This would not be a problem in a world of unlimited resources, but insufficient human and financial resources are the reality. Memory disorders in particular are becoming more common with the ageing of the population. More than 50 million people globally and more than 190,000 people in Finland have a memory disorder, with 14,500 new cases diagnosed every year in Finland. The key question is how to create a system where services can be optimally targeted in a timely manner while still being cost-effective. These two objectives are typically contradictory, and the assessment should therefore focus on the effectiveness of the services rather than the unit cost.
There is no one-size-fits-all solution to the growing service needs of the elderly. The solution requires a very holistic approach that also takes into account the ageing of individuals and the decline in functional capacity over time. An important part of the solution is housing for the elderly. Institutional care is extremely expensive, which is why supporting living at home for as long as possible is important. Living at home, which includes residential care, is beneficial to society, but it is not without its problems. Loneliness, the difficulty of keeping track of the elderly person’s wellbeing, falls, false alarms and sudden bouts of illness are examples of the challenges involved with living at home. As a result of climate change, prolonged heat waves cause an increase in mortality, especially in people over the age of 75. Digital services can support people living at home, their next of kin and healthcare professionals. Below, we will investigate related issues in more detail.
Digital services to support people living at home – holistic co-design leads to good results
We have been involved in the implementation of services to support the elderly, and have been able to learn from them. There are many different digital services on the market to support living at home. These services can be divided into two categories, the first of which includes all solutions that are invisible to the person living at home. The second category consists of solutions with which the person living at home interacts.
The first category includes sensors, cameras and meters that are placed in the home to collect data based on which it is possible to create snapshots and generate alarms. These can be used to detect issues such as an increased temperature in the home, a faucet that has been left open, the position of the front door and the immobility of the elderly person. Solutions in the second category include video communication equipment, an emergency telephone and the manual input of measurement results. There are also solutions that lie in the grey area between these categories. For example, a blood pressure monitor requires interaction just like a microwave, but it is not a digital solution as such. On the other hand, the transmission of the measurement results to a digital system clearly belongs to one of the two categories.
We see three clear problems with the solutions on offer. Firstly, most solutions are limited, meaning that they solve one problem well but ignore the whole picture. Secondly, many solutions are inflexible and their development is difficult to change. The third issue is the availability of solutions. As a result of these problems, the services offered are only applicable for a limited group of users and unable to accommodate changes in functional capacity over time.
Limited and inflexible solutions
A solution can include a good package to monitor the mobility of the person living at home and detect falls. Such a solution includes sensors, data transfer from the sensors to a server and user interfaces for professionals. The problem is how to connect all this to the person’s medication, vitals, treatment history or the layout of the apartment (for example, whether there are any stairs or thresholds). The supplier of the product has implemented a solution for a specific issue, but may be unable or unwilling to expand the solution in the desired direction. When considering digital solutions for living at home and all the information that can be obtained from them through analytics, the possibilities are virtually limitless.
However, it is clear that a service provider that focuses on a specific issue knows most about that issue, and utilising that information is a must. We need an approach where the core is an open, flexible IT infrastructure (platform) capable of receiving both the “elderly person has fallen” information from the limited solution and the associated raw data if it is deemed necessary. The platform must be able to convey the snapshot produced by the limited solution, but also produce further analyses by combining the person’s medication information and the snapshot/raw data generated by the limited solution, for example. The platform and specialised limited solutions would thus form an ecosystem to combine the best solutions into a single whole.
Such a platform would provide a virtually limitless knowledge base for researchers and healthcare professionals to generate new data to reduce costs and support living at home. The better the ability to predict the wellbeing of the person living at home to react in a timely manner, the longer the person will be able to lead a satisfactory life at home. The work of healthcare professionals will become more meaningful if they can receive a good and up-to-date snapshot to support their visit.
In the Virtuaalikaveri (Virtual Companion) pilot project with Oulun Digi and City of Oulu health services, we tested what kind of combined solution would best support elderly people with memory disorders in living at home. The solution combined a limited sensor solution worn on the person or put in the pocket that analysed movements with an interactive tablet app. Based on sensor data, the back-end system analysed whether the person was stationary for too long during the day or possibly moved too much at night, at which point the app generated alerts and prompts.
During the pilot project, we found that a wearable sensor was not the ideal solution for a person with an advanced memory disorder. They found the sensor difficult to put on, which is why it was easily left on the table. The tablet app was found to be useful as such in the Virtual Companion pilot project: Sanna Koivikko and Virpi Kariniemi from the City of Oulu health services stated that reminders, a visible clock, timed photos and exercise videos resulted in the customers showing more initiative.
The flexibility of the solutions is important, which is why configurability, such as adding your own photos and videos, was added to the app’s development list. As the customer’s functional capacity deteriorates over time, the app’s user interface must become simpler, because the user’s ability to absorb new information decreases, and things learned previously may be forgotten. Meanwhile, the data produced by invisible condition sensors becomes more important to the next of kin and nursing staff.
Accessibility
Digital solutions can be made easily accessible for professionals by means of co-designing and providing a uniform set of tools for the user in all situations. This does not mean abandoning the limited solutions but combining them under one umbrella. In the case of the elderly person living at home, accessibility is a much more difficult issue, because their abilities vary greatly. The most important thing here is to look at the big picture and to treat all solutions to support living at home in the same way as medication, for example, i.e. to keep in mind the big picture throughout the design process. Devices requiring any form of interaction in particular cannot be placed in the home without paying constant attention to all other devices.
