Care Ecosystem: Can the IoT Improve Dementia Patient Treatments?

A $10 million clinical trial will use smart watches, beacons and other sensors to aid caregivers tasked with helping patients cope with dementia, and to extend the amount of time they can live at home.
By Mary Catherine O'Connor
Aug 12, 2015

Health-care professionals have long felt that wireless devices and sensor networks could be used as aids in caring for elderly patients, especially those suffering from various forms of dementia. As Baby Boomers age, the impacts and costs of dementia on public health are likely to grow significantly. A 2013 research paper published in the New England Journal of Medicine concluded that dementia already inflicts a financial burden on par with that of heart disease and cancer. But to what degree can technology improve dementia patients' care and treatment—and could technology be used to cap or even lower the overall costs of caring for these individuals?

Those are questions that a group of researchers and physicians are setting out to answer through a clinical trial known as Dementia Care Ecosystem: Using Innovative Technologies to Personalize and Deliver Coordinated Dementia Care. Funded by a $10 million grant from the Centers for Medicare & Medicaid Services, the trial is being managed through a partnership between the University of California San Francisco's Memory and Aging Center and the University of Nebraska Medical Center. It will involve 2,100 patients who are at least 45 years old, live at home, have been diagnosed with some form of dementia and reside in California, Nebraska or Iowa. The trial will evaluate a model of care, based on the use of an online dashboard and telephone-based support for the patient's primary caregiver, that—according to the program's website—"emphasizes coordinated, continuous, and personalized care and aims to improve health and satisfaction for patients and their caregivers."

Katherine Possin
The trial will also evaluate, through a subset of 300 patients, the use of wireless technology to monitor participants' movements and habits. Via machine learning and analysis of baseline activity for each patient, the software that collects the sensor data will generate alerts in the event that apparent changes, either sudden or gradual, in a patient's movement or routines may signal a health problem or the progression of his or her symptoms.

"At the heart of the program is what we call the Care Team Navigator," explains Katherine Possin, one of the study's directors. The Care Team Navigator is a person who is assigned to coordinate care and support the patient and the patient's caregiver. He or she will use software called the Navigator Dashboard, an online workflow management tool that has three main modules, dedicated to the caregiver, decision-making and medications. The Care Team Navigator assigned to each patient will use the Navigator Dashboard to learn about that person's disease, and will be able to ask questions regarding treatment. The decision-making module is designed to help the patient and caregiver create a roadmap for how to proceed as his or her disease progresses. The pharmacy module serves as a means for a pharmacist to monitor any drugs that the patient may be prescribed, and to look for potential conflicts and harmful side effects. The Navigator Dashboard gives each Care Team Navigator access to a team of nurses, social workers and pharmacists with whom to consult. "The Care Team Navigator can triage anything with this team," Possin says.

For each of the 300 participants who will be involved in testing the wireless technology—which is referred to as Functional Monitoring—trial program assistants will install a number of Bluetooth beacons, made by Estimote, throughout his or her home. The team will also issue each patient a Sony SmartWatch 3, which runs the Android Wear operating system and has an integrated Bluetooth radio, an accelerometer and a gyroscope. The smart watch will be paired with a smartphone that each patient will also be issued for use during the trial, according to Katrin Schenk, an associate professor of physics at Randolph College. A few additional sensors will also be placed around the home, such as on the refrigerator door or on the handle of the toilet flusher, which will be used to deduce the patient's actions.

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