Using

1
Using Preventive Gerontechnology Systems to
Monitor Residents Behavior for Health Services
During Emergencies

• Dr. Robert Roush, Baylor College of Medicine,
  Houston, TX
• Dr. Gloria Gutman, Simon Fraser University,
  Vancouver, BC
• 7th World Conference of the International Society
  for Gerontechnology, Vancouver, BC
• May 28, 2010

This educational resource was developed, in part,
with grants from the U.S. Health Resources and
Services Administration All rights reserved,
2010
2
Our Wonderful World Is Also a Dangerous Place
Anthrax 2001 SARS 2003
Tsunami 2004 Bombings 2005 Hurricanes
2005 Avian Flu 2006 Swine Flu
2009 Earthquake floods 2010 Whats
next? 11
September 11, 2001
Is health care prepared? Are you?
3
Global Aging

• 1.2 billion older people worldwide in 2025
• 70 will be in developing countries
• 1 million people turn 60 monthly worldwide now!
• 12,000 persons in the U.S. turn age 62 daily!
• 1st of 77 million U.S. boomers turn 65 in May
  2011

4
Context and Perspective GEPR

• Older persons have altered levels of immune
  function
• Higher risk of infectious illness and reduced
  response to antibiotics
• Few health care workers have had adequate
  training in disaster planning
• Even robust elders have a greater risk in natural
  disasters
• We need all-hazards approach to geriatric
  emergency preparedness and response GEPR
• Technology can play an important role in
  mitigating effects of disasters

5
Topics for This Program

• Need for disaster training
• Preparedness issues
• Diagnosing treating older adults
• Bioterrorism and emerging infections
• Natural disasters, evacuation or shelter
• in place
• Communications and technology
• Reverse alerts to PERS subscribers

6
Need for Local Training in GEPR

• Heat waves France
• Extreme cold England
• Floods Manitoba and Nashville, TN
• Wild fires Australia and California
• Tsunamis S. Asia
• Earthquakes Haiti
• Hurricanes Katrina, Rita, Wilma, and Ike!
• Avian Influenza (H5N1), then Swine Flu (H1N1)
• Weaponized biological agents
• Your hometown
• Your family
• Your residents/patients

7
Need for National Training in GEPR

• lt50 health care workers have had bioterrorism
  and emergency preparedness training, only 1 in 10
  have had geriatrics-specific training
• Health care workers, acute and LTC
  administrators, 1st responders receivers, and
  ED staff need training in treatment and
  geroethics of triage, regardless of type of
  disaster whether natural or human-caused
•  

8
Need for International Training

• GEPR Geriatric Emergency Preparedness
  Response issues are global since 1995, heat
  waves, extreme cold, and floods in Europe plus
  earthquakes and weather-related disasters around
  the world have killed almost a million with over
  2.5 billion people affected and costing 738
  billion in US dollars .
• Older people are always among those
  disproportionately affected.
• The Public Health Agency of Canadas Division of
  Aging and Seniors has started a global initiative
  on GEPR issues.

9
Canadian-led Initiatives in GEPR PERS

• 1st meeting of International Work Group on
  Emergency Preparedness held in Washington, D.C.,
  in 2005
• Subsequent international conferences sponsored by
  the Public Health Agency of Canada/Division of
  Aging and Seniors held in Toronto, Winnipeg,
  Halifax, and Paris
• Regular teleconferences of the IWG on EP
• Research projects funded on GEPR tools used in
  LTC facilities and on use of PERS in disaster
  mitigation plans

10
Our Role in Emerging Threats

• Think pre-event preparedness
• Develop local relationships
• Education and training
• Communicate to our
• patients/public
• What is their risk?
• What is being done to protect them?
• How can I protect myself?
• How can I protect my colleagues?
• What else do we need to know?
• Which technology can help?

