Technology that supports older adults can have a positive effect on their psychological and physical well-being in a way that they may live independently for longer periods of time. This study is conducted to identify relevant factors that influence the use of smart home and telecare technologies in order to develop a measurement tool for telecare acceptance. In this study we revise the original Technology Acceptance Model (TAM) to explain the use of smart home and telecare technology by older adults. The model will be tested in the field by researching the use of telecare technology (with multiple functionalities, such as personal alarms, screen-to-screen communication, and teleservices) by approx. 100 Dutch households. The research will provide guidelines for design, implementation and functionality of smart home and telecare technology for older adults. It will provide insight into what features contribute to effective use of technology for older adults who live at home independently.
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The effectiveness of smart home technology in home care situations depends on the acceptance and use of the technology by both users and end-users. In the Netherlands many projects have started to introduce smart home technology and telecare in the homes of elderly people, but only some have been successful. In this paper, features for success and failure in the deployment of new (ICT) technology in home care are used to revise the technology acceptance model (TAM) into a model that explains the use of smart home and telecare technology by older adults. In the revised model we make the variable 'usefulness' more specific, by describing the benefits of the technology that are expected to positively affect technology usage. Additionally, we state that several moderator variables - that are expected to influence this effect - should be added to the model in order to explain why people eventually do (not) use smart home technology, despite the benefits and the intention to use. We categorize these variables, that represent the problems found in previous studies, in 'accessibility', 'facilitating conditions' and 'personal variables'.
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Expectations are high with regards to smart home technology. In particular, smart home technology is expected to support or enable independent living by older adults. This raises the question: can smart home technology contribute to independent living, according to older adults themselves? This chapter aims to answer this question by reviewing and discussing older adults’ perspectives on independence and their views on smart home technology. Firstly, older adults’ opinions on independence and aging in place are discussed. Secondly, this chapter will review to what extent smart home technology can support older adults’ independence. Thirdly, it will be explained how community-dwelling older adults’ concept of independence entails three distinct types or modes, and how these modes are related to their perceptions and acceptance of technology. In the last section of this chapter, an overview of key points is presented, and recommendations for technology designers, policy makers, and care providers are postulated.
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The 'implementation' and use of smart home technology to lengthen independent living of non-instutionalized elderly have not always been flawless. The purpose of this study is to show that problems with smart home technology can be partially ascribed to differences in perception of the stakeholders involved. The perceptual worlds of caregivers, care receivers, and designers vary due to differences in background and experiences. To decrease the perceptual differences between the stakeholders, we propose an analysis of the expected and experienced effects of smart home technology for each group. For designers the effects will involve effective goals, caregivers are mainly interested in effects on workload and quality of care, while care receivers are influenced by usability effects. Making each stakeholder aware of the experienced and expected effects of the other stakeholders may broaden their perspectives and may lead to more successful implementations of smart home technology, and technology in general.
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Purpose: To describe nurses' support interventions for medication adherence, and patients' experiences and desired improvements with this care. Patients and methods: A two-phase study was performed, including an analysis of questionnaire data and conducted interviews with members of the care panel of the Netherlands Patients Federation. The questionnaire assessed 14 types of interventions, satisfaction (score 0-10) with received interventions, needs, experiences, and desired improvements in nurses' support. Interviews further explored experiences and improvements. Data were analyzed using descriptive statistics and a thematic analysis approach. Results: Fifty-nine participants completed the questionnaire, and 14 of the 59 participants were interviewed. The satisfaction score for interventions was 7.9 (IQR 7-9). The most common interventions were: "noticing when I don't take medication as prescribed" (n = 35), "helping me to find solutions to overcome problems with using medications" (n = 32), "helping me with taking medication" (n = 32), and "explaining the importance of taking medication at the right moment" (n = 32). Fifteen participants missed ≥1 of the 14 interventions. Most mentioned the following: "regularly asking about potential problems with medication use" (33%), "regularly discussing whether using medication is going well" (29%), and "explaining the importance of taking medication at the right moment" (27%). Twenty-two participants experienced the following as positive: improved self-management of adequate medication taking, a professional patient-nurse relationship to discuss adherence problems, and nurses' proactive attitude to arrange practical support for medication use. Thirteen patients experienced the following as negative: insufficient timing of home visits, rushed appearance of nurses, and insufficient expertise about side effects and taking medication. Suggested improvements included performing home visits on time, more time for providing support in medication use, and more expertise about side effects and administering medication. Conclusion: Overall, participants were satisfied, and few participants wanted more interventions. Nurses' support improved participants' self-management of medication taking and enabled patients to discuss their adherence problems. Adequately timed home visits, more time for support, and accurate medication-related knowledge are desired.
