technology and caregiving

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Technology and Caregiving. Richard Schulz, Ph.D. University of Pittsburgh Computer-Based Technology and Caregiving for Older Adults, Spry National Conference, October 3, 2003. Tour de force of…. Creative ideas, products, applications, methodologies, issues, challenges - PowerPoint PPT Presentation

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  • Technology and CaregivingRichard Schulz, Ph.D.University of Pittsburgh

    Computer-Based Technology and Caregiving for Older Adults, Spry National Conference, October 3, 2003

  • Tour de force of

    Creative ideas, products, applications, methodologies, issues, challenges

    How does it all fit together?

  • Some common themeswhat have we achieved, where do we stand?The centrality of informationA philosophy for the application of technology to health and well-beingOutcomes measurementWell-defined problems as starting pointsIdentifying barriers Challenges

  • The Centrality of InformationMuch of technology is focused on Generatingsensory devices, telehealth (Alwan)CollectingPatient Safety Institute (Walker)OrganizingAtlantic Regional Commission (Schramm)TransmittingPiers study (Aversano)Interpreting(Aversano)Disseminating(Schramm)

  • Philosophical approachPerlinsafety, quality, patient centered, linkages and coordinationCobbimportance of care coordinatorregulates information flow among patient, family, and health care providerCantorprotecting privacy, who control information about self and othersIrvinetailoring and targeting

  • OutcomesSurvival (Aversano), Health (Lehman), functioningquality of life (VA)Health care utilization (VA Examples, Lehman)Cost analysis (Harrow, Whitten)Patient/Provider satisfaction (Whitten)You see it, hear about it, want it (Ackerman)

  • Well-defined and Ill-defined problemsCHF, Diabetes --(Lehman)Acute MI(Aversano)Nursebot(Matthews) multiple well-defined functions

    Caregiving

  • BarriersOlder persons and computers (Cobb)Utility trade-offsNext generation of older usersProvider Resistance-- (Whitten)Learning curve problem (Whitten)Changing definitions of professionalism (Cantor)

  • The ChallengesMethodologic IssuesConceptual IssuesEthical/Liability/Acceptability IssuesEvaluation Assessment Issues

  • Methodological issuesStudy designSample size and compositionStatistical power and analytic methodsReliability and validity of key measuresDelivery assessmentRole of technologyRelative value/cost-effectiveness

  • Conceptual issuesHow do you talk about technology across studies, applications,

    Develop taxonomy for characterizing technology-based interventionsWhittentype of information transmitted: data only, video and audio, video/audio plus data

  • Functions and Features

  • Ethical/Liability/Access Issues Technology facilitates decisions/behaviorsWho is responsible for wrong decisions/actions? Invasion of privacy By entering this home you agree to be under surveillanceHow much information do you want and how much are people willing to provide?

    Variability in access and usabilityenhance health disparities

    Technology can undermine functioning, adaptive capacity by providing too much support

  • Feasibility and usabilityTraining needsFactors that limit accessAdaptability to individual needs

  • Evaluating Technology The pocketbook vote as outcome

    Feasibility, Usability, Acceptability, Cost-effectiveness

    Conflicting Stake HoldersOlder personFamily memberHealth care providerInsurer

  • The information processing problem Capacity to generate vast amounts of informationposes profound data reduction interpretation challenges (the software problem)

    Too much, ambiguous/inconsistent, and unreliable informationRegulating information flowData reduction needs will vary for different user

    Potential for bad decisions, anxiety, distress, guilt, or alternatively, a false sense security

  • End

  • Caregiver InterventionsEducation on disease and available resources

    Training in problem solving; behavior and emotion management

    Counseling, case management

    Instrumental and emotional support

  • Care Recipient: Disability, Problem Behaviors, Physical and Social EnvironmentAppraisal of demands and adaptive capacitiesPerceived StressEmotional/ Behavioral ResponseMorbidity/MortalityStress-Health ProcessPharmacologic Treatment,Environmental ChangesSocial SupportSelf Care, Preventive Health PracticesCommunicationSkills TrainingEducationMulti-component interventions and their impact on the stress-health process

    Intervention Components

  • Key Questions:1. What types of technology have been used in caregiving interventions and how effective have they been?

    2. What are the limitations of the existing research in this area?

    3. What are the future opportunities for applications of technology to caregiving?

  • Review MethodologyData base searchesFeb. to Aug., 2002Medline 2966-2002PsychINFO 1967-2002CancerLIT1975-2002CinAHL 1982-2002Evidence-based databases 1991-2002Cochran Controlled Trials Register, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of EffectivenessTargeted journals: Journal of Telemedicine and Telecare, Telematics and Informatics

  • Inclusion/Exclusion CriteriaInclusion CriteriaPeer-reviewed journal reporting participant outcomesUsed technology to deliver intervention to older caregiver and/or older adult/patient coping with chronic physical illness or aging-related issuesExclusion CriteriaUsed technology as adjunct to non-tech. interventionFocused solely on personal assistive devicesTechnology incidental to intervention, not differentiated by treatmentFocused on older residents in long-term care facilities

  • Yield and Characteristics26 papers found reporting results of 22 non-overlapping studiesMethods: 8 (36%) randomized clinical trialsTargets: Caregivers only (23%), care recipients only (36%), both (41%)Conditions: Dementia (36%), hypertension, stroke, visually impaired,

  • Technologies UsedTelephone50%Internet14%Video/audio/computer 9%Various combinations including infrared sensing

  • Proximal goals of interventionsPercent

  • Primary outcomes of studiesImprove physical or psychosocial healthBurden, depression, emotional and relationship strain, activity restrictionUsability and satisfaction

    Promote independent functioning

    Development of assessment methods/tools

  • Current Applications

    Low-level adaptations of common objects, such as tableware and furnitureSocial support, technical assistance, and respite provided via telephone, videotape, and computersSophisticated monitoring of activity, location, and physical status through telemetric approaches

  • Caregiving and technologyUnique featuresInformation on demand quickly, across long distances, and tailored to needs of individuals and groupsIncreased access to health and social service professionalsAccess to multiple delivery modes (e.g., visual and auditory)Option of sender and/or receiver anonymity, facilitating the delivery of sensitive information

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