New findings show that older adults could benefit from enhanced partnerships between healthcare systems and affordable housing sites.
Research published in the Health Services Research journal concludes that these partnerships improve healthcare outcomes while reducing unnecessary spending and/or use.
Seniors living in sites with the R3 program had lower hospitalisation rates, days, payments and readmissions than residents living in similar control sites.
This is the first study to document a decline in 30-day re-hospitalisation rates among low-income senior housing residents who have access to place-based wellness teams, when compared to low-income seniors in buildings without this level of support.
R3 embeds a wellness nurse and coordinator in senior housing. The place-based team efficiently conducts assessments and routine proactive check-in calls, stratifies the population based on established key risk factors, puts services in place to meet needs, partners with organisations to strengthen care coordination and communication, and tracks/trends data to drive and monitor results.
Hebrew SeniorLife developed R3 to address the disconnect between housing and health systems in order to improve the health and wellbeing of seniors. Partners, including emergency responders, health plans, area agencies on ageing, and government agencies, were able to leverage congregate senior housing to achieve positive outcomes.
The research sought to determine the effect of this housing-based intervention on Medicare health service use among senior housing residents. R3 enrolled 400 participants across seven intervention sites, four operated by Hebrew SeniorLife and three operated by partner providers, including Milton Residences for the Elderly and WinnCompanies.
Researchers noted that: “The findings suggest that the combined focus on assessment, proactive outreach, and prevention (with special attention to high-risk individuals); coordination with off-site providers; and the strengthening of an ‘eyes-on’ culture, led to the positive results.”
“Both the comprehensive quantitative and qualitative analyses that we have undertaken demonstrate conclusively that the program is having a major and positive effect on residents and that health care payers also benefit from lower health care costs by having their members participate in the programme,” said Marc A. Cohen, Co-Director of the LeadingAge LTSS Center at UMass Boston.
“The R3 program hits all success metrics.”
Louis J. Woolf, president and CEO of Hebrew SeniorLife, added: “This research demonstrates that R3 delivers much-needed health and quality-of-life improvements for residents of senior housing.
At the same time, R3 contributes to efforts that avoid unnecessary care and reduce costs for a system that is beset with labour challenges and struggling to provide both sufficient and affordable services.
“We are encouraged by the fact that with this data, policy makers are giving serious consideration to the benefit of adopting R3-like programs across the Commonwealth.”
Researchers concluded: “Age-friendly health systems would do well to enhance partnerships with affordable housing sites to improve care and reduce service use for older residents.”
Revolutionary Scottish trial aims to improve outcomes for stroke survivors through exercise
A trailblazing rehabilitation hub using exercise and other therapies to help boost stroke survivors’ recovery has opened its doors at one of Scotland’s largest hospitals – with evidence already pointing towards its life-changing impact on patients.
The hub is part of a trial being conducted by the University of Strathclyde in partnership with NHS Lanarkshire, to meet the overwhelming demand for intensive stroke rehabilitation.
It’s already known that the sooner a patient can begin stroke rehabilitation, the more likely they are to regain lost abilities, such as speech and movement. It’s a common practice for therapy to start as soon as 24 to 48 hours after a stroke, while a patient is still in hospital.
New National Institute for Health and Care Excellence (NICE) guidelines in the UK suggest stroke patients receive three hours of rehabilitation a day, five days a week.
This is a significant increase from the previous NICE advice of 45 minutes per day.
However, due to the overwhelming demand for rehabilitation, the NHS has struggled to meet the minimum recommended level, with current data suggesting that on average patients receive just 14 minutes of physiotherapy, 13 minutes of occupational therapy, and seven minutes of speech therapy a day.
But the new technology-enriched stroke rehabilitation hub (TERHS) at the University Hospital in Wishaw, which lies 11 miles south east of Glasgow, allows patients to access therapy more quickly at the required frequency.
Just weeks after its launch, proof is already emerging that the hub, which has been designed to holistically address the physical and cognitive harm caused by a stroke, has the potential to positively transform the recovery process for survivors.
Now it’s hoped if further evaluation backs up the preliminary findings the concept could be rolled out not just across Scotland, but all four UK nations within the next two years, putting the NHS at the forefront of treating patients in the chronic stage of stroke recovery.
Dr Gillian Sweeney, an occupational therapist with NHS Lanarkshire and advanced practitioner for stroke survivors, who has led on the development of the trial and set up the hub, told Agetech World the model could receive a wider launch if health trusts are presented with concrete evidence of its physical and financial benefits.