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Background: Current use of smartphone cameras by parents create opportunities for longitudinal home-video-assessments to monitor infant development. We developed and validated a home-video method for parents, enabling Pediatric Physical Therapists to assess infants’ gross motor development with the Alberta Infant Motor Scale (AIMS). The objective of the present study was to investigate the feasibility of this home-video method from the parents’ perspective. Methods: Parents of 59 typically developing infants (0–19 months) were recruited, 45 parents participated in the study. Information about dropout was collected. A sequential mixed methods design was used to examine feasibility, including questionnaires and semi-structured interviews. While the questionnaires inquired after the practical feasibility of the home-video method, the interviews also allowed parents to comment on their feelings and thoughts using the home-video method. Results: Of 45 participating parents, 34 parents returned both questionnaires and eight parents agreed to an interview. Parent reported effort by the infants was very low: the home-video method is perceived as similar to the normal routine of playing. The parental effort level was acceptable. The main constraint parents reported was time planning. Parents noted it was sometimes difficult to find the right moment to record the infant’s motor behavior, that is, when parents were both at home and their baby was in the appropriate state. Technical problems with the web portal, reported by 28% of the parents were also experienced as a constraint. Positive factors mentioned by parents were: the belief that the home videos are valuable for family use, receiving feedback from a professional, the moments of one-on-one attention and interaction with their babies. Moreover, the process of recording the home videos resulted in an increased parental awareness of, and insight into, the gross motor development of their infant. Conclusion: The AIMS home-video method is feasible for parents of typically developing children. Most constraints are of a practical nature that can be addressed in future applications. Future research is needed to show whether the home-video method is also applicable for parents with an infant at risk of motor development problems.
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BACKGROUND: Telemonitoring and telerehabilitation can support home-based pulmonary rehabilitation (PR) and benefit patients with lung diseases or COVID-19. This study aimed to (1) identify which telemonitoring and telerehabilitation interventions (e.g. videoconferencing) are used to provide telehealth care for people with chronic respiratory conditions or COVID-19, and (2) provide an overview of the effects of telemonitoring and telerehabilitation on exercise capacity, physical activity, health-related QoL (HRQoL), and healthcare use in patients with lung diseases or COVID-19.METHODS: A search was performed in the electronic databases of Ovid MEDLINE, EMBASE, and Cinahl through 15 June 2021. Subject heading and keywords were used to reflect the concepts of telemonitoring, telerehabilitation, chronic lung diseases, and COVID-19. Studies that explored the effect of a telerehabilitation and/or telemonitoring intervention, in patients with a chronic lung disease such as asthma, chronic obstructive pulmonary diseases (COPD), or COVID-19, and reported the effect of the intervention in one or more of our outcomes of interest were included. Excluding criteria included evaluation of new technological components, teleconsultation or one-time patient assessment.RESULTS: This scoping review included 44 publications reporting the effect of telemonitoring (25 studies), telerehabilitation (8 studies) or both (11 studies) on patients with COPD (35 studies), asthma (5 studies), COPD and asthma (1 study), and COVID-19 (2 studies). Patients who received telemonitoring and/or telerehabilitation had improvements in exercise capacity in 9 out of 11 (82%) articles, better HRQoL in 21 out of 25 (84%), and fewer health care use in 3 out of 3 (100%) articles compared to pre-intervention. Compared to controls, no statistically significant differences were found in the intervention groups' exercise capacity in 5 out 6 (83%) articles, physical activity in 3 out of 3 (100%) articles, HRQoL in 21 out of 25 (84%) articles, and healthcare use in 15 out of 20 (75%) articles. The main limitation of the study was the high variability between the characteristics of the studies, such as the number and age of the patients, the outcome measures, the duration of the intervention, the technological components involved, and the additional elements included in the interventions that may influence the generalization of the results.CONCLUSION: Telemonitoring and telerehabilitation interventions had a positive effect on patient outcomes and appeared to be as effective as standard care. Therefore, they are promising alternatives to support remote home-based rehabilitation in patients with chronic lung diseases or COVID-19.
