Two years ago, this house, which Phil and June have called home for 30 years, became the first in the country to get a technological makeover to see if it could improve care for the 76-year-old 76 who has dementia
June and Phil Bells inviting period at home – complete with an Aga, plump sofa & # 39; s and countless happy family photos & # 39; s – looks a lot like others in this green part of Surrey.
This unlikely environment, however, is part of a groundbreaking plan that could change the care for dementia in this country.
Two years ago, this house, which Phil and June had kept at home for 30 years, became the first in the country to receive a technological makeover to see if it could improve care for 76-year-old dementia. Motion sensors were mounted on their doors and in their corridors, to check how often June visits the bathroom, for example, whether going to the sitting room or leaving the house.
There are also sensors that detect when a kettle is being cooked or the fridge door is being opened – and even sensors under the June mattress that can pick up how well it has slept. In addition, there are scales that not only weigh in June, but that also send an electrical pulse around her body to assess how well hydrated she is.
After putting her on the scales, Phil, 69, also takes the temperature with a thermometer that is simply moved over her forehead. He also has a blood pressure monitor and a pulse monitor, which he uses once a day.
The data from all of these devices is transmitted wirelessly to a main computer that can detect the least change that could indicate that the June health condition is failing.
For some, this all sounds a bit like & # 39; Big Brother & # 39; – but while the system is keeping a close eye on June, it is not without reason.
Motion sensors were installed on their doors and in their corridors, to check how often June visits the bathroom, for example, whether going to the sitting room or leaving the house
Within weeks of installing the technology, it saw changes in its temperature and bathing habits that suggested that it had developed a urinary tract infection (UTI). This was quickly treated with antibiotics, which meant that she avoided a hospital stay. Without the early warning, the outcome could have been very different.
UTI's are among the top five causes for someone with dementia to be hospitalized because they may not remember to drink as often as they should and personal hygiene may be missing.
& # 39; Despite the inconvenience that UTI & # 39; s cause, people with dementia can have trouble communicating this, so symptoms are often missed until the infection is so advanced that it requires hospital care. This system can help prevent it from happening, ”says Ramin Nilforooshan, a consultant psychiatrist at Surrey and Borders Partnership NHS Foundation Trust, and the clinician who manages the project.
Often when a person with dementia with an infection goes to the hospital, they also become rarefied and their cognition can get a hit that they cannot recover from.
& # 39; If we could avoid these crises, we could keep them at home for longer & # 39 ;, says Professor Nilforooshan.
Some predict that the new sensor system could soon be in thousands if not millions of homes. So how does it work?
The information collected by the devices is electronically bombarded to a large computer at the University of Surrey, which measures the data it receives against algorithms – software based on standard patterns – and can therefore determine whether something is outside the normal range and can indicate an issue.
Professor Nilforooshan explains: & # 39; People have a normal daily behavioral pattern: they can go to a certain room a certain number of times or always have so many cups of tea.
& # 39; Sometimes it can be so subtle that a caregiver cannot notice it, but over time the computer can recognize what is normal and abnormal for that individual. & # 39;
This information is sent to the control room – a small room on the edge of a hospital parking garage – where a team looks at their computer screens. If a deviation is detected in the data coming in from a house, it is marked with a red or orange warning light, depending on the severity of the problem.
Every problem that is identified – a possible UTI or increased blood pressure, for example, has a fixed action for those who check the data to follow, such as calling the caregiver or calling a doctor.
The system can detect changes that may indicate that a problem is brewing, even before the person shows clear symptoms.
Often when a person with dementia with an infection goes to the hospital, they also become rarefied and their cognition can get a hit that they cannot recover from
& # 39; If the computer detects that someone goes to the toilet more than usual, & # 39; For example, if the temperature is restless or the temperature deviates, this information may suggest a urinary tract infection.
& # 39; So the surveillance team would call the caregiver and say, "We think this person has an infection, talk to your doctor," says Professor Nilforooshan.