RB McFee, 2004
11
Today
The Disaster Cycle
12
What You Need to Know and Can Do Regarding
All Hazards

• What is the threat?
• What are the vulnerabilities?
• What special geriatric preparedness issues need
  to be addressed?
• What needs to be done?
• What can we do now?
• conduct community risk assessments
• train, train, train
• empower seniors
• take preventive actions
• use communications and technology

13
Understanding, Diagnosing, and Treating Older
Adults
14
Common Age-Related Changes

• Homeostatic ?s
• Baroreceptors postural, hypo-
• tension, syncope
• Thermoregulation hypothermia
• cardiac reserve fluid overload
• Renal perfusion nocturia, drug
• toxicity
• Barrier ?s
• Skin thinner barrier with reduced blood flow
• Lungs less active cough reflex
• Stomach reduced gastric acid
• CNS absence of fever

15
Older People Show Less Response to Severe
Infections

• Clinical Features by Age
• 20-49 50-64 65
• Unclear History 12 23 44
• Temp lt100 9 15 29
• Peak Temp 104 103 102
• WBClt10,000 26 40 34
• Mortality 14 32 44

• Patients with pneumoccocal infection where the
  bacteria grew from their blood.
• gt65 were more frequently without fevers, had
  lower peak temperature, and had higher mortality.
• Screening for infection in older people cant
  have absolute temperature cutoff many will be
  missed.
• Less response does not mean less severe
  infection.

Gleckman, 1981, Chassagne, 1996
16
Human-caused Disasters BNICE

• Biological weapons
• Nuclear/radionuclides
• Incendiary devices
• Chemical agents
• Explosive materials

Source RB McFee, 2004
17
Natural Disasters

• Basic needs shelter, fuel, clothing, bedding,
  household items
• Mobility incapacity, transport
• Health access to services appropriate food,
  water, sanitation psychosocial needs
• Family and social separation, dependents,
  changes in social structure, loss of status
• Economic and legal income, information,
  documentation

Source HelpAge International. 2001. Older
People in Disasters and Humanitarian Disasters
Guidelines
for Best Practice. Available online as a pdf
file http//www.reliefweb.int/library/documents/H
elpAge_olderpeople.pdf
.
18
Emerging Infections SARS in Toronto

• Outbreak of SARS, early March 2003 1st case
  diagnosed March 13, peaked mid-March
  resurgence early May with peak in mid-May
  ended mid-June
• March 28th Baycrest received a directive (Code
  Orange) to take SARS prevention measures
• gt15,000 persons underwent voluntary quarantine in
  greater Toronto area
• 44 deaths,100 health care workers infected, 3
  deaths

M. Gordon, 2006
19
Preparedness Issues

20
Today
The Four Pillars of GEPR

• Mitigation identifying threats and resources,
  taking preventive actions
• Preparedness planning, training exercises
• Response acting decisively with Incident
  Command structure
• Recovery getting back to normal, feeling safe
  again, analyzing response mode for next event
• Key How many health professionals have been
  trained for disasters where you live?

21
Natural vs. Human-caused Disasters

• Similar concerns for frail elders whose lives are
  disrupted by hurricanes, floods, wild fires,
  power outages
• Could experience interruption of home care
  services if damage is widespread and large
  numbers of people are affected i.e., their
  informal caregivers
• Even robust elders are affected more than younger
  people in times of natural disasters
• Same concerns for making people feel safe again
• Evacuation vs. shelter-in-place decisions
• Source Fernandez, LS, et al., Prehosp Disast
  Med 200217(2)67-74
  
• 
  

22
Roles and Responsibilities Pre-event Public
Health Emergency

• Public Health
• Disease surveillance
• Respond to outbreaks
• Investigation
• Control and prevention
• Laboratory support
• Participate in planning activities
• Training
• Assess for communications technology

• Hospitals Health Care Workers
• Disease reporting
• Immediately notify public health of unusual
  group expressions of illness or outbreaks
• State laboratory utilization
• Participate in planning activities
• Exercise plans
• Training
• Know where frail elders live and what their
  special needs are

D. Lakey, 2004
23
Roles and ResponsibilitiesDuring a Public
Health Emergency

• Hospitals Health Care Workers
• Implement notification protocols
• Activate staff
• Implement response plans/guidelines
• Coordinate efforts with public health
• Provide care
• Coordinate health-related information
• public health officials
• citizens
• media outlets
• check on communications with elders

