“You want to know what the lesson an elderly patient once gave me: “Doctor, but don’t you know that we old men die of fall?”. It is not wrong. To manage fragile patients you must avoid that, as with Murano glass, the glass falls to the ground and breaks ». To tell the anecdote is the professor Sergio Pillon, member of the Digital Health Working Group, European Public Health Alliance (WG-DH EPHA) and CIRM medical director. It fits perfectly as an introduction to the Fragility project that the digital health expert is coordinating regarding the clinical aspects. The initiative is being carried out by the Lazio Region, the National Research Council and Unidata, in collaboration with Confcooperative, which said it was available for the “field test”.
From monitoring the environment to video surveillance
Let’s talk about a remote assistance project, according to the definition of the national guidelines for telemedicine, which provides a home automation support system for fragile people. Or, if you prefer to remain in the field of metaphor, “a foam rubber tablecloth around Murano glasses”, as Professor Pillon comments. The frailties involved in the initiative may include elderly people with chronic diseases, disabilities, multimorbidity. The latest survey by Italia Longeva on long-term care reveals how they are in our country almost 14 million over-65s, of which 5 and a half million suffering from at least three chronic diseases and 4 million with severe disabilities. The project proposes a support realized through modular remote assistance services, which in the complete version they offer environmental monitoring, activity monitoring ed any video surveillance realized through a home system connected to a listening center and / or to the family caregiver. “If we take into consideration only the indicator of the type of chronicity that a patient has acquired, we are unable to have a real vision of his needs,” says Pillon. «What is needed, on the other hand, is precisely to evaluate its fragility. There are some interesting international indicators, but they are not enough ».
The detectable parameters
The project identified a series of parameters that can be detected with environmental sensors, such as temperature, the concentration of carbon dioxide and volatile organic compounds (the Voc, English acronym for Volatile organic compounds, used to evaluate indoor air quality), the opening and closing of doors and windows, the passage of people. Or the parameters are collected from wearable devices (trackers), when the patient is awake, or of “contactless” monitoring, when in bed, with the recording of heart and respiratory rate, movement, type and quality of sleep. The data thus generated is then processed by an artificial intelligence system which, through an algorithm developed by the CNR, is able to detect any “anomalies” and report them to the central office or to the caregiver through an alert dashboard.
The objectives to be achieved
There are several objectives to be achieved: reduce the social isolation of the frail person; to extend the support of social service cooperatives even beyond that “in presence” to the fragile person. But also prevent falls and pressure injuries o urgent hospitalization for pathologies treatable at home, if diagnosed early (respiratory pathologies, heart failure, falls); experiment and demonstrate the possibility of creating an economically sustainable system by the person, by the social health services and / or by the family members of the fragile patient that provides socio-health support to the fragile person. With parameter monitoring, the project allows you to evaluate the quality of care given to the fragile patient. The Vocs, for example, also indicate the “bad smell” present in the room, sometimes linked to the failure to change the diaper. Last but not least, the system could serve a monitor the work of non-professional caregivers, caregivers, relatives, service personnel, personal assistants. At what point in the process is the initiative? “We are about a third of the way through the project, then by the summer it should arrive in port»Replies Pillon.
February 27, 2021 (change February 27, 2021 | 18:48)
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