Thursday 30 April 2015

Ageing at home: Old folk in a smart new world

Technology is powering solutions for seniors and caregivers
By Radha Basu, Senior Correspondent, The Sunday Times, 26 Apr 2015

Mr Goh Ban Kim, 98, is too feeble to walk, cannot talk, uses a catheter and needs to take a dozen pills a day for a host of medical conditions.

When his caregiver and daughter Goh Tok Cheng, 56, is at work, the family's helper Widiya Nengsih, 24, checks his blood pressure, sugar levels, urine and temperature regularly. She then uploads the information using a software application known as iUvo Health Notes.

Madam Goh, who lives in a spacious semi-detached house in Katong, views all the information at her office in Shenton Way.

"This app is really a blessing," she says. "It enables us to monitor him just as he would be monitored at a nursing home - except that, despite being very ill, he can still be in his own room, at home."

Her father's happiness in his last years, she says, stems from being at home, among loved ones. "Ultimately, that's what iUvo helps us give him."

As tens of thousands of Singaporeans hurtle towards old age, software technologies and devices designed to help the elderly are slowly finding favour here.

Some - like motion sensors and smoke detectors - ensure home safety. Others empower people facing physical and cognitive challenges, so they can retain their dignity and independence. Yet others - like the iUvo (in Latin, "iuvo" means to "help") - enable caregivers to better manage seriously ill patients at home.

Developed in Singapore by two tech-savvy general practitioners - Dr Choo Wei Chieh and Dr Eugene Loke - the app allows dozens of pages of medical information to be uploaded if necessary.

"As a person ages, his medical file can become quite thick," says Madam Goh, an assistant vice-president with a foreign bank. "We can retrieve everything at the touch of a button, to show to family members or doctors."

When her father developed a rash on his leg recently, she uploaded photographs using the app, for his doctor to view remotely. "He knew exactly what to do, and I was saved the inconvenience of taking dad to a clinic in an ambulance."

The remote monitoring also takes the burden of responsibility off Ms Widiyah, who says: "All I do is key in the information and wait for instructions - and follow what my boss says."

Dr Choo, a home-care doctor who looks after geriatric patients, says the biggest benefit of the app is that it is easy to use.

"It helps put patients and their families on the digital bandwagon. There is no point having a fancy app if no one wants to use it," he says.

In future, he hopes to make the iUvo software interface seamlessly with wireless-enabled blood pressure monitors and glucometers - that would do away with having to key in the data manually. "The possibilities are immense," he says.

Tech-savvy caregivers like Madam Goh have warmed to the wonders of medical software, but even those like Ms Rose Kwek, 72 - a self-confessed technophobe - are buying digital products, albeit less geeky ones.

The retired teacher is thrilled with a "talking clock" and a pillbox with an alarm that she recently bought for her 95-year-old mother, who cannot see very well and sometimes forgets to take her medicines.

"They make her feel independent and empowered," says Ms Kwek. "She had to depend on others to know the time and take her pills. Now, she can do both herself."

Products that help ease caregiver burdens are also in demand. Among the newest in town is the Smart Sole - a miniature GPS tracker that is inserted into shoe insoles and helps locate cognitively impaired people who might be lost.

In use in the United States, the product is being retailed here by the Ministry of SilverLining, a small local assistive-device company run by former nurse Coco Guo. She says she imports technologies and products based on her extensive chats with former patients and their caregivers.

Dementia specialist Philip Yap says the Smart Sole is meant to overcome difficulties presented by other wearable GPS devices - such as pendants, wrist watches and mobile phones - which a user might easily forget to wear or take along.

"People with dementia often go outdoors on their own and risk getting lost," says the senior consultant in the department of geriatric medicine at Khoo Teck Puat Hospital (KTPH).

The product has a "geo fence" feature that alerts the caregiver by SMS if the patient ventures beyond a pre-defined "safe" zone.

"This is indeed useful should a cognitively impaired patient wander off alone," says Dr Yap. The device can also be used for those who have autism or are mentally ill.

Mr Kelvin Lee has been looking for such a product ever since his 77-year-old father, who has vascular dementia, wandered off by himself. It has happened a couple of times in recent months, and he did not answer his mobile phone.

"We were worried sick that he might get lost or injure himself," says Mr Lee, 46.

