Presentation
Developing Smart Technology for Dementia Care in Transitional Care Units: Barriers to Participant Engagement & Alternative Strategies
SessionMethods & Perspectives (PS8)
DescriptionBackground:
While most older Canadians share the desire to ‘age in place’, remaining in their familiar homes as they grow older, a number of factors may prevent this. For instance, their care needs may exceed the financial and/or human resources needed to allow them to remain at home. However, there are long waiting lists for institutional spaces as well, a situation worsened by the impact of COVID-19 and the aging Baby Boomer population. This can lead to older adults requiring skilled nursing home care waiting in acute care hospitals for a bed to become available. In Ontario Canada, one solution to discharge these so-called awaiting placement people was to create ‘transitional care facilities.’ One such facility was created in Ottawa, Canada, by converting a newly built retirement home.
A significant proportion of transitional care patients are living with dementia. Two significant issues in institutional care settings at night for Persons Living with Dementia (PLWD) including exploring and falls. An older adult with cognitive impairment may not recognize night-time cues (especially if the facility has lit corridors) and may get up and start exploring around. They may end up in another older adult’s similar-looking room or they may leave the building, causing stress to the older adults and staff. While the staff’s job is to ensure patients' safety, during the night their numbers are lower while their challenges are heightened.
Therefore, interventions aimed at reducing night-time exploring are highly relevant. Sensors that monitor exploring and falls, therefore, have the potential to decrease risk to the older adult, while increasing job satisfaction for the staff. While these two use cases (exploring and falling) are described, they are meant to serve as examples, rather than the only targeted activities.
Recognizing the need for innovative solutions to support PLWD and staff in institutional settings, we worked with a transitional care facility and Ottawa start-up, Esprit-ai, to advance the development of smart home technology focused on mobility and cognitive declines to facilitate aging in place. In-room installations included a bed sensor to monitor bed exiting, a motion sensor in the room to detect movement in the room, and two-door sensors on the closet as staff shared that patients would enter the closet occasionally at night. Upon patient bed exit during the night or opening the closet, these cloud-connected sensors sent text message alerts to a cell phone carried by the staff.
The objective of this research project was to trial the implementation of a SafeTech product in a transitional care unit through 2 phases.
Phase 1 of the study focused on implementing and evaluating the use of night-time monitoring technology in patient rooms from the staff’s perspective. We published a paper describing how a team of researchers and healthcare managers navigated the complexities of a hospital setting, using human-centred design and implementation strategies, to facilitate the implementation and adoption of the technology.
During the pandemic, many caregivers/family members were not able to visit their loved ones for months at a time and were disconnected from their care. Based on the data collected from the sensors, we were interested in exploring how the data collected at night-time could be used to provide an activity report to caregivers to keep them better informed or reassure them about the status of the patient. Phase 2 of the study aimed to learn about the type of information caregivers/family members wish to know about the daily habits of the PLWD beyond exploring and falls to develop design requirements which could inform our team’s future development of night-time monitoring systems. A phone-based application prototype and activity were developed to engage caregivers/family members of PLWD in dialogue about information they would be interested in accessing from night-time data. This presentation will review the methods and work that was developed for Phase 2, the challenges with recruiting caregivers within the context of transitional care facilities, and how this phase of the study had to be redesigned to pursue this goal.
Participants:
The SafeTech system was deployed at a closed, secure unit for patients with cognitive challenges at Greystone Transitional Care facility, a temporarily repurposed retirement home which would function as a “step-down” transition unit.
To facilitate this research, steering and implementation committees were formed, and the necessary research ethics approvals were obtained. Subsequently, front-line staff at Greystone, primarily from Bayshore Health, were invited to participate in this study. The recruitment process involved communication initiated by their unit manager, who elaborated on the study's purpose and premise.
In Phase 2, we aimed to engage caregivers/family members of patients who participated in Phase 1 in user testing and feedback on a phone application that could provide awareness of the patient’s night-time activity. Although we were not successful in recruiting this participant group due to various factors (short-stay unit), we feel the prototype and methodology could be of value to other researchers which we will share. We will also share how we adapted the study design to engage subject matter experts working with PLWD to develop preliminary design requirements to better inform future work, and ideally, future user testing with caregivers/family members of PLWD.
