Home automation for the elderly and disabled

Telehealth is the use of electronic technology services to provide patient care and improve the healthcare delivery system. The term is often confused with telemedicine, which specifically involves remote clinical services of healthcare delivery. Telehealth is the delivery of remote clinical and non-clinical services of healthcare delivery. Telehealth promotes the diagnosis, treatment, education, and self-management away from health care providers and into people’s homes.[3]

The goal of telehealth is to complement the traditional healthcare setting. There is an increased demand on the healthcare system from a growing elderly population and shortage of healthcare providers.[4] Many elderly and disabled patients are faced with limited access to health care and providers. Telehealth may bridge the gap between patient demand and healthcare accessibility.[4] Telehealth may also decrease healthcare costs and mitigate transportation concerns.[5] For the elderly and disabled populations, telehealth would allow them to stay in the comfort and convenience of their homes.[6]

Geriatrics is the role of healthcare in providing care to the elderly population. The elderly population involves many health complications. According to the National Institute of Health, “the main threats are non-communicable diseases, including heart, stroke, cancer, diabetes, hypertension, and dementia”. Telehealth may help provide management and monitoring of chronic disease in patient homes.[6]

One telemonitoring device measures vital signs: blood pressure, pulse, oxygen saturation, and weight.[6] Another telemonitoring device is video-conferencing, which can provide patient-provider consultation and electronic delivery of medication instructions and general health information.[7] Some studies have been done to analyze the effectiveness of telehealth on the elderly population. Some have found positive telehealth effects including reduction of symptoms and self-efficacy in the elderly population with chronic conditions.[8] Other studies have found the opposite effect, where telehealth home care produced greater mortality than the traditional hospital setting.[9] Then there are other studies that have found inconclusive results.

Persons with severe functional disabilities are statistically the highest users of all health care services and represent a large portion of health care costs and designated service. The disabled population requires many self-monitoring and self-management strategies that place a strenuous burden on healthcare providers. Telecommunications technologies may provide a way to meet the healthcare demands of the disabled population. According to the National Institutes of Health, “the largest proportion of health care… result from individuals with severe functional disabilities, such as stroke and traumatic brain injury”.[10] Patients with functional disabilities may benefit from telehealth care. According to the World Health Organization, functional limitation refers to the physical or mental conditions, which impair, interfere with, or impede one or more of the individual’s major life activities and instrumental activities of daily living.[11] Patients suffering from spina bifida, musculoskeletal disorders, mental illness, or neurological disorders may also benefit from telehealth care services. Telehealth technologies include vital sign telemonitoring devices, exercise routines, problem-solving assessments, and therapeutic self-care management tasks.[10] Telehealth care, however, is not sufficient in complete care but rather a supplement of separate care.

Concerns of telehealth implementation include the limited scope of research that confirm conclusive benefits of telehealth in comparison to the healthcare setting. Currently there is no definitive conclusion that telehealth is the superior mode of healthcare delivery.[12] There are also ethical issues about patient autonomy and patient acceptance of telehealth as a mode of healthcare. Lack of face-to-face patient-provider care in contrast to direct care in a traditional healthcare setting is an ethical concern for many.[13]

In 2015 the Texas Medical Board ruled that state physicians had to physically meet patients before remotely treating ailments or prescribing medication. The telemedicine company Teladoc sued[14] over the rule in Teladoc v. Texas Medical Board, arguing the bill violated antitrust laws[15] by inflating prices and limiting the supply of health care providers in the state. The bill, meant to go active on June 3, 2015, was then stalled.[14] Teladoc voluntarily dropped the lawsuit in 2017 after Texas passed a new bill allowing for remote treatment without a prior in-person interaction, which Teladoc Health had lobbied heavily for.[15] On September 15, 2017, the Texas Medical Board amended its regulations to allow state-licensed healthcare providers to care for patients without required face-to-face interaction,[16] potentially affecting up to 28 million patients in Texas.[16]

These simple systems and tools include personal alarm systems and emergency response telephones that do not have to be integrated into a smart home system.[17] A typical system consists of a small wireless pendant transceiver to be worn around the neck or wrist. The system has a central unit plugged into a telephone jack, with a loudspeaker and microphone. When the pendant is activated a 24-hour control center is contacted. Generally the 24 hour control center speaks to the user and identifies that help is required e.g. Emergency services are dispatched. The control center also has information of the user, e.g. medical symptoms, medication allergies, etc. The unit has a built in rechargeable battery backup and the ability to notify the control center if the battery is running low or if the system loses power. Modern systems have active wireless pendants that are polled frequently advising battery, and signal strength status as older style pendant could have a battery that has failed rendering the pendant useless when required in an emergency.

These systems and tools generate alarms and alerts automatically if significant changes are observed in the user's vital signs.[17] These systems are usually fully integrated into a home network and allow health professionals to monitor patients at home. The system consists of an antenna that a patient holds over their implanted cardiac device to transmit data for downloading over the telephone line and viewing by the patient’s physician. The collected data can be accessed by the patient or family members. Another example of this type of system is a Smart Shirt that measures heart rate, electrocardiogram results, respiration, temperature and other vital functions and alerts the patient or physician if there is a problem.[18]

These types of systems would help older adults and people with disabilities deal with loneliness and depression by connecting them with other elderly or disabled individuals through the Internet, reducing their sense of isolation.[17]