Supporting Good Practice in Technology-Enabled Health & Social Care. A Partnership Approach

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1 Mental Health of Older Adults and Dementia Clinical Academic Group (CAG) Supporting Good Practice in Technology-Enabled Health & Social Care A Partnership Approach Barbara Dunk OT Consultant Assistive Technology Manuela Schuette AT Lead and Telecare Manager

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3 Central Importance of cooking activities: Guidance on maintaining independence and managing risk for people with memory loss

4 Managing Fire Risk:

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6 The increasing options for GPS assisted monitoring and response services

7 Memory Services and EAT services working together Occupational Therapists providing specialist input to Monitoring Centre improved review processes availability of advice for all agencies for complex cases Joint-working for assessment and flexible introduction and trial of appropriate devices, individually tailored monitoring and response protocols Jointly facilitated groups for early engagement and information sharing raise awareness of devices/systems for people with memory problems that help with daily activities/safety at home provide an opportunity to interact with EAT devices and systems, signpost to services and purchase as appropriate provide opportunities to discuss and share experiences managing day to day memory problems in a relaxed and friendly environment

8 Importance of Diagnosis Cognitive deficits typically seen in dementia Memory Language Executive functioning and attention Praxis & motor skills Visuospatial perception and visual processing Speed of information processing Variation in cognitive deficits between sub-types of dementia Alzheimer s: gradual, memory, disorientation, word finding, judgement Vascular: memory, disorientation, emotion, mobility challenges, falls, incontinence Lewy body: Changes in alertness, muscle stiffness, tremor, hallucinations, falls, unsteadiness Frontotemporal: language, behaviour, personal awareness (hygiene, etc), planning

9 Frontal Lobe Initiation Problem solving Judgment Inhibition of behavior Planning/anticipation Self-monitoring Motor planning Personality/emotions Awareness of abilities/limitations Organization Attention/concentration Mental flexibility Speaking (expressive language) Brain-Behavior Relationships Frontal Lobe Temporal Lobe Memory Hearing Understanding language (receptive language) Organization and sequencing Temporal Lobe Parietal Lobe Occipital Lobe Cerebellum Brain Stem Brain Stem Breathing Heart rate Arousal/consciousness Sleep/wake functions Attention/concentration Parietal Lobe Sense of touch Differentiation: size, shape, color Spatial perception Visual perception Occipital Lobe Vision Cerebellum Balance Coordination Skilled motor activity

10 Strong Links between Memory Services and EAT services -

11 Nuffield Council on Bioethics (2009) p 10

12 Balances & Compromises Adapted from Opinion Leader (2008) Deliberative Workshop on Dementia: A report prepared for the Nuffield Council on Bioethics London: Opinion Leader), p16.

13 Occupational Therapist based in Monitoring Centre Solutions to Communication Problems: speech impaired, deaf-blind, mute service users Use of sound amplifiers Working with Royal Association of the Blind Joint work with speech therapist, investigating user s safety awareness and reliability of interaction methods Development of service-user-specific Makaton communication-folder, including body-chart Pointing protocol: help, pain, where in body, drink, doctor On-going EAT training of monitoring and response staff through jointwork

14 Occupational Therapist based in Monitoring Centre Makaton Examples Sign for Careline: Tap on left shoulder to greet, C24 in user s hand.

15 The evidence-base for electronic assistive technology (EAT) for people with Dementia Few empirical studies involve people with dementia using EAT Studies have tended to focus on one aspect of EAT e.g. acceptability to carers, evaluating a particular device No randomised control trials (RCTs) have focused on people with dementia living at home No studies have addressed the potential of EAT in postponing residential care Ensures care services are cost-effective given economical constraints on services [no current conclusions about cost effectiveness of EAT] Topo, P. (2009). Technology Studies to Meet the Needs of People with Dementia and Their Caregivers: A Literature Review. Journal of Applied Gerontology, 28 (1), 5-37.

16 The Role of Good Practice When there is a lack of high quality evidence, guidance tends to be based on good practice instead SCIE develops and promotes knowledge about good practice in social work. Good practice is often generated by consensus of expert opinion the absence of empirical evidence for the effectiveness of a particular intervention is not the same as evidence for ineffectiveness NICE & SCIE (2007) Evidenced based practice (EBP) and good practice used together

17 Planning Ahead for New Ways of Working Across Health & Social Care Best practice in remote communication Contributing to the evidence base (ATTILA) Further development of clinical guidance

18 Towards optimising remote ( (telephone) communication with people with Dementia A pragmatic approach, adapting existing communication strategies Remote communication, in the face of decreasing resources and greater numbers of people with dementia, is a communication method of the future and must be refined and optimised Assessment performed by telephone may provide an efficient, practical and valuable alternative and/or complementary strategy to the traditional face-toface test administration methodology Castanho et al. (2014)

19 What is ATTILA? Assistive Technology and Telecare to maintain Independent Living At home for people with dementia ATTILA is a multi-site, pragmatic randomised control trial (RCT) It is funded by the Health Technology Board which is part of the National Institute for Health Research and is sponsored by King s College London and SLaM

20 ATTILA Objectives Primary: To establish whether ATT assessments and interventions extend the time that people with dementia can continue to live independently in their own homes and whether this is cost-effective. Secondary: Carer burden Quality of life of carers Number and severity of serious adverse events

21 Thank you for listening