As dementia care comes under strain, the NHS turns to tech

In January 2016, Surrey and Borders Partnership NHS Foundation Trust launched Technology Integrated Health Management (TIHM) for dementia, a research programme aimed at investigating the impact of modern technology in the homes of dementia patients. The study is attempting to create a health-focused Internet of Things, connecting multiple devices and investigating whether assistive technology can improve home care to reduce hospital visits and care-home admissions.

TIHM for dementia will be testing a range of assistive technology. Wearable devices will be used to monitor the blood pressure, pulse, temperature and hydration of patients, while sensors in the home will track movement, falls and restlessness at night, as well as room temperature, humidity and light.

It comes at a time when there are an estimated 850,000 people living with dementia in the UK, a number that is set to rise to more than one million by 2025. There is currently no cure. Early diagnosis is improving the life expectancy of dementia patients, but as more people develop the disease, social care must evolve.

Assistive technology programme

Dementia is an umbrella term for a number of neurological diseases that affect each person uniquely. The symptoms most people associate with brain disease include confusion, memory loss and changes in mood, but it can have an impact on everything from communication and language skills to the ability to walk, eat and control the bladder.

The “Support. Stay. Save.” report from the Alzheimer’s Society showed that 83% of patients with dementia consider staying in their own home to be very important, as being in a familiar environment can maintain a sense of comfort and clarity. Unfortunately, the symptoms of dementia mean that the everyday home can be a dangerous place for someone with brain disease; a gas hob could be left on, they may forget to drink water, or they might fall and not be able to get back up.

This, coupled with the fact that hospitals are often unequipped to deal with the specific needs of dementia patients, is why assistive technology is so important in the future care of dementia patients: it can be used to neutralise many of the risks that threaten their independence and ability to stay at home.

Technology in the home

The NHS has partnered with a number of innovative tech companies to put TIHM for dementia into action. Intelesant, for example, is providing Howz: an app connected to sensors that track the patient’s patterns of activity and alerts carers to anomalies. Sense.ly, meanwhile, has created a virtual nurse called Molly, who can provide personalised monitoring and medical advice using artificial intelligence and speech recognition.

The programme is currently in its early testing stages. A small pilot group of dementia patients have been trialling the technology, but the test pool will widen in March when the main trial begins. There is even talk of VR being utilised – the myShoes project, for example, has been testing a dementia simulation that could allow carers and professionals to gain better insight into living with the disease.

(Above: Sensely’s virtual nurse, Molly)

Despite the positivity surrounding the development of assistive technology, there is still a long way to go. “Technology has a very significant role in the future of dementia research and dementia care, but at the moment it’s perhaps defined in terms of the potential of technology,” said Colin Capper, head of research development and evaluation at the Alzheimer’s Society. He explained that, although there have been recent contributions in funding from charities and the government towards dementia research, social-care spending has seen huge cuts and assistive technology can only be truly beneficial in conjunction with high-quality community social care.

Dementia and the diseases that cause it are progressive – meaning that over time symptoms worsen. Those requiring assistive technology will therefore need to undergo not only an initial assessment, but regular evaluations to ensure they receive tailored technology and care for their current state. This means that for every patient eligible for assistive technology, the NHS will have to pay for an array of expensive resources, and that’s a lot of money in a time of crisis.

The risks of using technology

Tight budgets aren’t the only limiting factors. As with any application of modern technology, there are dangers, something that Capper was keen to highlight. “Whilst there’s huge potential, there’s also quite a lot of risk,” he explained. “Part of that is because we don’t have a very well-established regulatory or evaluation framework for technology.”

That’s also true for assistive technology outside of the NHS. There are few regulations on what can be bought and sold online, and as dementia patients are vulnerable members of society, this means there’s an adult-protection issue. “I think we have to be very careful in what we recommend and what’s accessible to people, and how we talk about technologies and their benefits or otherwise,” said Capper.

As well as carers and professionals receiving appropriate training, it’s also paramount that the technology works exactly how it should. For example, GPS tracking can be used to reassure families that their loved one is safe at home, but it requires good Wi-Fi or 4G coverage. If the signal drops out, then the tracking becomes unreliable and the potential benefits are lost. This is why thoroughly testing TIHM for dementia is so vital.

Saving money for the NHS

At a time when the NHS is in financial crisis, opportunities to save money are invaluable. Short-term costs need to be weighed up against long-term savings – with the so-called “digital revolution” estimated to save the NHS £5 billion over the next ten years.

Capper seems confident that improving home care for dementia sufferers could make massive savings. “Something in the region of 25% of hospital beds are occupied by people with dementia. Being able to reduce that effectively by people living in their communities saves hundreds of thousands of pounds, and certainly tens of thousands of pounds per admission.”

It’s not only the length of hospital stays that can be addressed by assistive technology and home care: supporting people to manage their condition at home stands to improve how they engage with primary care. If effective memory prompts are in place, dementia patients will be less likely to miss GP appointments, for example, or require emergency visits.

(Above: Some of the devices being used in the TIHM for dementia trial. Credit: Surrey and Borders Partnership NHS Foundation Trust)

Although it sounds like a huge task, Capper believes that if people can manage their condition well enough at home and within their communities, the financial benefits could be significant. “I think given what we’re beginning to see, it has the potential for scale, and then those numbers [of potential savings] can go up very, very quickly.”

The NHS’s TIHM for dementia programme is already generating support, according to a spokesperson from Surrey and Borders Partnership NHS Foundation Trust: “The trial has received a very positive response from across the board, from people with dementia and their carers, to GPs and other health and social care practitioners, working in hospitals and in the community.”

It seems there is a huge opportunity for assistive technology to save the NHS money while also improving the lives of dementia sufferers, and TIHM for dementia is hopefully just the beginning. It’s also clear that further investment is required in social care if we are to really utilise this technology and ensure those using it feel comfortable. Regulatory framework, training for professionals and the continued funding of community healthcare is urgently required, all of which may be impossible if cuts to the NHS continue.