Recruitment Methods:
To learn about the type of information that caregivers/family members wished to know about the daily habits of their loved ones residing in facilities like Greystone Village, we planned to conduct multiple virtual focus groups, of 90 minutes. The focus group was designed to consist of 2 parts:
- Part 1: A virtual open card sorting activity was designed to understand the type of information caregivers deemed valuable regarding their loved one’s daily habits. This research method is used to help design and evaluate the organization of information, and to understand the type of information valuable to participants.
- Part 2: Participants would be presented with a Figma prototype and asked to share their thoughts about the structure, content and navigation.
Our aim was to reach a maximum of 15 research participants for the virtual focus group to constitute a valid representation of the population. This sample size can be justified by the ‘five-user principle suggesting that five experts will elicit 75% of usability problems with an interface.
Despite our efforts, we faced various challenges in recruiting caregivers/family members for this activity, including a lack of response, and busy schedules to participate in additional activities. As an alternative approach, we invited subject matter experts from our steering committee to participate in a focus group using a qualitative matrix of desired information features which they would then rank. The tool used in the activity was designed to elicit and prioritize the expertise of individuals knowledgeable about the care of older adults to identify crucial patient information that may be of interest to caregivers/family members. This information will be used to guide the development of an application to test with caregivers/family members in the future.
Results and Discussion:
The subject matter expert focus group is scheduled to occur subsequent to the submission of this proposal. The method, data collection/analysis tools and findings from this phase will be presented during the presentation.
Conclusion:
Our research journey highlights the fundamental importance of being creative and fluid in working towards meeting research objectives. This creative adaptation led to the development of a novel data collection/analysis tool and reinforced our determination to achieve the research objective despite recruitment obstacles. Sharing such complexities and ‘failures’ in healthcare design research is important to provide insight to other teams facing similar challenges, especially within the context of the COVID-19 era and the unique demands this placed on participation in research.
While most older Canadians share the desire to ‘age in place’, remaining in their familiar homes as they grow older, a number of factors may prevent this. For instance, their care needs may exceed the financial and/or human resources needed to allow them to remain at home. However, there are long waiting lists for institutional spaces as well, a situation worsened by the impact of COVID-19 and the aging Baby Boomer population. This can lead to older adults requiring skilled nursing home care waiting in acute care hospitals for a bed to become available. In Ontario Canada, one solution to discharge these so-called awaiting placement people was to create ‘transitional care facilities.’ One such facility was created in Ottawa, Canada, by converting a newly built retirement home.
A significant proportion of transitional care patients are living with dementia. Two significant issues in institutional care settings at night for Persons Living with Dementia (PLWD) including exploring and falls. An older adult with cognitive impairment may not recognize night-time cues (especially if the facility has lit corridors) and may get up and start exploring around. They may end up in another older adult’s similar-looking room or they may leave the building, causing stress to the older adults and staff. While the staff’s job is to ensure patients' safety, during the night their numbers are lower while their challenges are heightened.
Therefore, interventions aimed at reducing night-time exploring are highly relevant. Sensors that monitor exploring and falls, therefore, have the potential to decrease risk to the older adult, while increasing job satisfaction for the staff. While these two use cases (exploring and falling) are described, they are meant to serve as examples, rather than the only targeted activities.
Recognizing the need for innovative solutions to support PLWD and staff in institutional settings, we worked with a transitional care facility and Ottawa start-up, Esprit-ai, to advance the development of smart home technology focused on mobility and cognitive declines to facilitate aging in place. In-room installations included a bed sensor to monitor bed exiting, a motion sensor in the room to detect movement in the room, and two-door sensors on the closet as staff shared that patients would enter the closet occasionally at night. Upon patient bed exit during the night or opening the closet, these cloud-connected sensors sent text message alerts to a cell phone carried by the staff.
The objective of this research project was to trial the implementation of a SafeTech product in a transitional care unit through 2 phases.