D. Lakey, 2004
24
Roles and Responsibilities Post-Event Public
Health Emergency

• Public Health, Hospitals Health Care Workers
• Evaluate response
• Review after-action reports
• Coordinate/implement changes to plans and
  procedures
• Implement recovery plans
• Determine if communications technology worked

D. Lakey, 2004
25
Overview of American Society on Aging Article in
Healthcare and Aging

• 1st step knowing where our frail elders are
  before, during, and after disaster
• 2nd step training frontline health care
  providers on how older people present differently
  
• 3rd step teaching all-hazards approach on
  physical, mental, and psycho-social issues
• 4th step ensuring that providers know about
  culturally and linguistically appropriate
  communication strategies and services
• 5th step making sure health care providers and
  older persons are involved in planning for such
  practical considerations as evacuations,
  shelters, and receiving emergency alerts

26
Communications and Resources
27
Challenges to Aging in Place

• Gerontechnology can be used to assess
  well-being
• Expensive smart homes to inexpensive devices
• Activities of Daily Living Reporting Systems
• e-ADLRS gather data on elders routine home
  activities
• Wireless motion and light sensors upload data
• Establishes baseline, looks for marked changes
• Clients sent reports via website, e-mail or
  phone
• Possible problems checked out sooner
• Receiving reverse alerts from PERS in
  emergencies

28
PERS Helps Elders.

• Live safer and more independently in their
  homes longer by
• Alerting caregivers to emerging problems,
  thereby reducing risks
• of hospitalization
• Providing circle of safety via e-ADLRS
  integrating PERS
• motion sensor monitoring bi-directional
  communications 24/7
• Recognizing and better understanding
  resident/patient condition
• Facilitating eldercare agencies to fill gaps in
  coverage and direct
• care where most needed
• Reducing anxiety of and burden on family
  caregivers
• Mitigating effects of disasters

29
Indications for Smart Home Technology

• What are the leading medical indications CVD,
  
• frequent faller, recent hospitalization?
• What are the main social indications living
  alone,
• no informal caregivers nearby, cant afford
  in-home help?
• What criteria should be used in writing an
  environmental
• Rx for e-ADLRS monitoring?
• Is the SmartHT bundled with a reverse-alert
  PERS?

30
Smart Home Technology for Telecare

Sensors
Only required information leaves home

31
Why PERS, e-ADLRS GEPR?

• Congregant care communities are where
• the density of elders at risk is far higher
  than
• among community dwelling elders
• 24/7 emergency response and motion-by-
• locus monitoring systems help mitigate risks
  
• of elders harmed in disasters when systems
• have bi-directional communications capability
  
• Mitigation requires interoperability between
• caregivers, both at a distance and those on
• site

32
Funded Study on PERS in GEPR

• DAS contracted with Sandra P. Hirst, RN, PhD,
  GNC(C), Director,
• Brenda Strafford Centre for Excellence in
  Gerontological Nursing,
• University of Calgary, for a 3-phase
  environmental scan to determine
• the state of PERS services used to mitigate
  harm to elders in disasters
• 1. Literature scan on general uses of technology
  in personal and large
• scale emergency settings to understand key
  technical and non-
• technical considerations and hence criteria
  for studys assessment
• 2. Detailed survey of North American PERS
  providers, to understand
• product capabilities and variations in
  technologies, target clients, and
• patterns of communication
• 3. Contacted PERS providers to obtain company
  assessments of
• the actual and potential benefits of their
  systems in disaster settings

33
Assumptions of Study on PERS GEPR

• PERS system support in disasters settings would
  have these minimum capabilities
• Be able to reach all the targeted individuals
• Allow broadcast of specific messages to a
  targeted set of individuals
• Permit local authorities to provide messages for
  distribution
• Putative benefits of PERS systems for disaster
  situations were these
• PERS have databases of client information,
  including medical information and
• chains of contacts for both caregivers or
  family and the entire caregiver network
• PERS technology designed to accommodate older
  adults with special needs,
• e.g., large buttons, lights or audio
  accessories for those with hearing impairment
• PERS technology is accessible to and accepted by
  older adults and
• communications/systems infrastructure is in
  place.