Referring to the hospital trial currently underway and research being done by the University of Strathclyde’s Department of Biomechanical Engineering into the use of such hubs, Dr Sweeney said: “This is groundbreaking, a life-changing trial for those who have had a stroke. I’m a therapist myself and I’ve worked in the NHS for around 20 years, and what I would say is, we have never been able to deliver enough rehabilitation within the current model and resources, and things are getting more pressurised.
“I think every therapist that works in stroke would probably say ‘We know we are not delivering the level of intensity that we should be.’ We know from evidence that the greater the intensity the better the outcomes.
“But we have been on a hamster wheel for a number of years, and I think we are now at the point where this model, with modest investment – and I don’t want to say within current resources because we need the investment in the equipment and staff to run the groups – but with a realistic, modest investment, could actually achieve those levels of rehab activity that we never foresaw we could do without making a huge investment in staffing for one-to-one treatment.
“For me, the feedback from participants, both within the university and even in the early stages on the hospital ward, is that the difference that makes is massive.
“I think for me, as well, what it does, is that it brings back the person’s control of their own rehabilitation. They have the opportunity to attend this hub and with the minimum amount of support, they are back in control of their own rehab.
“They can choose how often they come for and how long they stay. That, in itself, has been huge.”
Even more remarkable is that participants from the community that have taken part in the university-based study – some of whom suffered a stroke up to a decade ago – have seen functional improvements.
“It wasn’t what we expected to see, but we did,” Dr Sweeney said.
“The study initially was just to look at, ‘is it safe, and do people like it?’ Ten years after a stroke there wasn’t a huge amount of expectation that things like arm function or walking speed would improve.
“But with the outcome measures we have taken, pretty much everybody has improved in one or more areas.
“If you look at that and think ‘we can make those improvements 10 years down the line,’ what could you do in the very early phases after a stroke when your brain is more likely to make the changes to see improvement?
“For me, it is groundbreaking. If you use this model and put some of this equipment in so people can do the things they need to, it is a total no-brainer.
“Yet it (the resource) is not there. There are reasons for it not being there, and part of that has to do with people within healthcare systems often working so hard and under such pressure they don’t get the space to think about new ways of working or to test them.
“There are traditional ways of working and it takes a long time within the NHS to adopt new ways and to embed that.”
The impact of stroke can be profound and the months immediately after suffering one are key to recovery.
Located within the University Hospital’s stroke unit, the TERHS hub has a virtual reality treadmill with a specialist harness, a balance trainer, and power-assisted equipment from UK-based wellness and wellbeing supplier Innerva, which supports users to exercise allowing them to work passively or actively, depending on where they are in their recovery stage.
The technology also incorporates ‘gamification’, such as virtual reality, puzzles and problem-solving activities, which helps to improve the engagement with and response to therapy.
In addition, the hub houses specialist cognitive and VR equipment, helping to enrich the environment and improve users engagement with and response to rehabilitation therapy.
The hub builds on the research being carried out by the University of Strathclyde which has seen a team led by Dr Andy Kerr and Professor Philip Rowe in the Department of Biomechanical Engineering, set up a gym-like space offering an eight-week programme to survivors under the supervision of Dr Sweeney and research physiotherapist, Mel Slachetka, in the Sir Jules Thorn Centre for Co-Creation of Rehabilitation Technology.
The hospital hub has attracted 15 patient recruits so far, all of whom have been “extremely positive” about the programme, Dr Sweeney said, with some managing three hours of rehabilitation a day.
“People are getting much more activity time than would have been the case. Patients like the Innerva equipment as all they have to do is press a button, and they feel they are in control.
“The setting seems to be popular, and what we are finding is that patients are coming up in a group. Having a stroke can be isolating, but the feedback we are getting is that users value the opportunity to meet people who are going through the same experience as them.
“We know that on stroke wards across the country there isn’t enough staff. Often what happens is that the nursing staff will help patients get out of bed and then they will sit in a chair for hours.
“But with the hub they are using their brain, they are being active, they are off the ward, and they are having the opportunity to socialise.”
The hub can support five patients at a time alongside two support staff.
Given the evidence already accrued through the University of Strathclyde’s rehabilitation programme in which every person using the Sir Jules Thorn Centre facility has seen an improvement, mostly in walking speed but also in some cases speech, it seems difficult to understand why the hub idea isn’t being rolled out as a priority.
Especially as Dr Sweeney admits her ambition is to see technology-driven rehabilitation hubs established in community settings across the UK to provide stroke survivors with easily accessible therapy for optimal recovery.