Before the illness struck, his father was an active and independent man who loved meeting friends, going to the movies and travelling. "We don't want to curtail his independence," says Mr Lee, who is attending a training programme in Australia for caregivers of dementia patients. "So this product holds promise."

He tested the Smart Sole last month after hearing about it from his father's doctor at Changi General Hospital. "It was unobtrusive, and we could easily log onto the portal and track the Smart Sole's location in real time," he says.

However, it costs nearly $600, so many might find it expensive. Also, currently, it does not work well in basements and MRT stations.

Mr Lee is worried about software malfunctions as well, and whether the product could be discontinued here because there are few takers.

"If the price is reasonable, and these concerns are addressed, we will consider buying it," he says.

He has a point. Technology troubles can be hard to outgrow. Products that once held promise can perish fast.

Indeed, even though many new-age devices intended to help older folk have been launched here with much fanfare in the past decade, few have stood the test of time.

Cost and the fact that seniors were largely averse to technology were big stumbling blocks, say doctors, caregivers and IT experts.

Even newer devices such as the GPS-enabled insoles might not find acceptance among the elderly today, points out Dr Yap.

Many of his patients are used to wearing sandals or slippers that have no insoles, and they might be unaccustomed to wearing insoles.

Dr Yap's colleague, IT industry veteran Alvin Ong, says the limitations of technology are another major challenge.

Some products require the user to press a button, which might not be possible if he is suddenly incapacitated by a stroke or heart attack, for example. Many are therefore reluctant to pay monthly subscription charges for call centres.

"There are automated systems that do not require pressing a button, but those have the possibility of false alarms," says Mr Ong, the chief information officer at Alexandra Health System, which manages KTPH.

A short battery life and the inability of patients to keep wearing devices or uploading information are other problems. New habits are hard to form, and old ones die hard.

Constantly having to keep up with fast-changing technology is a further challenge, says IT entrepreneur Kelvin Lek. Five years ago, he launched a wearable emergency device for older folk called eAlert, which was widely publicised as the first such "panic button for the elderly".

But the product was connected only to fixed phone lines, rather than mobile phones, and it was restricted to indoor use. It became obsolete pretty fast.

Mr Lek is now in talks with an Australian technology firm to introduce a new-age panic button that works both indoors and outdoors. His company, Emo 2 Enterprise, is one of at least four that say they are launching similar products in the coming months.

"Technology becoming obsolete has been an occupational hazard," says Mr Lek. "We've had to always move with the times."

Still, he believes that as people become more tech-savvy and affluent, and as more sophisticated yet user-friendly technologies enter the market, demand will pick up.

The industry is about to turn a corner, he says. Ageing baby boomers will definitely value these products.

"This time, I feel we're here to stay - and stay for good."

Hong Kong hotline offers free care for the poor
By Radha Basu, The Sunday Times, 26 Apr 2015

In Hong Kong, a 24/7 hotline service run by a social enterprise has been providing emergency aid to seniors in distress since 1996.

It was set up by a popular radio host and a professor of social science after about 100 elderly people living alone were found dead at home during a prolonged, bitter winter that year.

The Senior Citizens Home Safety Association currently has more than 80,000 clients who can call a personal emergency hotline which offers referral, care and counselling for as little as HK$115 (S$20) per month.

For those willing to pay an additional fee, it uses GPS technology to help families locate dementia patients who have wandered off.

Around 10,000 clients who are poor receive the service free for life.

Around 14 per cent of people in Hong Kong are aged 65 and above, compared to 12.4 per cent in Singapore. Hong Kong is also one of the few places in the world where people live longer than the average Singaporean.

The association's "Call and Care Centre" receives around 2,000 calls a day, said chief executive Irene Leung, who was in Singapore earlier this month to share more about the system with health and community officials.

Around 140 older folk in distress who call are sent to hospital every day, but nine in 10 calls are not emergencies. "Very often they just need someone to talk to and that's what we try to provide," said Ms Leung.

The emergency hotline - a panic button known as the Personal Emergency Link which, when pressed, links to the call centre - was the only service till 2008. However, it can be used only indoors and is connected to fixed phone lines.

The association now offers a range of mobile services. There is a safety phone, which can be used outdoors, as well as a GPS-based mobile link service to locate dementia patients. Around 11,000 people use these outdoor services, with location-tracking functions.

A missing person report is made to the call centre every two days.

