Integrated Telehealth and Telecare for Monitoring Frail elderly with Chronic Disease

Abstract

Abstract— Aim: To investigate the potential of an integrated 2 care system that acquires vital clinical signs and habits data to 3 support independent living for elderly people with chronic 4 disease. 5 Materials and methods: We developed an IEEE 11073 6 standards-based telemonitoring platform for monitoring vital 7 signs and activity data of elderly living alone in their home. The 8 platform has important features for monitoring the elderly: 9 unobtrusive, simple, elderly-friendly, plug and play 10 interoperable, and self-integration of sensors. Thirty six (36) 11 patients in a primary care practice in the UK (mean (SD) age, 82 12 (10) years) with Congestive Heart Failure (CHF) or Chronic 13 Obstructive Pulmonary Disease (COPD) were provided with 14 clinical sensors to measure the vital signs for their disease (BP 15 and weight for CHF, and pulse oximeter for COPD) and one PIR 16 motion sensor and/or a chair/bed sensor were installed in a 17 patient’s home in order to obtain their activity data. The patients 18 were asked to take one measurement each day of their vital 19 sign(s) in the morning before breakfast. All the data were 20 automatically transmitted wirelessly to the remote server and 21 displayed on a clinical portal for clinicians to monitor each 22 patient. An alert algorithm detected outliers in the data and 23 indicated alerts on the portal. Patient data has been analyzed 24 retrospectively following hospital admission, ER visit or death, in 25 order to determine if the data could predict the event. 26 Results: Data of patients who were monitored for a long 27 period and had interventions were analyzed to identify useful 28 parameters and develop algorithms to define alert rules. 20 of the 29 36 participants had a clinical referral during the time of 30 monitoring; 16 of them received some type of intervention. The 31 most common reason for intervention was due to low oxygen 32 levels for patients with COPD and high BP levels for CHF. 33 Activity data were found to contain information on the well-being 34 of patients, in particular for those with COPD. During 35 exacerbation the activity level from PIR sensors increased 36 slightly, and there was a decrease in bed occupancy. One subject 37 with CHF who felt unwell spent most of the day in the bedroom.