But whilst the idea may indeed, to quote Dr Sweeney, be a ‘no-brainer,’ even the most obvious concepts need to be proved on a number of levels.
With funding from the Engineering and Physical Science Research Council’s Impact Acceleration Account, a research assistant will assess the impact of the hub on inpatients in the early phase of their recovery with the aim of enabling them to achieve, or even exceed, the recommended levels of rehabilitation.
“We need to look at the costs and the harsh economics,” Dr Sweeney said. “From a research point of view, we must prove that. We are often not very good at proving that something is cost-effective.
“Rehabilitation in general has been run in the same way for a long time and it can be difficult to change traditional practices. And rehabilitation therapists as well as the public can be frightened of technology.
“There is often a feeling that if somebody who has had a stroke is elderly, they won’t be able to cope with technology. But one of our patients is 94, and we are finding that age isn’t as much of a barrier as people may think it is.
“But we need to prove all these things as well as the positive impact this approach can have on stroke survivors. At the minute we have tried it with people who are in the very early stages of stroke rehab, we have tried it in an acute inpatient ward, and we know it is safe and that it is acceptable.
“But we need to prove that people like the hub idea, that they get great intensity of rehabilitation, and that it improves people’s outcomes. Once we do that that will hopefully allow us to make a case that these facilities should be in place.
“Obviously, there are initial costs in terms of buying equipment, and there needs to be a discussion around how do we change the pathways and how do we change the ways the services work to allow this to become part of the normal treatment.
“But at the end of the day, what we want is to keep people out of hospital so they can go home and lead as normal a life as possible in the community.”
Agetech World podcast: The age-old lessons we can learn from Japan
With governments across the globe facing a ticking timebomb when it comes to funding the care needs of their ageing populations, a leading social and medical anthropologist has told the latest Agetech World podcast that there is much Japan can teach policymakers.
Click here to listen to the latest Agetech World podcast
Among Dr Iza Kavedžija’s main research interests is exploring the lived experience of ageing in urban Japan.
The Assistant Professor of Medical Anthropology in Cambridge University’s Department of Social Anthropology has lived in Japan and conducted extensive ethnographic fieldwork with two distinct groups of people in the Kansai region.
This led to her first in-depth study, Making Meaningful Lives: Tales from an Ageing Japan, and has underpinned a series of journal articles addressing a broad range of topics including care, hope and hopelessness, and happiness and gratitude.
In conversation with Agetech World, Dr Kavedžija said Japan had long been known for its widespread respect for the older population and its sense of obligation to caring for them.
The country has one of the world’s oldest populations, with nearly 30% of its 125m inhabitants aged over 65. This age group is expected to account for 34.8% of the populace by 2040.
Whilst this is inevitably putting a strain on Japan’s long-term care system, the country’s politicians and wider society are continuing to learn, evolve, and devise radical solutions to meeting this growing demographic challenge.
Japan has always had a strong tradition of family caring for its older citizens. But to this has been added a Long-Term Care Insurance (LCT) scheme, a complete package for the over-65s covering both the financing and the implementation of social care according to needs, supported by mandatory premiums levied on those aged 40-plus and co-payments from users.
Further responding to the nation’s ageing society, Japan is preparing to introduce a new Community-based Integrated Care System by 2025, with the aim of ensuring the comprehensive provision of health and nursing care, housing, and livelihood support.
Japan has also been working on developing robots to automate care for older adults, and other innovations include government investment in non-medical activities that can help prevent age-related illnesses; helping the over-65s flourish by working with them in their homes and communities rather than expecting them to conform to current societal norms or live in neglect; and making their towns and cities easier to navigate so seniors can still participate in everyday life whether for pleasure or work.
The number of residential homes is restricted with the emphasis on community care
Asked what Japan can teach the likes of the UK – which is facing a soaring health and care crisis – Dr Kavedžijan said: “I think there are many things that Japan has paid close attention to.
“I think the Long-Term Care Insurance is one of a kind… that allows for the drawing on services from various sectors, so it is possible to create a mix of forms of support, whether it be home care, whether it be various forms of assisted living…so a lot of interventions that are in the community and a lot of providers that range from non-governmental to the state sector to the private sector, where one can create a plan of care and support with a care manager that’s tailored to the needs (of the individual) drawing from the broad range of services.
“It isn’t always the same sort of story where the plan has led towards institutional living.
“In this sense I think Japan has been particularly successful. Of course, as the proportion of older people is so high in the population, this system is somewhat coming under strain. I don’t want to represent it as a particularly rosy situation. It isn’t. There are challenges to it.
