Daniele Sancarlo Laboratorio di Geriatria e Gerontologia, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG) Ausili tecnologici per persone con disabilità motorie e cognitive

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 The number and percentages of people in need of advanced assistive technology are increasing every year. About 3 million of Italians have a disability that affects one or more of their major life activities. In 2025, over 26% of the Italian population will be over 65 years of age, with one in two working adults serving as informal caregivers.

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 Services for the elderly based on health-enabling technologies promise to contribute significantly to the efficiency and effectiveness of future health care. Due to this promise, over the last years the scientific community has designed a complex variety of these valuable innovations to offer new possibilities for preventing health risks, managing chronic diseases, and providing support to elders and people with disabilities living independently.

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 L’anziano non è rappresentabile come una unica omogenea categoria. Sono necessari strumenti accurati per stratificare i pazienti sulla base della loro reale condizione. I metodi di valutazione monodimensionali appaiono solo in parte adeguati nell’affrontare questa tipologia di pazienti.

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 Frail individuals have greater nonspecific vulnerability and are more susceptible to adverse health outcomes, i.e. Hospitalization and Mortality Frailty: definition

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 La domotica è l’applicazione di tecnologia informatica e robotica alla casa col fine di migliorare: il comfort la quantità di servizi disponibili la sicurezza DOMOTICA

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 Rappresenta l’applicazione della tecnologia domotica all’assistenza di anziani e disabili con l’obiettivo di renderle più autonome, sicure, migliorando la qualità di vita e prolungando il più possibile la permanenza a domicilio riducendone l’istituzionalizzazione.GERONTOTECNOLOGIA: Campo interdisciplinare di ricerca di applicazioni tecnologiche orientate alle aspirazioni e opportunità delle persone anziane. DOMOTICA DI SUPPORTO

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 LE TECNOLOGIE UTILIZZATE Sensori per l’acquisizione di dati ambientali e di parametri fisiologici Valutare temperatura, umidità, presenza di fumi, Avvisare se viene lasciata l’acqua, la porta o il gas aperto etc. Tracciare la posizione del paziente identificando possibili comportamenti pericolosi Valutazione dei parametri vitali Identificare cadute o situazioni di agitazione

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – RFIDIDentificazione a Radio Frequenza RFID: IDentificazione a Radio Frequenza La lettura a distanza delle informazioni contenute in un’etichetta elettronica permette di: identificare oggetti e persone leggere informazioni relative alla storia clinica dei pazienti scrivere informazioni relative alle cure da effettuare …. determinare la posizione della persona all’interno della casa / struttura svolgere azioni senza interazione fisica (apertura porte, accensione luci, …)

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – Utilizzo di Sistemi per l’acquisizione di immagini Telecamere con sistema brevettato per il filtraggio dei dati e il riconoscimento di immagini. Il controllo degli ambienti sia all’interno che all’esterno della residenza / abitazione fornisce importanti informazioni per il sistema di valutazione degli eventi.

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 Ausili robotici  Facilitare e permettere di eseguire compiti basali della vita quotidiana  Utilizzo di semplici sistemi motorizzati per aiutare la persona ad alzarsi dalla sedia, alzare le tapparelle, chiudere la porta etc.  Prototipi di assistenti “umanoidi”

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – L’uso dell’Intelligenza artificiale La valutazione “intelligente” di eventi ambientali consente: monitorare con precisione situazioni di potenziale pericolo agire tempestivamente in caso di necessità

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 SMART HOME TECHNOLOGIES FOR HEALTH AND SOCIAL CARE SUPPORT (REVIEW) Inclusion criteria Randomised controlled trials (RCTs), quasi-experimental studies, controlled before and after studies (CBAs) and interrupted time series analyses (ITS). Participants Adults over the age of 18, living in their home in a community setting. Participants with a physical disability, dementia or a learning disability were included. Included interventions Social alarms, electronic assistive devices, telecare social alert platforms, environmental control systems, automated home environments Outcome measures Any objective measure that records an impact on a participant’s quality of life, healthcare professional workload, economic outcomes, costs to healthcare provider or costs to participant. Measures of service satisfaction, device satisfaction and healthcare professional satisfaction. Martin et al, The Cochrane Collaboration 2009

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 SMART HOME TECHNOLOGIES FOR HEALTH AND SOCIAL CARE SUPPORT (REVIEW) Main results No studies were identified which met the inclusion criteria Authors’ conclusions This review highlights the current lack of empirical evidence to support or refute the use of smart home technologies within health and social care, which is significant for practitioners and healthcare consumers.

