,

Specialisti)

o Specialista Ospedaliero

Istituisce un gruppo di lavoro per definire, sulla base di parametri condivisi, i diversi attori da

coinvolgere nel servizio.

1

Ente Pubblico/Accreditato

Clinici

Paziente

o ASL

o Azienda Ospedaliera

o Regione

2

o Paziente cronico complesso

Call Center

• A disposizione sin dal primo

medico/paziente arruolato svolge le seuenti

attività:

o formazione sull’utilizzo del sistema.

o supporto educazionale nella gestione dei

pazienti.

o gestione problematiche tecniche

o gestione sistema di Triage secondo il

protocollo di servizio.

Selezionano i pazienti elegibili per il

servizio sulla base di un protocollo

di servizio

3

USER TYPOLOGIES SPECIFIC RELATED NEEDS

All elderly people Increase level of safetyControl of the home environment to detect dangerous condition

Monitoring of daily activities to detect abnormal situations

Communication with families and caregivers

Receiving information on personal status and environment (monitoring)

Control of environmental condition and electronics after their use

Help in IADL (Instrumental Activities of Daily Living) (buying, etc)

Cognitive impaired older people MemoryRemind to take medicine

Remind scheduled appointment

Remind how/when use some tools

Remind when a food is out of date

Remind nutritional condition and diet

Remind telephone numbers

OrientationSee an obstacle in the path

Attention and concentration

Reasoning

Learning alternative strategies, cognitive training

Communication/Emotional/Psychological abilitiesGeneral ability of sending warnings/suggestions

Receiving information on personal status and environment (monitoring)

Control of environmental condition and electronics after their use

Communication with families and caregivers

Ageing – User Needs

USER TYPOLOGIES SPECIFIC RELATED NEEDS

Physical impaired older people MobilityBring heavy objects

Assistance while walking

Prevention of falls

Help if he/she falls in the home

Driving

Mobility in urban and rural areas

Help in dangerous situation

Vision

Hearing

Chronic diseaseManagement of treatments, information on health condition, monitoring

RehabilitationCognitive and physical training at home

Communication/Emotional/Psychological abilitiesGeneral ability of sending warnings/suggestions

Receiving information on personal status and environment (monitoring)

Control of environmental condition and electronics after their use

Communication with families and caregivers

Horizontal: Level of autonomy Low assistance

Medium assistance

High assistance

Almost independent (Living alone people)

Horizontal: Attitude towards

technology

End-user characteristics (age, education…)

Interest and familiarity with technology

Attitude and predisposition

Learning and coping strategies

Ageing – User Needs

TE

CH

NO

CA

RE

External Environment Control

Humidity Control

Air Conditioning Heating System Lighting Control/ Switches

Door/Windows Opening

Elevators

Access control systems

Tools for disabled people

Multimedia Devices

Internet/e-mailing

INTEGRATION PLATFORM

Mobile Phone

Controlled Accesses

Call Center

Video Surveillance

Alarm Systems(Gas, Fire, Water,

Smoke, CO2 detectors)

Water

Electric power

Gas

Fall detection

Assistive Robotics

Tools/Devices for personal use and household

Remote health monitoring/ Telecare/Telemedicine

Mobile Phone

Computers

COMFORT/WELLNESS

HOMEAUTOMATION

HOUSEHOLD APPLIANCE NETWORK

COMMUNICATION/ENTERTAINMENT

REMOTECONTROL

SECURITY/SAFETY

MANAGEMENTOF ENERGY

SYSTEMS

AMBIENT ASSISTED

LIVING

TELEHEALTH

Memory support systems

Monitoring vital parameters

Computers

Come si attiva il servizio e chi sono i principali

attori

o Medico Curante (es. MMG,

Specialisti)

o Specialista Ospedaliero

Istituisce un gruppo di lavoro per definire, sulla base di parametri condivisi, i diversi attori da

coinvolgere nel servizio.

1

Ente Pubblico/Accreditato

Clinici

Paziente

o ASL

o Azienda Ospedaliera

o Regione

2

o Paziente cronico complesso

Call Center

• A disposizione sin dal primo

medico/paziente arruolato svolge le seuenti

attività:

o formazione sull’utilizzo del sistema.

o supporto educazionale nella gestione dei

pazienti.

o gestione problematiche tecniche

o gestione sistema di Triage secondo il

protocollo di servizio.

Selezionano i pazienti elegibili per il

servizio sulla base di un protocollo

di servizio

3

TE

CH

NO

CA

RE

External Environment Control

Humidity Control

Air Conditioning Heating System Lighting Control/ Switches

Door/Windows Opening

Elevators

Access control systems

Tools for disabled people

Multimedia Devices

Internet/e-mailing

INTEGRATION PLATFORM

Mobile Phone

Controlled Accesses

Call Center

Video Surveillance

Alarm Systems(Gas, Fire, Water,

Smoke, CO2 detectors)

Water

Electric power

Gas

Fall detection

Assistive Robotics

Tools/Devices for personal use and household

Remote health monitoring/ Telecare/Telemedicine

Mobile Phone

Computers

COMFORT/WELLNESS

HOMEAUTOMATION

HOUSEHOLD APPLIANCE NETWORK

COMMUNICATION/ENTERTAINMENT

REMOTECONTROL

SECURITY/SAFETY

MANAGEMENTOF ENERGY

SYSTEMS

AMBIENT ASSISTED

LIVING

TELEHEALTH

Memory support systems

Monitoring vital parameters

Computers

The set of methodological tools, technologies and artifacts that

support independent living of elderly people

Techno-Care

22

Telemedicine

Impact of telemonitoring at home on the management of elderly patients with congestive heart failure. Journal of Telemedicine and Telecare 2008; 14: 300–305.

Antonicelli R., et all

The effects of home telemonitoring in elderly patients with congestive

heart failure (CHF) on mortality and rate of hospitalization, compliance

with treatment, quality of life and costs of CHF management, by

comparison with a group receiving usual care

Home telemonitoring was associated with improvements in the

composite endpoint of mortality and rate of hospitalizations (P=0.006)

and a better compliance with therapy

23

Hub-Spoke Model

Hospital

Hospital LTC / Nursing home

Health and

Social Services

Local Health Unit

Central system

• Sardinia (Italy)• Okinawa (Japan)• Crete (Greece)• Cuba • Loma Linda (Ca – USA)

California

Eating legumes

Adequate resting

Religious participation

Japan

Supportive social network

and friendship

Healthy diet

Keeping objectives and

scopes

Italy

Drinking red wine

Sharing with spouse

Eating “pecorino” cheese

ALL

No smoking

Family first

Active daily living

Social inclusion

Eating fruits, vegetables and

cereals

Genetics explains 25% of longevity