Monthly subscription fees for the additional services are higher. The one for dementia patients, for example, costs around $50 a month. "We can now customise services based on different people's needs and preferences," said Ms Leung.

Significantly, 85 per cent of the association's total revenue comes from income generated by its various services. The rest is from donations.

The association also provides counselling, befriending and nursing advice on the phone.

It does not record the number of calls made "accidentally", but even those are followed up. "We don't dismiss a case just because an older person says she called by accident," said Ms Leung.

The centre recently received a call from a woman well past midnight. "The moment someone picked up, the caller said she had pressed the button accidentally and wanted to hang up," said Ms Leung.

But the trained call centre attendant kept talking to the woman. "She understood just from her tone that she needed emotional support," said Ms Leung.

It soon emerged that the older woman, who lived alone, had just been released from hospital. She was confused about which medicine to take and was worried that not taking the medicine in the correct order would worsen her health. As a result, she could not sleep.

The next day, the call centre attendant helped connect the woman to a nurse, who assisted her in sorting out her medicine. "So a call that seemed an 'accident' was actually a very genuine cry for help," said Ms Leung.

Sensors help keep seniors safe at home
By Radha Basu, The Sunday Times, 26 Apr 2015

At first glance, Mr Foong Keng Soon's spartan two-room flat looks just like any other.

But peer closely and you'll see one big difference. Palm-sized sensors dot the whitewashed walls, in the bathroom, above the stove, below the mattress. There is even a tiny one in his pillbox.

They are designed to collect data, track motion and ambient air quality, and check whether he takes his pills daily.

The 77-year-old retired accounts clerk is divorced, and his only child - a daughter - lives in Hong Kong. Having lived there himself for most of his working life, he has few friends or family here.

He cannot walk very well because of an old leg injury and uses a motorised wheelchair to get around.

Last year, he slipped and fell in the dark. With no one to help him, he had to pull himself up and get into bed himself. "It was painful, but I had no choice," he told The Sunday Times. It was a key reason he signed up to get his home wired.

Some other sensors being used in flats here detect mainly inactivity, but these Singapore-made devices can also sense falls and send alerts to caregivers' phones. They can even alert caregivers if a senior forgets to take his medicine.

Mr Foong knows the system is entirely voluntary but, given his history of falling, he signed up readily. He has a panic button, which he can wear and activate if he falls again. "It gives me peace of mind."

About 100 Housing Board flats in Marine Parade are being hooked up with sensors as part of a pilot project initiated by Singapore Management University (SMU).

When fully operational, they will be able to check ambient air quality as well, and trigger an alert if, say, a person has left the gas on for too long, said research programme manager Elina Yu from SMU's School of Information Systems, which is helping to devise the technology for the project.

The project is unique and not just because of the technology. Its promise lies in its ambitious attempt to marry technology with care services for frail or elderly poor people who have no caregivers.

While other sensor and emergency alarm projects enable older folk to connect to a family member or call centres they pay a monthly subscription fee for, this project connects those who have little or no family support to volunteer caregivers in the area, who can check on them if something goes wrong.

"We are trying to create a community where neighbours and volunteers can stand in as caregivers for those who have no one to look out for them," said Goodlife director Desmurn Lim. The centre for seniors is run by non-profit group Montfort Care.

Mr Lim's staff are responsible for following up on emergency calls during office hours. But early in the morning, late at night or during holidays, volunteers step in. There are nearly 25 currently, including 15 who opted to have their homes wired. "They are eager to help out too and give back," said Mr Lim.

The system has been activated a couple of times since being installed in October last year.

Once, an elderly man living alone pressed the emergency button on a weekday evening. "He was dizzy and breathless, but after my staff spoke to him and calmed him down, he said he did not need to go to the hospital," said Mr Lim. "Sometimes, it's just fear, and they need someone to talk to."

SMU is not the only university researching how sensor-enabled smart homes can be used to help older folk who live alone.

Similar projects are under way at Nanyang Technological University (NTU). The Research Centre of Excellence in Active Living for the Elderly (Lily) - a partnership with the University of British Columbia in Canada - was set up in 2012 to enable researchers to develop technology solutions for the elderly, including ones that enable them to age at home. Researchers have already developed software games that can help predict a person's risk for illnesses such as Parkinson's.

Some of the prototypes are also based on unobtrusive sensor technologies. Sensors are designed to maximise the privacy of seniors, said Lily centre director Miao Chunyan, who is from NTU's school of computer engineering.