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 European Commission Ambient Assisted Living Joint Programme ( ) The concept of Ambient Assisted Living is understood as:  to extend the time people can live in their environment by increasing their autonomy, self-confidence and mobility,  to support maintaining health and functional capability of the elderly individuals,  to promote a better and healthier lifestyle for individuals at risk, to enhance the security, to prevent social isolation and to support maintaining the multifunctional network around the individual. to support care givers, families and care organizations. to increase the efficiency and productivity of used resources in the ageing societies.

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 European Commission Ambient Assisted Living Joint Programme ( ) The objective of the AAL Joint Programme is: 1) to enhance the quality of life of older people and 2) strengthen the industrial base in Europe through the use of Information and Communication Technologies (ICT). The motivation of the new funding activity is in the demographic change and ageing in Europe, which implies not only challenges but also opportunities for the citizens, the social and healthcare systems as well as industry and the European market.

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 BESTA COMHOME PROSAFE SAFE-AT-HOME SEVEN OAKS ENABLE SOPRANO AMIGO KITE I SISTEMI SVILUPPATI E IN FASE DI REALIZZAZIONE

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 Smart Home for Elderly People (HOPE) è un progetto finanziato dalla comunità europea che ha come obiettivo il miglioramento della qualità della vita, incrementare l’indipendenza, monitorare la salute e rendere più facile la comunicazione alle persone anziane malate di Alzheimer utilizzando una piattaforma “intelligente” che permette di utilizzare sistemi tecnologici innovativi. Smart Home for Elderly People (HOPE)

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 Prevalenza di Demenza 6,4% > 65 anni In Italia i pazienti affetti da demenza sono oltre

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 Storia naturale della Demenza Gauthier S., Anni Sintomi cognitivi Perdita dell’autosufficienza Disturbi del comportamento Ricovero in strutture sanitarie Morte Pre-DA MCI Lieve-ModerataIntermediaGrave MMSE

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 Demenza: ambiti dei problemi MEMORIACOGNITIVITA’ DISABILITA’FUNZIONALE DISTURBI AFFETTIVI E DI COMPORTA- MENTO

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 Aim of the study To determine the needs and preferences of relatives/caregivers for improving the assistance of patients with Alzheimer Disease (AD), and guiding the technological development of the HOPE system

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 Methods I Parameters of patients 1. Date of birth, gender 2. Educational level : 1=elementary school 2=high school diploma 3=Graduate 3. Diagnosis of dementia (DSM-IV) 4. Severity of dementia according to the CDR 5. Time in which patient was at this stage (months) Cognitive assessment 1. Mini Mental State Examination (MMSE) 2. Clinical Dementia Rating (CDR) Parameters of relatives/caregivers 1.Date of birth 2.Gender 3.Educational level 1=elementary school 2=high school diploma 3=Graduate 4. Length of time care (in months) 223 relatives/caregivers of AD patients consecutively recruited at:  Geriatrics Unit, Casa Sollievo della Sofferenza, IRCCS, San Giovanni Rotondo, Italy  Andalusian Centre of Innovation, CITIC Foundation, Màlaga, Spain  CETEMMSA Technological Centre, Barcelona, Spain  KMOP non-profit Organization, Athens, Greece

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – ) A five-minute video on HOPE ICT-systems was showed 2) A 13-item questionnaire that evaluated the potential role of: A) the ICT-systems in improving quality of life, quality of care, and safety B) the devices for monitoring movements and medication use by patients as well as environmental conditions C) the devices used to improve the communication to the health-care center and/or caregivers, home-made rehabilitation program, reduction of specific risks D) the agreement in using ICT-systems by AD patients 3) Responses were expressed as: 1) Not useful at all 2) Low useful 3)Moderately useful 4)Very useful Methods II

