Keywords

1 Introduction

The ageing population and the increasing longevity of individuals is a challenging reality forhealthcaretoday. Longevity often leads to increased dependence and the need for continued care, whichis often left to informal caregivers, given the inability of the elderly care network to provide The informal care provided to the dependent elder occurs either at the caregiver’s or the elderly person’s home. This caregiver may be a family member, a friend or a neighbor, as they are someone who is part of the elderly person’s informal social support network, who assumed the responsibility for the care, either voluntarily or as an “obligation”. Care provision requires continuous organization and effort from the elderly person and from the caregiver. Assuming responsibility for the care commonly occurs when the caregiver experiences difficulties in carrying out the therapeutic plans established by the health team. Technology application in healthcare has been attracting the attention of engineers for a long time, especially in providing support for health recovery and maintaining therapy. Due to major advances in technology, particularly in movement capture optic systems and information extraction through digital image analysis, support systems are being created to monitor how therapeutic plans are carried out, as well as to evaluate people’s physical recovery or to assist healthcare professionals and informal caregiver to provide care for dependent elders. In other projects related to accessibility and elderly support, technology has already been successfully adopted [1, 2].

This paper reports on a project proposal with the general objective of using information and communication technologies to develop a prototype for a system focused on monitoring and assisting the execution of a therapeutic plan integrating physical mobilization and medication.

As part of the project, an aid and surveillance program was designed, which was backed up by a sensor network. In addition, a methodology was created to assess its impact on promoting the health care of the dependent elderlyin their homes.

The assessment was designed to include six stages:

  • Evaluating the dependent elderly person’s health statusat home, under the care of an informal caregiver.

  • Identifying the established therapeutic plan and the major difficulties found by the informal caregiver while executing this plan.

  • Monitoring the user/caregiver’s adherence to the therapeutic plan.

  • Implementing a therapeutic plan assistance and vigilance program through a sensor network.

  • Evaluating the impact of the therapeutic plan assistance and vigilance program through a sensor network on promoting the elderly person’s health.

  • Evaluating the impact of the therapeutic plan assistance and vigilance program through a sensor network on assisting the informal caregiver.

The project is halfway through the implementation phase, therefore this paper focuses on the challenges and options of the activities and prototype design, as well as on the adoption of the assessment methodology.

2 The Portuguese Population

According to the PORDATA data from the Francisco Manuel dos Santos Foundation [3], the ageing index of the Portuguese population, defined as the ratio of the number of elderly people of an age when they are generally economically inactive (65 and over) to the number of young people (from 0 to 14), is dramatically increasing. In 2017 the ageing index was 153, 2%, combined with the increase of longevity and the increase of dependency.

The elderly above 60 years old are in the age range that will increase the most. In the next few years it is estimated that the number of people over 65 years old will surpass the number of children under 5 years old [4].

Considering the ageing and dependency statistics and also the fact that, according to the Portuguese Health Regulator Agency, Portugal has the highest rate of informal home caring by a resident in the same home, it is essential that action is taken to provide support to the informal care givers in their daily care activities. Many of them dedicate most, if not all, their working day to providing care, consequently there is a need to empower them with tools and to improve their quality of life.

3 Ageing and Comorbidity

Some of the elderly assisted by informal care givers in home caring environments have mobility issues and disabilities, meaning they are often bedridden. The lack of movement can cause musculoskeletal pathophysiology changes that promote deformities and postural alterations, leading to the on-set of pressure injuries. In the absence of regular care and proper interventions, these changes can affect the quality of life of the elderly and predispose them to the appearance of diseases [5].

A Pressure Injury (LPP) is defined as localized damage to the underlying skin and/or soft tissue, striking regions of bone saliences or in regions of continued contact with equipment or devices that cause continued or intense pressure, combined or not, with friction and/or shear. The pressure on bone saliences affects the blood circulation promoting cell death and the consequent appearance of these lesions in places of greater risk, such as the occipital, scapular, sacral, ischial, trochanter, iliac crest, knee, malleolus, and calcaneus [6].

Providing care to an elderly person may require the caregiver to restructure their lives, depending on the care necessity, its complexity or duration. The care giver is often required to change routines and behaviors, which is not always easy, leading to feelings of tension, anguish, and in some cases, even overload. For this reason, the caregiver may either choose to ignore their own needs orneglect the care of those for whom they are responsible r [7].

An important issue in providing care to the elderly is the necessity to comply with their doctor’s instructions and treatment prescriptions, in particular regarding medicine administration and schedules. Most of the elderly suffer from several comorbidities and take several medicines throughout the day, often in a complex system, which can be prone to error. Their non-compliance increases the risks of incorrect medicine usage [8].

Benefits of installing a network of sensors:

  • To programalerts for positioning warningsat predetermined hours;

  • To define alarms in case of forgetfulness or delay in positioning the elderly on the bed;

  • To establish alerts for medication schedules.

These alerts/alarms can take the form of audible sounds or written messages and should be available to the caregiver and to other health professionals. To interact with the elderly population, itis very important that the user interface establishes a common context and provides an effective communication as experienced in previous projects [9, 10].

4 The Project

To develop the prototype, a project was designed and implemented with an intervention plan to select and install the sensors network. The project is the SAICT-POL/23428/2016 – “IPAVPSI – Impact of an aid program and surveillance of the therapeutic plan supported by a sensor network, in promoting the health of the dependent elderly in their homes”, referenced as: NORTE- 01-0145-FEDER-023428, financed by the Foundation for Science and Technology and co-financed by the Regional Development European Fund (FEDER), through the North Regional Operational Program(NORTE2020).

Two main criteria were used to select the homes where the project would be developed:

  • The geographical proximity of the homesto the University of Trás-os-Montes and Alto Douro, where the project is based;

  • The availability and willingness of the caregivers to work together with the project.

The initial plan is to include two groups, a control group and an experimental group, with 15 elderly people and 15 caregivers in each group, sharing similar characteristics, such as age, gender and level of dependency.

Subsequently, the research team will apply the ESC scale which evaluates the objective and subjective overload of the informal caregiver, the Barthel Scale to assess the degree of dependence of the person in the accomplishment of their daily life activities and Braden scale to assess the patient’s risk of developing pressure injuries.