Freed by gadgetry?

Innovative firms are latching on to the fact
that there is a growing market for products and systems that boost
older people’s independence. But do they work, asks Ruth
Winchester.

Until recently, approaching old age meant
accepting that you would lose a large part of your independence.
Fortunately, as the population ages and the number of older people
grows, more use is being made of technology to sustain quality of
life. And the new wave of equipment promises to be more
user-friendly, and cost less than previous items.

Designers are now donning “old age suits” to
find out what impact stiff joints and failing eyesight will have on
the use of devices such as mobile phones and cars. And companies
are putting all manner of innovative equipment onto the market
designed to help older people stay mobile, in touch and safe.

One major development is smart homes – the use
of sophisticated built-in technology to ensure people are safe
while living alone. But these smart homes can be expensive and
inflexible, and living in them may prove a bit too Big Brother for
some.

A more promising compromise, and one being
investigated in a ground-breaking study in West London, is the use
of items incorporating relatively low-cost, portable technology.
These devices range from pressure mats which alert carers when
someone gets out of bed, to fall detectors and health monitors
which generate an alarm if someone falls or gets too cold.

The New Technology in Elderly Care (NTEC)
Project involves the London boroughs of Ealing and Hammersmith and
Fulham, and Charing Cross Hospital’s department of medicine for the
elderly.

Frank Miskelly, consultant physician at
Charing Cross hospital, says that NTEC’s starting premise was a
healthy scepticism about the usefulness and reliability of the
devices tested. And, he says: “It’s just as well we did start from
that position. Our experience is that very few of these pieces of
equipment behave as the manufacturers say they will.”

The project borrowed or bought equipment from
a range of manufacturers, and the testing was conducted in a range
of settings, including sheltered accommodation, residential and
nursing homes, and in people’s own homes. Anyone over 65 could be
involved, although participants had to consent to the testing and
so people with advanced dementia were excluded. Intial assessments
were carried out by volunteers or social services and health
staff.

The project will report this spring. Initial
results suggest that while the devices show great promise, most are
not ready for large scale, off-the-shelf distribution, although
many are already on sale.

But there have been some notable sucesses.
Pressure mats tested in sheltered and residential accommodation
were found extremely useful by care staff. These mats lie under a
mattress and send an alarm to the nurses’ station when someone gets
out of bed, which means someone can be present very quickly to help
avoid falls. The mats are now being tested by people living in the
community with their carers, and initial findings show that carers
are able to sleep better because they do not have to be constantly
vigilant in case their relative gets up.

A television link system was one of the most
expensive devices tested, at £1,500. Older people had a camera
link set up in their home, rigged so that whenever they rang a
particular person’s number, a television fired up and showed a live
picture of the person at the other end, and vice versa. Up to eight
cameras can be installed, and if a relative calls and the older
person does not pick up the phone within five rings the camera
system starts automatically. The caller can then pan, tilt and zoom
the cameras to see whether their relative is in trouble.

After a lot of initial technical trouble, this
arrangement proved extremely popular with older people. According
to Miskelly: “It stops people feeling isolated, and stops relatives
worrying about whether something has happened, whether they’ve
fallen or whatever. That’s really significant, because a lot of
older people end up moving into nursing homes because of pressure
from worried relatives.”

Other devices presented more of a problem.
Three fall detectors were tested – small units, about the size of a
pager, which are worn on a belt and generate an alarm if someone
falls. But only one was found to be of any use, and even that
needed more work to be viable. The main problem was false alarms –
some went off every time the wearer turned around or bent forward.
Many older people also found them uncomfortable and inconvenient.
The detectors are still in testing, but the NTEC results clearly
suggest more work needs to be done on both the technology and the
“wearability” factor.

This is a pity, because a reliable fall
detector could improve many older people’s quality of life. One
rule of thumb is that older people have to spend an extra day in
hospital for every hour they spend on the floor after a fall, so
generating an immediate alarm could vastly reduce hospital
admissions and length of stay. And, according to Geraldine O’Shea,
sheltered housing manager for Ealing Council social services:
“Sometimes people worry about doing things in case they fall,
perhaps because they know there’s no one coming to see them until
the next morning. A good fall detector would give them peace of
mind that someone will come immediately if they do.”

The NTEC project has also looked at hip
protectors, health-monitors and chair alarms. All of these have
shown potential, but have hitches which mean they are currently not
really suitable for wide-scale distribution.

Hip protectors – similar to cycling shorts
with padded sections – were found to work brilliantly, if only
people would wear them. Testers found that they were tight and
difficult to get on and off, making it impossible for elderly
people with limited mobility or weaker hands, and a constant
nuisance for people who need to use the toilet often.

Health monitors – a wristwatch device which
measures skin temperature, sweating and movement – show great
promise. However, they are prone to going off at 2am after the
wearer has been lying still for a while, and there were problems
with linking the device to a community alarm system.

Chair alarms – a basic pressure sensor allied
to an alarm unit on the arm of the chair – were found to be
extremely useful after a bit of DIY modification. Care assistants
were able to be at someone’s side within seconds of them getting
up, helping to prevent falls.

NTEC has thrown up a number of unexpected
results – including one care home resident who was thought to have
been completely bed-ridden for years until a mattress pressure mat
revealed she was regularly getting up three times per night to walk
to the toilet on her own.

The project has revealed both how useful
technology can be, and how much more research and testing needs to
be done before most devices can be put into general service.

The government is in the process of spending
£900m on intermediate care and related services designed to
“promote independence and improve quality of care for older people”
as part of the NHS Plan.¹ One part of this is the
proposal to enable “50 per cent more people” to benefit from
assistive technology, including more sophisticated equipment “such
as fall alarms and remote sensor devices.”

The government’s aims are laudable and
probably financially sound. It is clearly vital that older people
are involved in the development of these devices and that the
technology is assisting people, rather than taking over. But NTEC’s
experience suggests that minor and relatively inexpensive home
adaptations and bits of kit might in future make it possible for
people to stay independent for much longer. When compared with the
cost of other home adaptations – such as a stairlift at £4,000
– these devices seem like very good value for money.

So far the project has been funded using the
social services modernisation grant, and a modest £60,000 has
been spent, including salaries and hire or purchase of equipment.
Their first year of funding runs out at the end of March, and while
Miskelly and O’Shea are confident that further funding will be
forthcoming, they are arguing that further research should be
conducted – and funded – nationally.

For further information on NTEC contact
Christophe Heintzeler, project co-ordinator, on 020 8758 5997.

¹ Department of Health,
NHS Plan, Dignity Security and Independence in Old Age,
par 15.14, Stationery Office, 2000, available at www.nhs.uk/nhsplan  

Do you have any experience of using new
technology to help older people? Or would you like to know more
about a particular aid? We would like to receive your views and
questions, which Frank Miskelly, consultant physician at Charing
Cross hospital, will answer. Have your say by e-mailing us at:
comcare.haveyoursay@rbi.co.uk
by 30 January. Your comments will be posted on the site on 5
February.