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 Demographic and clinical characteristics of patients p (n = 115)(n = 85)(n = 23) Sex Males/Females45/7042/437/16 Males (%) Age (years) Mean ± SD79.03 ± ± ± 6.89 Range Educational level (1=Low educational level; 2=High School Diploma; 3=Degree) Mean ± SD1.24 ± ± ± 0.51 Range1 - 3 Grade of the Cognitive Impairment (1=Early stage; 2=Advanced; 3=Vary advanced) Mean ± SD1.90 ± ± ± 0.79 Range1 - 3 How long time is the patient in this stage? (months) Mean ± SD17.31 ± ± ± Range

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 Characteristics of relatives and caregivers of the patients p (n = 115)(n = 85)(n = 21) Sex Males/Females43/7214/715/16 Males (%) Age (years) Mean ± SD59.6± ± ±15.3 Range – 78 Educational level (1=Low educational level; 2=High School Diploma; 3=Degree) Mean ± SD1.51± ± ± 0.64 Range1 – Lenght of time care in months Mean ± SD27.8 ± ± ± 12.3 Range

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 A) To what extent do you think that user-friendly high- technology systems could be useful in order to:

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 B) To what extent do you think that the following support devices could be useful for the patient:

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 C) To what extent do you think that high-technology devices for improving visual and sound direct communications between patient and relatives/caregivers or medical centre could be useful in order to:

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 Results according to the severity of the cognitive impairment  Early stage (MMSE scores 24-18): 41 elderly patients (M=16, F= 25, mean age 76.1 ± 6.8 years, range 65 – 97 years)  Advanced (MMSE scores 10-18): 44 elderly patients (M=16, F= 28, mean age 79.7 ± 5.1 years, range 72 – 91 years)  Very advanced (MMSE scores < 10): 30 elderly patients (M=13, F= 17, mean age 82.1 ± 4.8 years, range 72 – 93 years

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 A)To what extent do you think that high-technology systems could be useful in order to: 1. Improve the quality of life of patient

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 A)To what extent do you think that high-technology systems could be useful in order to: 2. Improve the quality of care that you provide to the patient

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 A)To what extent do you think that high-technology systems could be useful in order to: 3. Improve the safety of patient in the activities of daily living

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 B) To what extent do you think that the following support devices could be useful for the patient: 1. Devices for monitoring bed-rest and movements of patients, such as integrated video/sound systems and imbalance sensors, inside of his/her home to reduce the risk of falls

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 B) To what extent do you think that the following support devices could be useful for the patient: 2. Devices for monitoring the medication use, such as pill dispenser and/or time schedule reminder systems to avoid errors in drug use by the patient

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 B) To what extent do you think that the following support devices could be useful for the patient: 3. Devices for monitoring the ambient environmental conditions, i.e. security systems to control temperature, gas, smoke, lights, humidity, entrance-exits of main doors.

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 C) To what extent do you think that high-technology devices for improving visual and sound direct communications between patient and relatives/caregivers or medical centre could be useful in order to: 1. Carry out emergency communication “alert” messages

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 C) To what extent do you think that high-technology devices for improving visual and sound direct communications between patient and relatives/carers and/or medical centre could be useful in order to: 2. Improve the care provided to the patient by home-based physical and/or cognitive rehabilitation programs

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 C) To what extent do you think that high-technology devices for improving visual and sound direct communications between patient and relatives/caregivers or medical centre could be useful in order to: 3. Develop tailored interactive prevention programs to reduce specific risks, i.e. urinary incontinence, dehydration, panic attacks

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 Results according to the age of the patients  years: 28 patients (M=17, F=11)  years: 67 patients (M=21, F=46)  ≥ 85: 20 patients (M=7, F=13)

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 A) To what extent do you think that high-technology systems could be useful in order to:

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 B) To what extent do you think that the following support devices could be useful for the patient:

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 C) To what extent do you think that high-technology devices for improving visual and sound direct communications between patient and relatives/caregivers or medical centre could be useful in order to:

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 Results according to the age of the caregivers  years: 52 caregivers (M=16, F=36)  years: 37 caregivers (M=11, F=26)  ≥ 75: 26 caregivers (M=16, F=10)