"The sensor-enabled service preserves both the dignity and independence of the elderly," she said.

Among the prototypes being developed is the eHealth portal, a software-based social support hub meant to provide information and alerts for older folk living alone.

Taking cues from data gathered by the sensors, an "e-nurse" can remind a senior to take his medicine, turn off the gas and even suggest social or educational activities advertised online that he might enjoy, said researcher Wang Di, who is working on the project.

"Eighty-three per cent of seniors here already own smartphones, so future cohorts are likely to be far more tech-savvy than before," said Dr Wang. "That's an opportunity we want to tap."

Help is just a tug of a cord away
By Radha Basu, The Sunday Times, 26 Apr 2015

When Madam Mary Tan, 79, felt dizzy and had chest pains last month, she pulled an emergency cord in her one-room flat.

Within minutes, Ms Khaing Khaing Nyunt, 35, a trained nurse from Myanmar, was by her side.

"If you are old and live alone, you can panic when you feel unwell," says the housewife, who has been living on her own since her husband died seven years ago. "I am lucky that I can get medically trained nurses at my bedside should I need them."

She is fortunate to live in an Ang Mo Kio housing block fitted with a medical emergency response system that can be attended to 24/7.

As part of a programme started in the early 1990s, around 15,800 Housing Board rental flats and 6,800 studio apartments for the elderly have been equipped with these alert-alarm systems. However, the vast majority get help only during office hours.

Madam Tan's block is special because it happens to house a community home for seniors who have no family support.

Run by the Asian Women's Welfare Association (AWWA), a voluntary welfare group, the home has a nursing team on-site round the clock.

"We realised that having an emergency system that worked only during office hours wasn't of much use," says AWWA chief executive Tim Oei.

"People often need help when neighbours are asleep. Since we had nurses on-site, we decided to extend the round-the-clock monitoring facility to the entire block."

As is the practice islandwide, during office hours, emergency calls at Madam Tan's block are answered by staff of the local senior activity centre, which is also run by AWWA. At night and on public holidays, the community home nurses are in charge.

Islandwide, senior activity centres responded to an average of 25 alerts per rental block a month last year. The majority - more than nine in 10 - were "non-emergency" calls, an HDB spokesman said.

These calls are monitored by the centres during office hours, but most centres have taught residents to attend to distress calls when the local centre is closed.

Efforts are now on to twin the alarm technology with care services.

As part of a pilot scheme started late last year, some of these same rental blocks now enjoy the services of community nurses and home-help aides. They can deal with patient emergencies during office hours, and also take care of the personal needs of those who are very old and have no caregivers.

Apart from Ang Mo Kio, the programme is also in place in Kreta Ayer-Kim Seng.

Temasek Cares, a non-profit initiative under Temasek Holdings, has given $1.38 million over three years to fund the project, which is expected to benefit nearly 1,000 seniors.

In Kreta Ayer, the scheme is managed by the Kreta Ayer Senior Activity Centre. Since October last year, community nurse Helen Alburque'V - who speaks Malay, Hokkien, Cantonese and Mandarin - has been traversing the corridors of rental blocks in Chin Swee Road and Banda Street to tend to people too old or ill to look after themselves.

Among them is retired magician Lee Kok Siang, 93, who has a host of medical problems. Ms Alburque'V found him while knocking on doors to see who needed help.

On Dec 1, at around 7am, Mr Lee fell and bruised his cheek. He then pulled the emergency cord. Although neighbours had been trained to help outside office hours, no one came to his aid until Ms Alburque'V and staff from the centre arrived. They rushed to his flat right after they got to work at around 9.30am.

"He was hurt, but did not want to go to the hospital initially," Ms Alburque'V says. "We were able to convince him to go."

The father of two had suffered two falls before. So while he was away in hospital, Ms Alburque'V and her team rearranged his furniture with his permission. Furniture, boxes and bags had blocked the way from his bed to the toilet. "We cleared a path for him."

After he returned home, Ms Alburque'V visited him every day to help him shower, eat and do his exercises. Now that he has improved physically, she drops in once a week. "He is definitely in better spirits."

When The Sunday Times visited his flat, Mr Lee was obviously enjoying the company and care of the cheerful nursing team. He pointed out that he was older than the late former prime minister Lee Kuan Yew.

"At my age, I need help. And they help me," he says with a small smile.

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