“But I think nonetheless that this very, very well thought out system of support is important and it also cultivates these various forms of dependence, or interdependence, where one can draw on different types of assistance.”
Dr Kavedžija added: “It actually also allows people to continue living relatively independent lives….it doesn’t necessarily mean they have to move in with their children.
“So, they think of older people as the ones who continue the tradition and social changes as something that is brought on by younger people.
“In this case, I think we have seen very clearly that it is older people themselves that have often been the active leaders in social change. They have been the ones often saying, ‘I know there is an expectation for me to depend on my older son, but I don’t want to be a burden on my children.’
“So, they cultivate various forms of care in the community and they themselves become very involved in a huge range of activities, volunteer activities, that foster support in the community and create these communities of care.
“That is, I think another lesson that would translate well elsewhere.”
But Dr Kavedžijan also gave a note of caution. “I don’t want to paint too much of a positive picture because certainly challenges are there. That is something that again is perhaps an important lesson, and that is to do with the circulation of care, as I like to call it, where we need to think of care in systemic ways.
“For instance, elder care largely depends on a volunteer workforce, and that had for many years often consisted of women.
“In order to support better care for elders I think it is necessary to consider in which ways we can perhaps support childcare. So, to think about these flows of care in a much broader way and try and foster support across the board rather than thinking of them as separate units…that are not intertwined.”
Innovative robotic cup could empower older adults to stay hydrated
A one-of-a-kind robotic cup designed to help people living with cerebral palsy stay hydrated could also be a game-changer for older adults suffering from mobility impairments.
The aptly named RoboCup enables people with limited upper body mobility to stay hydrated without relying on a caregiver for help.
The battery-powered device, which can be mounted on a user’s wheelchair and customised to suit their mobility needs, is activated either by a button or a proximity sensor that brings a straw directly to their mouth.
The user can then take a drink, and once they have finished the straw automatically withdraws.
The cup is the brainchild of engineering students Thomas Kutcher and Rafe Neathery, who came up with the innovative idea after Rice University’s Oshman Engineering Design Kitchen (OEDK) in Houston, Texas, in the United States, was approached by spastic quadriplegic cerebral palsy patient Gary Lynn for help creating an assistive drinking device.
The result is RoboCup, which Thomas and Rafe hope will offer users greater freedom as they won’t need to rely on a caregiver whenever they need a drink.
To this end, the undergraduates have generously made their design available for free to anyone with access to a 3D printer to assemble their own drinking device by downloading instructions from RoboCup’s OEDK website.
Having made it possible for those living with cerebral palsy to drink water autonomously, Thomas and Rafe are now looking at the cup’s wider application – and believe it could prove to be a life-changing piece of technology for those with age-related eating and drinking problems caused by muscle weakness, pain, disease, and neurological conditions that can seriously affect mobility.
Thomas told AgeTech World: “While our client who had the idea for this device has cerebral palsy, the potential use cases spread far and wide. Rafe and I wanted our design to be as generalisable as possible.
“The device is catered to anyone with impaired mobility in a wheelchair, to the extent that they can either push a button or hold their finger in front of a motion sensor, and sip water from a straw.
“Once the device is set up it is very intuitive. It just needs to be set up in a manner where the straw rotates directly to a comfortable location for the user, and the sensor should be placed in a position where the user is able to trigger it.
“Once that criteria is met it should be very easy for the user.”
Dehydration is dangerous for anyone of any age. But older people are at a greater risk than any other age group.
This is because as people age their bodies don’t demand the same levels of liquid as they did in their younger years. This in turn changes a person’s sense of thirst.
However, the body still needs fluids to function, whether that be helping lubricate joints, regulating body temperature, pumping blood to the muscles, or ensuring the kidneys and urinary tract continue to function properly.
According to the British Nutrition Foundation, dehydration is not only a common cause of hospital admissions in older people but is associated with increased mortality.
For example, a two-fold increase in the mortality of stroke patients has been reported.
Even mild dehydration can be dangerous, affecting tiredness levels and mental performance, potentially leading to low blood pressure, dizziness, weakness, and an increased risk of falls.
In older people, dehydration is often associated with dementia, poorly controlled diabetes, Alzheimer’s disease, and stroke.
Certain medications can also cause dehydration.
The obvious way to prevent a lack of fluids is to drink more. But this can be easier said than done if you have impaired physical or mental abilities that may confine you to a bed or a wheelchair.
There are several hydration aids on the market aimed at older adults and those with cognitive impairments such as dementia and Alzheimer’s, from water sweets to sports-type bottles and wearable devices that can monitor fluid intake.