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 A) To what extent do you think that high-technology systems could be useful in order to:

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 B) To what extent do you think that the following support devices could be useful for the patient:

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 C) To what extent do you think that high-technology devices for improving visual and sound direct communications between patient and relatives/caregivers or medical centre could be useful in order to:

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 Results according to the educational level of the caregivers  Basic educational : 77 caregivers (M=19, F=58)  High school diploma: 17 caregivers (M=14, F=3)  University Degree: 21 caregivers (M=10, F=11)

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 A) To what extent do you think that high-technology systems could be useful in order to:

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 B) To what extent do you think that the following support devices could be useful for the patient:

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 C) To what extent do you think that high-technology devices for improving visual and sound direct communication between patient and relatives/caregivers or medical centre could be useful in order to:

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 HOPE-Questionnaire by Italian, Spanish and Greek groups. A) To what extent do you think that high-technology systems could be useful in order to: p Yes, very useful N (%) Improve the quality of life of patient58 (50.4)28 (32.9)13 (56.5) 2. Improve the quality of care that you provide to your patient 68 (59.1)28 (32.9)13 (56.5) Improve the safety of patient in the daily living activities82 (71.3)36 (42.4)14 (60.9)0.000

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 HOPE-Questionnaire by Italian, Spanish and Greek groups B) To what extent do you think that the following support devices could be useful for the patient p Yes, very useful N (%) Devices for monitoring bed-rest and movements of the patient, such as integrated video/sound systems and imbalance sensors, inside of his/her home to reduce the risk of falls 67 (58.3)45 (52.9)17 (73.9) 2. Devices for monitoring the medication use, such as pill dispenser and/or time schedule reminder system, to avoid errors in drug use by the patient 99 (86.1)36 (42.4)16 (69.6) Devices for monitoring the ambient environmental conditions, (i.e. security systems to control temperature, gas-smoke, lights, humidity, entrance-exits of main doors etc.) to improve the safety and wellness of patient 111 (96.5)26 (30.6)19 (82.6)0.000

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 HOPE-Questionnaire by Italian, Spanish and Greek groups C) To what extent do you think that high-technology devices for improving visual and sound direct communications between patient and relatives/caregivers or medical centre could be useful in order to: p Yes, very useful N (%) Carry-out emergency communication “alert” messages104 (90.4)43 (50.6)18 (78.3) 2. Improve the care provided to patient by home-based physical and/or cognitive rehabilitation programs 22 (19.1)19 (22.4)6 (26.1) Develop tailored interactive prevention programs to reduce specific risks, i.e. urinary incontinence, dehydration, panic attacks 14 (12.2)23 (27.1)11 (47.8)0.000

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 HOPE-Questionnaire by Italian, Spanish and Greek groups D) To what extent do you think that the patient will agree to use the following high-technology systems for 1) daily assistance in the home: reminder to take medicines, a tracking mechanism to find easily personal objects, i.e. keys, teeth, purse or glasses. p N (%) Video system 83 (72.2)44 (52.8)14 (60.9) Sound system 66 (57.4)58 (68.2)19 (82.6) Movement sensors 65 (56.5)62 (72.9)14 (60.9) Electronic dispencers 95 (82.6)61 (71.8)17 (73.9) Time-schedule reminders 87 (75.7)66 (77.6)14 (60.9) Related ambient control 83 (72.2)66 (77.6)16 (69.6) 0.600

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 HOPE-Questionnaire by Italian, Spanish and Greek groups D) To what extent do you think that patient will agree to use the following high-technology systems for: 2) monitoring and tracking patient and his movements in the house or in case of wandering outside by a mechanism to find easily the way back home etc. p N (%) Video system 71 (61.7)45 (52.9)15 (65.2) Sound system 49 (42.6)55 (64.7)17 (73.9) Movement sensors 69 (60.0)67 (78.8)18 (78.3) Electronic dispencers 1 (0.9)54(63.5)8(34.8) Time-schedule reminders 46 (40.0)60 (70.6)8 (34.8) Related ambient control 2 (1.7)55 (64.7)7 (30.4) 0.000

