Mohammed T. Abou-Saleh

Principles and Practice of Geriatric Psychiatry.Editors: Professor John R. M. Copeland, Dr Mohammed T. Abou-Saleh and Professor Dan G. BlazerCopyright & 2002 John Wiley & Sons LtdPrint ISBN 0-471-98197-4 Online ISBN 0-470-84641-0126New Technology and the Care of CognitivelyImpaired Older PeopleAndrew J. SixsmithUniversity of Liverpool, UKRecent years have seen a rapid growth in research anddevelopment of new technologies to improve services and enhancethe independence and quality of life of older people. The actualand potential role of new technologies has been recognized by theUK Royal Commission on Long-term Care 1 , by the EuropeanCommission in their COST-A5 initiative on ‘‘Ageing andTechnology’’ and TIDE R&D programme on ‘‘Telematics forDisabled and Elderly People’’. A wide range of products is beingdeveloped 2–4 , using new technologies within robotics, telecommunicationsand information processing. In this chapter, telecareconcepts and applications are discussed in terms of their potentialbenefits for cognitively impaired older people.TELECARE CONCEPTS AND APPLICATIONS‘‘Telemedicine’’ is now well established worldwide and refers tothe use of electronic information and communication technologiesto link medical practitioners and patients 5 . This could includeapplications to support a wide range of medical practices, such asdiagnostics, patient monitoring, therapy, rehabilitation and healtheducation. ‘‘Telecare’’ is a more recent concept 6,7 and refers to theuse of new technology to deliver and facilitate health and socialcare support services in the community.New technology is likely to play a significant role in thecommunity support of older people for several reasons 8 . Increasingnumbers of older people have forced health and social servicesto look at more cost-effective approaches to care and support.Health and social care policy argues that most older people wantto stay in their own homes and the improved services andenhanced levels of safety and security afforded by telecare systemsmay have the potential to help very disabled people to do so.Manufacturers and service providers have recognized the marketpotential for meeting the demand from older people and theircarers for new products and related services. A number of telecareapplications are available or being developed within severalapplication areas.Health and Social Care Information SystemsThese are used to provide healthcare professionals and clientswith health information. These can include simple operator-basedsystems, interactive websites and self-navigating informationservices using terminals in surgeries 6 .Client SupportTelecare can include telephone-based services to sophisticatedmedical systems utilizing state of the art telecommunications.These can be used to provide emergency response, counselling,training, information and client and carer support 9,10 .Client Records and Care PlanningHuston 11 argues that medical records are a weak link withintelemedicine and telecare and outlines a model for a comprehensivemedical records system. The EU-funded ITHACA projectaims to provide a standard IT-based system for the assessmentand planning of client care.AssessmentHome-based technology can provide patient data that can be usedfor assessment and the specification of treatment and care.Doughty and Costa 12 outline a system to assess the ability ofelderly people to live alone in the community, using sensors toprovide electronic measures of activities that indicate functionalperformance after discharge from hospital.TeleconsultationThis refers to the use of technology to facilitate communicationbetween a healthcare professional and client. For example,Whitten et al. 13 report the use of a cable television interactivevideo system to deliver home health services from ‘‘telenursingcockpits’’.Patient MonitoringThe most widespread technologies are community alarms orpersonal response systems 14 , which allow a person to raise analarm at a central control facility by pressing a button on his/hertelephone or on a pendant worn around the neck. Recent work 15,16has been aimed at developing a second generation of systems thatuse sensors in the home and artificial intelligence to automaticallydetect emergencies, even when a person is unable to raise an alarmhim/herself.Principles and Practice of Geriatric Psychiatry, 2nd edn. Edited by J. R. M. Copeland, M. T. Abou-Saleh and D. G. Blazer&2002 John Wiley & Sons, Ltd