But Thomas and Rafe believe RoboCup is in a class of its own.
Rafe said: “RoboCup is primarily focused on allowing those with limited mobility to find increased autonomy in their day-to-day lives. The primary alternative to something like RoboCup would be a water bottle with a long adjustable straw that can be positioned near the user’s mouth.
“However, the issue with these products is that they intrude on the user’s headspace, and they tend to leak water down their shirt. RoboCup gives people autonomy to have hydration when they want it, and to have control over their own personal space.”
Whilst currently designed for use with a wheelchair, Rafe and Thomas say the RoboCup could be adapted for use in other situations, such as a hospital or care home environment, where a patient is confined to bed.
Thomas and Rafe, who are both 21 and in their final year at Rice University studying bioengineering and mechanical engineering respectively, are currently busy with senior design projects in other fields.
But Thomas said: “As far as assistive devices go our focus is still on RoboCup. As there is such a wide range of potential users, we’re still looking for and exploring ideas to make RoboCup more customisable.
“The main ones are investigating different sensors and locations to fit an individual’s personal ability, adjusting the design to accommodate more viscous fluids, or making it simpler for people to adjust the timing of the motion.”
Making the device as accessible as possible has meant simplifying it. During its development, the duo removed some of the more complicated or expensive parts and found alternatives for custom pieces that required special equipment to be made.
Rafe explained: “It was challenging walking that thin line between simplifying the device and sacrificing functionality or robustness. We wanted to keep it working well while still making it simpler and cheaper.
“Balancing all these considerations was really tricky, but we did get to a point where it’s now a lot easier to 3D print and assemble the device using simple, readily accessible tools.”
The pair worked closely with Gary Lynn during the development stage to optimise the design, which went through several iterations. An initial prototype featured a camelback but was scrapped for the current mounted cup-and-straw version.
Both Gary and his mother Andrea Lynn have expressed their hope that the project will bring attention to the struggles of people living with disabilities who can often strain with something as seemingly easy as drinking water.
Gary has said of Thomas and Rafe’s design: “This cup will give independence to people with limited mobility in their arms. Getting to do this little task by themselves will enhance the confidence of the person using the device.”
To help spread the word about RoboCup, Rafe and Thomas entered the device in the World Cerebral Palsy Day Remarkable Designa-thon competition intended to promote “ideas for a new product or service that could change lives” for people in the cerebral palsy community.
Sadly, RoboCup didn’t win. The prize went to a woman with cerebral palsy who developed an idea for an app that knows who she is, and where she is, and contains a list of her contacts for emergencies, allowing those with speech challenges to effectively communicate their needs to anyone.
Rafe said: “I’m glad the money is going to someone with cerebral palsy who has an important need to be met.”
That hasn’t stopped Rafe and Thomas from getting the word out about RoboCup.
But why did they decide to make their invention freely available rather than taking the entrepreneurial route?
Thomas said their goal had always been to bring it to as many people as possible, especially as they had neither the time nor the investment to commercialise it.
“Helping other people make their own is best,” he commented. “We have open-sourced the part files and code online, and everything else is available to buy from other vendors. After everything is printed, all it takes is a screwdriver and less than an hour to assemble Robocup – the instructions are also online with a few dozen pictures.
“The idea behind all of this effort is to enable others to make Robocup themselves, regardless of access to tools or machinery.
“The low cost, small size, and wide capabilities of a desktop 3D printer are bringing it into more and more households, as well as schools, labs, and maker spaces. There are also several online services that can print and ship 3D-printed parts.”
He added: “We hope the manufacturing process doesn’t prove too burdensome, as Rafe and I worked hard to make it as simple as possible. We do believe that the fully idealised version of this device is purchasable off the shelf to make it as easy as possible for the consumer.”
With graduation looming, Thomas and Rafe admit they are keen to move on to future endeavours. Rafe is going to work for SpaceX post-graduation and Thomas is planning to pursue a PhD in Neural Engineering.
That doesn’t mean if the RoboCup takes off, it might not become a commercial enterprise.
Thomas said: “Like I said before, Rafe and I have wanted to get the word out about RoboCup and move on, as we are graduating. We were potentially hoping that another organisation could take the reins on the RoboCup, or our open-source website could become popular.
“We mostly just wanted to get our work out there through open sourcing, but Rafe and I have more things to discuss in terms of making sure the RoboCup is successful, reaching as many people as possible.
“I personally am somewhat interested in turning it into a commercial enterprise if there is a clear path there, but I need to do more research.”
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