In addition to UTI & # 39; s, the system can continue to work if a patient becomes irritated and needs to be assessed.
& # 39; If they go up and down from room to room, don't sit on their chair (which can hold a sensor) and their blood pressure is raised, all those things together give an impression of increased excitement & # 39 ;, says professor Nilforooshan.
The security staff works seven days a week from 9 a.m. to 5 p.m. and monitors the information of the approximately 80 homes that currently have the devices.
The aim is to reduce hospital admissions and to try to keep patients with dementia at home longer. This saves the NHS money and improves both their lives and those of their caregivers.
& # 39; We know from conversations with people and the calls we receive every day that people with dementia say they want to stay in their home as long as possible & # 39 ;, says Fiona Carragher, head of policy and researcher at the Alzheimer's charity Society.
And it is not only an emotional attachment – there are also financial problems.
& # 39; We discovered that if we could find a way to postpone the transfer to a care home of people with dementia for six months – for example by improving home care – we could potentially have £ 2 billion a year across the country can save, & # 39; says professor Nilforooshan.
The full results of a randomized, six-month controlled trial of the system, called Technology Integrated Health Management or TIHM, involving 400 people (half with dementia, half of their caregivers) in and around Surrey, will be available later this year be published.
However, the initial results were so encouraging – depression, anxiety and excitement were all reduced in patients – that pilot schedules will also be launched next month at the Birmingham Community Healthcare NHS Foundation Trust and by Middlesex GPs.
For Phil Bell, who, like most in his situation, has no medical expertise – he previously worked in sales – but now he is his wife's full-time caretaker, it has been a solution.
It was five years ago, when she was just 71, in June, a former secretary and a mother of three, diagnosed with dementia with Lewy bodies – a particularly cruel form of the disease that can cause hallucinations and Parkinson's-like movement problems , as well as problems with cognition and memory. The loving grandmother of two has gradually deteriorated since then.
The full results of a randomized, six-month controlled trial of the system – called Technology Integrated Health Management, or TIHM – involving 400 people (half with dementia, half of their caregivers) in and around Surrey, will later this years to be published (file image)
& # 39; All I do is try to make life easier for June, and we want to keep her at home as long as possible & # 39 ;, Phil says.
June now needs help walking, dressing and washing. Her speech is impaired and she is starting to have problems swallowing.
& # 39; I'm standing out here in the Surrey countryside and trying to do this on my own, so I welcome everything that makes it easier & # 39 ;, says Phil.
The only help he has is a daily visit from caregivers to work their way up and to be dressed.
That is why, when he and June heard about the scheme through the Alzheimer's Association, they were willing to participate. Researchers soon fitted 21 devices in and around their homes.
Shortly after the equipment was installed, Phil received a call from the monitoring unit to say they thought June had a UTI.
& # 39; It was great & # 39 ;, says Phil. & # 39; June didn't look any different to me – so when they said, "We think she's got a urinary tract infection," my response was, "How the hell would you know?"
Certainly, when the doctor sent a paramedic, they confirmed with a urine test that June had an infection and within five hours of the first call she had started taking antibiotics.
& # 39; During the trial, we picked up that someone had high blood pressure and had a raised pulse – they had a stroke & # 39 ;, says Professor Nilforooshan.
& # 39; The surveillance team called the caretaker at the house and said: & # 39; You have to go to the hospital. & # 39;
& # 39; So & # 39; an early warning can make a difference. & # 39;
With a cure for dementia that does not yet look good, the idea that technology can improve healthcare is a buzz (file image)
He predicts that the system will soon be in & # 39; thousands of houses & # 39; will be – possibly later this year.
& # 39; We are approached about this all the time & # 39 ;, says Professor Nilforooshan. & # 39; Surrey County Council, for example, thinks it could be in about 200 homes soon and we have more questions from different agencies.