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 HOPE-Questionnaire by Italian, Spanish and Greek groups D) To what extent do you think that the patient will agree to use the following high-technology systems for: 3) Entertainment, mind games (i.e. showing pictures of family members), a reminder for favourite tv programmes. p N (%) Video system 74 (64.3)69 (81.2)21 (91.3) Sound system 70 (60.9)68 (80.0)22 (95.7) Movement sensors 0 (0)57 (67.1)9 (39.1) Electronic dispencers 1 (0.9) 51 (60.0)8 (34.8) Time-schedule reminders 2 (1.7)57 (67.1)13 (56.5) Related ambient control 2 (1.7)53 (62.4)9 (39.1) 0.000

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 HOPE-Questionnaire by Italian, Spanish and Greek groups D) To what extent do you think that the patient will agree to use the following high-technology systems for: 4) An easy way to communicate to family/ caregivers/professional with a very easy to use “touch screen” with pictures and names of the family members. p N (%) Video system 82 (71.3)70 (82.4)21 (91.3) Sound system 80 (69.6)72 (84.7)19 (82.6) Movement sensors 32 (27.8)56 (65.9)12 (52.2) Time-schedule reminders 45 (39.1)58 (68.2)13 (56.5) 0.000

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 The “HOPE” Questionnaire CONCLUSIONS Relatives and caregivers of elderly patients with cognitive impairment and AD reported as “very useful” those technology solutions that may help patients to achieve a more independent life-style Most of patients agree to use high technology systems to improve autonomy, quality of life and safety

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 Older and low educated relatives/caregivers had higher expectations on the possible role of ICT-systems in improving the management of AD patients. Relatives/caregivers considered that HOPE ICT- systems could be useful to improve the management of AD patients, especially if they are aged years and with moderate dementia. Conclusions

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 Comprehensive Geriatric Assessment (CGA) 1. Functional (ADL, IADL) 2. Nutrition (MNA) 3. Comorbidity (CIRS-CI) ; drug use 4. Social support network (co-habitation) Cognitive and Affective assessment 1. Mini Mental State Examination 2. Hamilton Rating Scale (HAM-D) 3. Geriatric Depression Scale (GDS) Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q)  58 items that explore five areas: - physical health (13 items); subjective feelings (14 items); leisure activities (6 items) - social relationships (11 items); general activities (14 items)  2 items on appreciation and an overall satisfaction  Rate: 5-point scale Endicott J, et al. Psychopharm Bull 1993;29:321 Informed Consent Multidimentional and Quality of Life Assessment

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 Final impressions by the End Users  The HOPE system is not invasive  The system appears to be user-friendly  They feel themself more safe at home  They appreciate especially the videocall system  Information on how monitoring the activities of the sensors are working or not  They have high expectatives (but they are not sure) that the HOPE system will improve their quality of life

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 Installazioni dei prototipi ITALY2 installations, 1 in a private home and 1 in a geriatric residence in San Giovanni Rotondo (1 man and 1 woman) GREECE1 installation completed and 2 installations in December all in private houses in Athens (1 man and 2 woman) SPAIN1 installation in the common rooms of a geriatric residence in Malaga (multiple users)

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – HOPE: pianta della casa e device implementati

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 Informatica medica Nasce negli anni 50 quando vi sono stati i primi tentativi di applicazione delle tecnologie informatiche alla Medicina. 1966: negli Stati Uniti Medline. 1976: European Federation for Medical Informatics. Una delle definizioni risulta: ‘ …un campo scientifico in rapido sviluppo che riguarda l’immagazzinamento, l’estrazione e l’utilizzo ottimale di informazioni biomediche, dati e conoscenze finalizzate alla risoluzione dei problemi e al processo decisionale’. (Shortliffe and Perrault,1990)

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 Gunther Eysenbach’s diagram 1999

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 Negli ultimi 10 anni vi è stato un incremento esponenziale delle applicazioni in ambito medico e delle pubblicazioni ad esso associato dovuto allo sviluppo tecnologico e alla vasta diffusione di tecnologie a basso costo. Recentemente l’FDA ha stimato in un bilancio presentato alla Regulatory Affairs Professional Society che sono presenti 17,828 health and fitness apps e 14,558 medical apps. Background