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The nursing home is often a final stage in the living career of older persons, but the question remains whether it is a true home or merely a place where care is provided for the residents. This study investigates the sense of home and its constituent factors among both permanent and temporary residents of nursing homes in The Netherlands. A qualitative research design was chosen for the study, which consisted of in-depth interviews using a topic list that was developed through literature review and a focus group session. Autonomy and safety and security are the basic aspects for a sense of home. These aspects refer to the relationships and actions of nursing home residents and the environment in which people live. The research findings show that developing a sense of home encompasses much more than just being surrounded by personal belongings and having a private room with certain facilities. Subjective components of relationships and (inter)actions are as important as the physical component of living and housing. Only when a right balance is achieved between all factors, a true sense of home, albeit away from the familiar home someone spent most of his/her life, can be developed. Understanding these perspectives and needs can contribute to a better design and retrofitting process of future nursing homes.
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Home automation that allows for telecare services is increasingly becoming a tool to help older adults live independently and to improve perceived safety and security. The number of older adults receiving professional care, in relation to housing, on a daily basis is not very large. Only 15% receives home care, 5% lives in a care home, and about 2.5% resides in a nursing home. The majority of older adults live in the community. The Unattended Autonomous Surveillance system by TNO Defense is an integrated system that combines many functionalities for community-dwelling (older) adults, who are entitled to receiving nursing home care based on official assessments. The technology is implemented among people in the towns of Baarn and Soest in the centre of the Netherlands. The UAS system aims to support Ageing-in-Place and delaying the demand for expensive institutional care. Besides the benefits for the care recipient, informal or family carers are supported in care through the technology installed as well. Professional carers, for instance, home care, can benefit from the increased self care capabilities of the care recipient. In cases of emergency, i.e., when alarms are activated, people in the care centre can access the home via a camera. The aim is to study the perceptions of independent living, the role and quality of care received, and how people think technology can support them in their daily lives. This is the first round of interviewing on a total of three rounds. Methods In order to investigate the needs of the users, phenomenological qualitative research is carried out among a group of 30 independently living older adults (some with mild psychogeriatric health problems) and their (family) carers, using semi-structured questionnaires on home care received, demand for care, use and need of assistive technologies and perceived safety and security. The questionnaires were based on earlier work by Bijsterveld1 and Demeris et al.2. The first part of the study, performed between May and September 2007, included 14 subjects. The transcripts were analysed using the MAXQDA program. First, each transcript was read in its entirety. Then, they were read a second time to develop codes that were grouped into themes consistent with the interviews, which emerged from the narratives and the interview guides. To be considered a major theme, the code had to have appeared in more than 25% of the narratives and more than once in each of the narratives. Third, quotes that summarised the essence of each person’s subjective experience were recorded. Finally, a master list of themes from each interview was developed to allow for easy cross-interview examination. Results and discussion Preliminary results showed a positive attitude of older adults towards the system as a means to provide additional telecare and to increase perceived security in their surroundings. The fact that professional carers are immediately available after an emergency call, for instance via video communication, eases their feelings of insecurity. Family carers were more enthusiast about the system than many older adults, because the UAS system that is always present and vigilant takes away a part of the care burden. The over-time contribution of the UAS system to independence is to be studied.
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Telehomecare is one of the technological solutions used by older persons to remain living at home in their own community. A selection of 85 Dutch telehomecare projects was examined in terms of the barriers to their implementation. Three categories of telehomecare technologies were distinguished: (i) remote telecare, (ii) activity monitoring, and (iii) a category comprising telemedicine and e-health solutions and services. There are numerous barriers to the implementation of telehomecare technologies. In the majority of the Dutch telehomecare projects, the needs of both care recipients and family carers are addressed. The integration of needs derived from one's health condition and the requirements set to technology are not always a match. Some projects give consideration to how to get commitment of the care professionals and their managers. Only a few projects consider economic aspects, for instance by the development of a social business case. To lift the barriers to the implementation of telehomecare, a better exchange of knowledge and experiences related to functionalities and user needs, the use of home modifications and assistive technologies, as well as the available care support should be considered.
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