& # 39; But the goal is to get it into millions of homes – and not just for dementia, because the technology can be adapted to help with all kinds of long-term illnesses, such as chronic obstructive pulmonary disease (COPD), Parkinson's and asthma. & # 39;
The system, developed in collaboration between Surrey and Borders Partnership NHS Foundation Trust, the University of Surrey and a technology partner, Howz, has just received a CE mark, a safety indicator for products in Europe.
The system is so refined that it can sift through data even if two or more people live in a house and still worry about disturbing signals.
Anything that contributes to shortening hospital admissions for the 850,000 people with dementia in this country should certainly be welcomed – a 2015 survey of 570 Alzheimer Society caregivers found that only 2 percent believed that hospital staff met the specific needs of people with dementia understood.
Currently, a person with dementia covers one in four hospital beds and 20 percent of these admissions are due to preventable causes, such as dehydration or infections, according to NHS figures.
With a cure for dementia that does not yet look good, the idea that technology can improve healthcare creates something of a buzz.
Imperial College London has just opened a £ 20 million care research and technology center, focused on developing other technological systems to improve home care for people with dementia.
They work on earphones that can analyze the state of affairs, brain activity and sleep.
Professor Nilforooshan, who is part of this team, says they also develop devices to assess the risk of falling.
Phil Bell has discovered that TIHM has brought great peace of mind. & # 39; June does have agreements with specialists, but most of the time I am not included here & # 39 ;, he says. & # 39; We have an excellent general practitioner operation on the road, but I can't get a June there now.
& # 39; That is why TIHM is brilliant for us, because it reassures you. We went through a phase before we did this when I took A & E to June 5 in five months because she didn't eat or drink or get out of bed.
& # 39; But with TIHM we think twice about it. Because I can see that her blood pressure and temperature are okay, I don't panic. & # 39;
The system has of course not been without errors.
& # 39; When we first started, we used black scales and received feedback that people with dementia felt like they were stepping into an open space – so we had to change the color & # 39 ;, says Professor Helen Rostill, Director of innovation, development and therapies at Surrey and Borders.
Phil Bell has discovered that TIHM has brought great peace of mind. & # 39; June does have agreements with specialists, but most of the time I am not included here & # 39 ;, he says (file image)
It is now time to see whether the results of a second half-yearly trial, involving 120 people and ready by the end of July, show that it is cost-effective.
The technology – including a mobile phone on which all data is downloaded so that the caregiver can provide the GP with information for a week – costs around £ 750 for a whole house.
& # 39; And the more people use it, the cheaper it gets & # 39 ;, says Professor Nilforooshan.
But the scheme will not appeal to everyone. & # 39; There will be a number of people who can stand the idea of having technology at home & # 39 ;, says Fiona Carragher.
& # 39; Even though technology offers real opportunities, it is not a substitute for care, and not all people will be able to stay at home with them, even with the technology. & # 39;
What do those who are unrelated to its schedule make?
& # 39; It is a good idea that this is rolled out, but someone has to indicate that money can be allocated somewhere & # 39 ;, says Andrews, emeritus professor of dementia studies at Stirling University.
Professor Helen Stokes-Lampard, president of the Royal College of GPs, describes it as & # 39; a very interesting idea and one that could certainly reassure caregivers and keep our patients safe & # 39 ;.
However, it also insists on caution, "in particular with regard to ensuring the security of sensitive data and minimizing any kind of intrusion into the lives of our patients before it is rolled out on a larger scale".
Trevor Truman, 79, a retired engineer and now a full-time caregiver for his wife, who was diagnosed with Alzheimer's in 2016, has had TIHM since 2017 and believes that others should benefit from it.
& # 39; It's very disturbing to have someone in your family diagnosed with dementia & # 39 ;, he says.
& # 39; You come in, not knowing what to expect. With this technology I feel much better about the situation. I think my wife has also been comforted. & # 39;
Professor Nilforooshan sees the need for systems such as TIHM grow.
& # 39; I pray that treatment for dementia will come – but two major drug tests have failed in the last six months, so we need to find other ways to tackle this. & # 39;
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