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 Rappresentano degli ausili software e/o hardware sviluppati su diverse piattaforme e con diversi approcci d’interazione che hanno lo scopo di facilitare e/o permettere determinate azioni finalizzate al miglioramento della pratica clinica che possono essere indirizzati sia al medico che al paziente e/o care-giver. Strumenti informatici in medicina

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 Strumenti informatici in medicina 1)Gestire eventi avversi Chiamate d’emergenza, rilevazione automatica di comportamenti anomali, cadute e alterazioni dei parametri vitali. Prevenzione di situazioni potenzialmente pericolose. 2) Monitorare lo stato di salute Riscontro di conosciute e sconosciute malattie e condizioni cliniche. Monitoraggio degli interventi terapeutici. 3) Consulto e formazione 4) Motivazione e feedback 5) Richiesta servizi 6) Inclusione sociale

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 I livello (monodimensionali) Strumenti per la gestione clinica del paziente che includono il riconoscimento vocale, diari clinici, test clinici etc. Consultazione e-book e ipertesti Valutazione delle interazioni farmacologiche e valutazione dell’aderenza al trattamento II livello (multidimensionali) Supporto decisionale clinico Smart Home Robotica assistiva di supporto Telemonitoraggio di situazioni complesse Strumenti informatici in medicina

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 Per il paziente I)Monitoraggio terapeutico (PA, glicemia, INR, valutazione dell’aderenza, pill reminder) II)Sistemi di monitoraggio ambientale e clinico intelligenti “smart home” III)Consulto telematico e riabilitazione virtuale domiciliare

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 I)Migliorare la salute del paziente II)Ridurre i rischi III)Ridurre i costi IV)Incrementare l’efficienza del sistema Vantaggi

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 I)Possibilità di implementare modelli matematici complessi in modo semplice e intuitivo II) Accesso in tempo reale ad ampie basi di dati biomediche basate sulle evidenze e aggiornate continuamente e linee guida III) Segnalazioni automatizzate sulle possibili interazioni, sull’ appropriatezza, precedenti ADR o utilizzo non congruo dei farmaci. IV)Incrementare l’efficienza della gestione dei pazienti attraverso dei database V) Monitoraggio dei parametri vitali di interesse Vantaggi

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 Risk factors of 1-year mortality in 838 hospitalized elderly patients Risk factors Standardized β coefficient OR95% CIp value Age ADL (Activities of daily living) IADL (Instrumental-ADL) SPMSQ (Mental Status) CIRS (Comorbidity) Number of drugs MNA (Nutrition) ESS (Pressure sore risk)

Physical domainMalesFemales Total Physical health Weight loss Difficulty in walking Difficulty in balance Poor hearing Poor vision Strenght in hands Physical tiredness Psychological domain Problems in memory Feeling down Feeling nervous/anxious Social domain Living alone Social relations Social support it is essential to divide the concept of frailty into domains. These domains appear to aggregate together and share a common underlying construct. Frailty is a multidimensional concept Determinants of Frailty 484 community-dwelling persons > 75 years; self-report questionnaire

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – Activities of Daily Living (ADL) 6 items - Instrumental Activities of Daily Living (IADL) 8 items - Short Portable Mental Status Questionnaire (SPMSQ)10 items - Mini-Nutritional Assessment (MNA) 18items - Exton-Smith Scale 5items - Cumulative Illness Rating Scale_comorbility (CIRS) 14items - Number of drugs 1 - Social index 1 TOTAL63items Development and Validation of a CGA-based Multidimensional Prognostic Index (MPI) MildModerateSevere SCORE 0.18    0.08 RANGE M. P. I. Pilotto & Ferrucci, Rejuvenation Res 2008; 11:

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 The Multidimensional Approach to the Older Patient with Chronic Kidney Disease Alberto Pilotto, Daniele Sancarlo, Marilisa Franceschi, Massimiliano Copetti, Piero D’Ambrosio, Carlo Scarcelli, Luigi Ferrucci Multidimensional Prognostic Index Based on a Comprehensive Geriatric Assessment Predicts Short-Term Mortality in Older Patients With Heart Failure Alberto Pilotto, Filomena Addante, Marilisa Franceschi, Gioacchino Leandro, Giuseppe Rengo, Piero D’Ambrosio, Maria Grazia Longo, Franco Rengo, Fabio Pellegrini, Bruno Dallapiccola and Luigi Ferrucci Circ Heart Fail 2010; 3: A Multidimensional Prognostic Index (MPI) based on a comprehensive geriatric assessment predicts short- and long-term all-cause mortality in older hospitalized patients with transient ischemic attack Daniele Sancarlo Andrea Pilotto Francesco Panza Massimiliano Copetti Maria Grazia Longo Piero D’Ambrosio Grazia D’Onofrio Luigi Ferrucci Alberto Pilotto J Neurol 2012; 259 (4):

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 Schocken, Circulation Heart Fail 2010: 3: 2-3 Prognosis of Heart Failure in the Elderly Not an Affair of the Heart? Douglas D. Schocken, MD Editorial What is the real message here? Is there actually something new under the sun? ….this focus on geriatric factors is a commendable step forward What is the practical utility of this new instrument? …Weighting the risk according to the MPI would be very helpful in setting the direction of the clinical plans toward comfort care and compassionate end-of-life plans or more aggressive care … MPI speaks of the powerful impact of frailty… the end of the road is a common pathway when the frail elderly meet acute decompensation of chronic systemic illness

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 Trajectories of Disability in the Last Year of Life: conditions leading to death p< community-dwelling older, F=59.8%, mean age=84.4±5.8, Monthly interviews, CGA at 18-month intervals, Follow-up=10 years 754 community-dwelling older, F=59.8%, mean age=84.4±5.8, Monthly interviews, CGA at 18-month intervals, Follow-up=10 years Gill et al, NEJM 2010; 362: p<0.001 %

92 Progetto di formazione sul campo CARTELLA INTEGRATA MEDICO-INFERMIERISTICA E VALUTAZIONE MULTI-DIMENSIONALE PER IL PAZIENTE ANZIANO FRAGILE IN OSPEDALE

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 Anamnesi clinica / Farmaci FARMACI Diagnosi principale / Comorbidità (ICPC) COMORBIDITA’ Valutazione Infermieristica VIP SVaMA: Scheda di VAlutazione Multidimensionale dell’Anziano Scheda VALUTAZIONE SANITARIA Scheda VALUTAZIONE FUNZIONALE ADL (Activities of Daly Living) V.ADL Barthel MOBILITÀV.MOB SPMSQ (Short Portable Mental Status Questionnaire) V.COG Scala di Exton-Smith (rischio lesioni da pressione) V.PIA ADL (Activities of Daly Living) V.ADL Barthel MOBILITÀV.MOB SPMSQ (Short Portable Mental Status Questionnaire) V.COG Scala di Exton-Smith (rischio lesioni da pressione) V.PIA Scheda VALUTAZIONE SOCIALE Profilo di Autonomia Indice di Rischio di Mortalità / Istituzionalizzazione Profilo di Autonomia Indice di Rischio di Mortalità / Istituzionalizzazione Dimensioni V.SOC

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – Assistenza Infermieristica (VIP)11 items 2. Exton-Smith Scale (V_PIA) 5 items 3. Activities of Daily Living (V_ADL) 6 items 4. Barthel Index (V_MOB) 10 items 5. Short Portable Mental Status Questionnaire (V_COG)10 items 6. Social Index (V_SOC) 3 items Totale45 items + ETA’ + SESSO + PATOLOGIA PRINCIPALE (demenza,neoplasie,fratture, ictus, cardiovas, resp, neurol, s.ipocinetica, altro) 1. Assistenza Infermieristica (VIP)11 items 2. Exton-Smith Scale (V_PIA) 5 items 3. Activities of Daily Living (V_ADL) 6 items 4. Barthel Index (V_MOB) 10 items 5. Short Portable Mental Status Questionnaire (V_COG)10 items 6. Social Index (V_SOC) 3 items Totale45 items + ETA’ + SESSO + PATOLOGIA PRINCIPALE (demenza,neoplasie,fratture, ictus, cardiovas, resp, neurol, s.ipocinetica, altro) Development and Validation of a MPI-SVaMA MPI-SVaMA MildModerateSevere RANGE HR (95%CI) 1.0 Ref.6.05 ( ) 26.01( ) MildModerateSevere RANGE HR (95%CI) 1.0 Ref.6.05 ( ) 26.01( ) MPI-SVaMA Pilotto SIGG Nov 2011

