Impacting sleep quality in care homes through simple, novel technological interventions

Transcription

1 Impacting sleep quality in care homes through simple, novel technological interventions Prof Roger Orpwood, Dr Bruce Carey-Smith, Nina Evans Bath Institute of Medical Engineering

2 Overview Sleep problems prevalent in later life Caused by a variety of exogenous and endogenous factors Can technology help tackle these factors or support interventions that do? SomnIA Work Package 7 Aim: Investigate the potential for technology to help improve sleep in later life Context: Care homes and community

3 Overview Description of user-led design approach Areas of identified user need Potential solutions Three design ideas: Outcomes from iterative development and testing Results from remote monitoring survey

4 Process Findings from SomnIA care home observational studies and previously published work Stage 1 Ethical approval Collate results and summarise areas of need Interviews with care home staff and residents Identify technology concepts Prioritise concepts Interviews with care home staff Early prototypes Demonstrations with care home staff and residents Stage 2 Ethical approval Technology development Design User evaluation

5 Environmental Psychosocial Model of user need Anxiety over provision of care Supporting staff to provide timely and appropriate care Reassuring residents that care is available Enabling residents to reliably access appropriate care when it is needed External disturbances Minimising external sources of noise Providing appropriate ambient light levels Minimising disturbance associated with physical checks Comfort and accessibility of the environment Improving ability to engage in soporific nighttime activities Enabling residents to satisfy their physical needs Factors contributing to poor sleep

6 Environmental Psychosocial Technology Concepts Anxiety over provision of care Supporting staff to provide timely and appropriate care Noise activated call system Reassuring residents that care is available Accessible call button Enabling residents to reliably access appropriate care when it is needed Remote monitoring External disturbances Minimising external sources of noise Providing appropriate ambient light levels Minimising disturbance associated with physical checks Comfort and accessibility of the environment Improving ability to engage in soporific nighttime activities Versatile lighting Night-time communication Personal radio or music player Encouraging reluctant callers Enabling residents to satisfy their physical needs Factors contributing to poor sleep Bedside item storage Design ideas

7 Technology Iterative process Work with small numbers of users Short and long term testing

8 Night time tray Problem: Good quality sleep can be affected by anxiety. For many care home residents being able to find personal items at night, especially the call bell, can be of real concern. Design Brief: Needs to help residents find personal items during the night Call bell, spectacles, hearing aids, medication, drink of water Needs to fit on a standard over-bed table Needs to be wipe-clean Needs to be stable yet easily moved by staff Solution: Compartmentalised tray with touch sensitive illumination

9 Night time tray Results Four users, age yrs, used between 3 and 21 days Improved access All participants used tray to help organise the space on the overbed table Lower acceptance if already organised I like things organised (the tray) makes life much tidier Effect on sleep and (I am) able to know where things are. Two users felt they were able to sleep better with the tray I don t leave the ensuite light on now I am able to go to sleep more quickly.

10 ComfySound Problem: Desire to be able to listen to music or spoken word when unable to sleep Late night TV can cause disturbance to other residents Design Brief: Needs to provide audio from a variety of sources (TV, radio, mp3) External surface needs to be able to be cleaned Different pillow options important Controls need to be simple to use and accessible It must operate without trailing wires Solution: Rechargable in-pillow audio player In-pillow or wireless remote control

11 ComfySound Results Four users 76 to 92 yrs 4 to 14 days use 2x end-of-life care Ease of use In-pillow controls difficult to use Effect on sleep and night time relaxation Participants who used pillow at night found it helpful to settle and to reduce sleep onset time (The participant) liked it very much. She settled well and slept for longer periods. Staff

12 Versatile lighting Problem: Appropriate levels of bedroom light are important Reduce sleep disturbance Provide reassurance to residents Reduce risks of falls Reduce risks to staff Design Brief: Automatic to detect & respond to movement of staff & residents Provide a low level of ambient light when no movement Provide an increased level of light when movement detected Position of light not in direct line of sight Solution: Automatic under-bed light

13 Versatile lighting Results Two users Age > 80yrs 1 to 8 weeks Reduce risks to staff Allowed staff to remain safe while minimising disturbance to resident Before, we would have to stumble around the bed to switch the ensuite light on. Reduce risk of falls Provided safety for both residents who wanted to maintain their independence Reduce sleep disturbance One participant had a history of falls which was reduced significantly after the installation of the light Provide reassurance to residents Participants found the light helpful and reassuring

14 Remote Monitoring Problem: High proportion of sleep disturbances in care homes can be attributed to nursing activities. Providing information to staff remotely may reduce the need for physical checks It may also allow staff to delivery care in a more timely and appropriate way An effective remote monitoring system will need to provide all the information a staff member gathers when checking in person Aim: To understand from a staff perspective what they look for during a physical check

15 Remote monitoring Night time checks questionnaire 87 responses Job Title Care Assistant 42% Not Specified 3% Type of care Residential home only 23% Manager 17% Nursing, Residential & Respite 5% Nurse 38% Nursing home only 70% Residential & Respite 1% Not Specified 1%

16 Vital Signs General Wellbeing Resident Activity Nursing Activity Remote monitoring Breathing irregularity Heart rate irregularity Body temperature & skin colour Incontinence pad capacity Residents who are well Residents who are receiving extra care Non-contact technology available NC technology under development General mental state Changes in behaviour or appearance Vocalisations Observed and reported pain Fluid balance Wandering Falls Resident in bed Signs of restlessness Asleep Time and duration of care delivery Time of last repositioning Medication Data entry by staff

17 Remote monitoring If the monitoring system reliably alerted you to the needs of your residents w ould you still w ant to physically Physical checks are an important part of night time care check them? Probably 14% Definitely 76% Unlikely 2% Definitely not 2% If the monitoring system reliably alerted you to the needs of your residents would you still want to physically check them? Not specified 6% Staff acceptance of remote monitoring will be dictated by Its reliability in conveying the necessary information in an easily accessible and appropriate way How well it frees up staff to provide appropriate care when and where it is needed

18 Conclusion Many areas where technology may improve sleep quality in residential care Anxiety over provision of care External disturbance noise, light and night-time checks Comfort and accessibility of environment Iterative user-led design has resulted in successful prototypes addressing some of these areas Potential for remote monitoring technology to support timely nighttime delivery of care

19 Acknowledgements The wider SomnIA research team Staff and residents at Henford House, Barchester Homes, Warminster Bloomfield, Barchester Homes, Paulton Wingfield, Barchester Homes, Trowbridge John Wills House, St Monica Trust, Bristol This research is supported by the New Dynamics of Ageing initiative, a multidisciplinary research programme supported by AHRC, BBSRC, EPSRC, ESRC and MRC (RES ) ( )