Phase 1 of the study focused on implementing and evaluating the use of night-time monitoring technology in patient rooms from the staff’s perspective. We published a paper describing how a team of researchers and healthcare managers navigated the complexities of a hospital setting, using human-centred design and implementation strategies, to facilitate the implementation and adoption of the technology.
During the pandemic, many caregivers/family members were not able to visit their loved ones for months at a time and were disconnected from their care. Based on the data collected from the sensors, we were interested in exploring how the data collected at night-time could be used to provide an activity report to caregivers to keep them better informed or reassure them about the status of the patient. Phase 2 of the study aimed to learn about the type of information caregivers/family members wish to know about the daily habits of the PLWD beyond exploring and falls to develop design requirements which could inform our team’s future development of night-time monitoring systems. A phone-based application prototype and activity were developed to engage caregivers/family members of PLWD in dialogue about information they would be interested in accessing from night-time data. This presentation will review the methods and work that was developed for Phase 2, the challenges with recruiting caregivers within the context of transitional care facilities, and how this phase of the study had to be redesigned to pursue this goal.
Participants:
The SafeTech system was deployed at a closed, secure unit for patients with cognitive challenges at Greystone Transitional Care facility, a temporarily repurposed retirement home which would function as a “step-down” transition unit.
To facilitate this research, steering and implementation committees were formed, and the necessary research ethics approvals were obtained. Subsequently, front-line staff at Greystone, primarily from Bayshore Health, were invited to participate in this study. The recruitment process involved communication initiated by their unit manager, who elaborated on the study's purpose and premise.
In Phase 2, we aimed to engage caregivers/family members of patients who participated in Phase 1 in user testing and feedback on a phone application that could provide awareness of the patient’s night-time activity. Although we were not successful in recruiting this participant group due to various factors (short-stay unit), we feel the prototype and methodology could be of value to other researchers which we will share. We will also share how we adapted the study design to engage subject matter experts working with PLWD to develop preliminary design requirements to better inform future work, and ideally, future user testing with caregivers/family members of PLWD.
Recruitment Methods:
To learn about the type of information that caregivers/family members wished to know about the daily habits of their loved ones residing in facilities like Greystone Village, we planned to conduct multiple virtual focus groups, of 90 minutes. The focus group was designed to consist of 2 parts:
- Part 1: A virtual open card sorting activity was designed to understand the type of information caregivers deemed valuable regarding their loved one’s daily habits. This research method is used to help design and evaluate the organization of information, and to understand the type of information valuable to participants.
- Part 2: Participants would be presented with a Figma prototype and asked to share their thoughts about the structure, content and navigation.
Our aim was to reach a maximum of 15 research participants for the virtual focus group to constitute a valid representation of the population. This sample size can be justified by the ‘five-user principle suggesting that five experts will elicit 75% of usability problems with an interface.
Despite our efforts, we faced various challenges in recruiting caregivers/family members for this activity, including a lack of response, and busy schedules to participate in additional activities. As an alternative approach, we invited subject matter experts from our steering committee to participate in a focus group using a qualitative matrix of desired information features which they would then rank. The tool used in the activity was designed to elicit and prioritize the expertise of individuals knowledgeable about the care of older adults to identify crucial patient information that may be of interest to caregivers/family members. This information will be used to guide the development of an application to test with caregivers/family members in the future.
Results and Discussion:
The subject matter expert focus group is scheduled to occur subsequent to the submission of this proposal. The method, data collection/analysis tools and findings from this phase will be presented during the presentation.
Conclusion:
Our research journey highlights the fundamental importance of being creative and fluid in working towards meeting research objectives. This creative adaptation led to the development of a novel data collection/analysis tool and reinforced our determination to achieve the research objective despite recruitment obstacles. Sharing such complexities and ‘failures’ in healthcare design research is important to provide insight to other teams facing similar challenges, especially within the context of the COVID-19 era and the unique demands this placed on participation in research.
Event Type
Oral Presentations
TimeWednesday, March 279:37am - 10:00am CDT
LocationSalon A-3
Patient Safety Research and Initiatives