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – Year Mortality by MPI-SVAMA in community-dwelling olders. Development cohort and Validation cohort ( years) patients, M=2.909, F=4.967, mean age=81.8, range= years patients, M=1.506, F=2.638, mean age=81.8, range= years Mortality 1 monthC-Index C-LowerC-Upper Development Cohort0,8270,8170,837 Validation Cohort0,8320,8180,845 Mortality 1 yearC-Index C-LowerC-Upper Development Cohort0,7910,7840,798 Validation Cohort0,7920,7830,801 Institutionalization 1 monthC-Index C-LowerC-Upper Development Cohort0,7980,7870,809 Validation Cohort0,7830,7680,799 Institutionalization 1 yearC-Index C-LowerC-Upper Development Cohort0,7870,7790,795 Validation Cohort0,7790,7680,790

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 MPI-SVaMA

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 Evidenze Home Telehealth for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis. J. Franek. Ontario Health Technology Assessment Series; Vol. 12: No. 11, pp. 1–58, March 2012 No significantly reduction of outcomes considered. Trend show a reduction of hospitalization. Evidence-Based Strategies for the Optimization of Pharmacotherapy in Older People. E. Topinkova Drugs Aging 2012; 29 (6): There is sufficient evidence that implementation of computerized decision-making support programs can significantly but modestly reduce prescribing errors across multiple healthcare settings. An Electronic System to Document Reasons for Medication Discontinuation and to Flag Unwanted Represcriptions in Geriatric Patients. Carolien M. J. Drugs Aging DOI /s y Encouraging data about automatic signalation of ADR and motivations. Effect of a centralized prescription network on inappropriate prescriptions for opioid analgesics and benzodiazepines. Colin R. CMAJ November 6, 2012 vol. 184 no. 16 First published September 4, 2012, doi: /cmaj % and 42.4% relative reduction respectively in inappropriate prescriptions for opioids and benzodiazepines after PharmaNet was implemented

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 Evidenze Use of accelerometry to measure physical activity in adults and the elderly BentoT. Rev Saúde Pública Smart Home Technologies for health and social care support. Martin et al, The Cochrane Collaboration 2009 Technology to enhance physical rehabilitation of critically ill patients.Needham DM. Crit Care Med Oct;37(10 Suppl):S Robot-assisted practice of gait and stair climbing in nonambulatory stroke patients. Hesse S, J Rehabil Res Dev. 2012;49(4): Telehealth for persons with severe functional disabilities and their caregivers: facilitating self-care management in the home setting. Forducey PG. Psychol Serv May;9(2):

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 Le tecnologie applicate alla medicina appaiono promettenti come ausilio nell’attività clinica. Le evidenze attuali tuttavia non permettono ancora di consigliare in modo obiettivo e secondo “linee guida” l’utilizzo su larga scala di queste applicazioni. Inoltre per la maggior parte di queste non è presente attualmente un ente di validazione e autorizzazione. Conclusioni

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 Nessuno strumento può attualmente sostituire il medico. Tuttavia queste applicazioni possono, se vagliate criticamente, migliorare la salute pubblica con benefici evidenti sin da subito sui pazienti e sui medici stessi. Conclusioni

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 Futuro Watson che è un sistema ideato dalla IBM gestito dal software DeepQA e che permette di comprendere e analizzare il linguaggio umano ma non solo, attualmente sta venendo testato a scopi medici presso l’università di medicina di Cleveland allo scopo di potenziare le funzionalità della tecnologia di Deep Question Answering in campo medico, potrebbe essere il primo gradino verso un avvicinarsi ad una zona di confine dove si potranno aprire molteplici e interessanti scenari di confronto.

Progetto BAITAH FORMAZIONE – OF 1 – PON 01_00980 PON R&C 2007 – 2013 Grazie per l’attenzione