34
Results of Study on PERS GEPR

• SWOT analysis of 28 PERS companies revealed
• PERS communications systems are not generally
  designed for mass broadcast
• PERS on-person alert devices are usually not
  designed for incoming notices
• Geographic coverage is fragmented a
• region may be covered by multiple PERS providers,
  resulting in even greater difficulty for local a
  authority to distribute messages
• No existing channels for local authorities to
  communicate with PERS providers

35
Recommendations for PERS use in Disasters

• Demographics
• Assess percentage of seniors using PERS to
  solicit response in personal medical
• emergencies and coverage of providers
• Plan for next generation of seniors or their
  caregivers who will be looking for
• PERS with such enhanced capabilities as
  wide-area coverage, global positioning
• Technical aspects
• How can current technologies such as GPS, and
  cellular voice data services be
• packaged into simple, effective devices
  easily usable by seniors with a variety of
• age-related limitations?
• What data flows will be needed between PERS and
  other agencies so PERS can
• participate as fully as possible in an
  overall disaster management setting?
• Non-technical aspects
• What information security, privacy, and
  regulation considerations are needed for
• private companies to play key roles in
  overall disaster management?

36
Center for Aging Services Technologies CAST

37
CAST Members with Reverse Alert Capability

• CAST director Majd Alwan, PhD, in a personal
  communication on May 14, 2010, stipulated that,
  to his knowledge, only two PERS companies have
  reverse alert capability ltmalwan_at_agingtech.orggt.
• Touchtowns e-Notify system was recently used to
  warn residents
• of Holley Creek Retirement Community near
  Denver, CO, to take
• appropriate action as they were in the path
  of a tornado.
• http//www.touchtown.us/welcome/products/safe
  ty-devices.aspx
• Wellcores bi-directional communication
  capability converts text messages to voice,
  forwarding them to residents regarding up-coming
  events. While not used yet for disaster messages,
  the on the go feature uses GPS with compatible
  mobile phones to locate residents should they
  leave the facility for any reason.
  http//www.wellcore.com
•  

38
Touchtowns e-Notify System

39
Touchtown Command Center Showing Location of
Unit Acknowledging OK

40
Wellcores Bi-directional Communications
Capability

41
Wellcores On-the-Go Feature Uses GPS and
Residents Mobile Phones

42
Online Resources 1

• Center for Aging Services Technologies (CAST)
• http//www.aahsa.org/article_cast.aspx?id102
  35
• International Community on Information Systems
  
• for Crisis Response and Management
  http//www.iscram.org/index.php?optioncom_front
  pageItemid1
• WHO Report, A Safer Future Global
• Public Health Security in the 21st Century
• http//who.int/whr/2007/en/index.html

43
Online Resources 2

• Decision-making Criteria for Evacuation of
  Nursing Homes
• http//www.fhca.org/emerprep/evacsurvey.pdf
• GAO Report on Evacuation of Hospitals and Nursing
  Homes Due to Hurricanes
• http//www.gao.gov/new.items/d06790t.pdf
• Older people in disasters and humanitarian
  crises Guidelines for Best Practice
• http//www.helpage.org/Resources/Manuals

44
Online Resources 3

• Public Health Agency of Canada Pandemic Flu
• Plan
• http//www.phac-aspc.gc.ca/ep-mu/index.html
  
• U.S. Department of Health and Human
• Services Disasters and Emergencies
• http//www.hhs.gov/emergency
• U.S. Centers for Disease Control and
• Prevention - Pandemic and Avian Flu
• www.pandemicflu.gov/

45
Online Resources 4

• U.S. Agency for Healthcare Research and
  Quality
• Disaster Response Tools and Resources
• http//www.ahrq.gov/path/katrina.htm
• U.S. Federal Emergency Management Agency
  Metropolitan
• Management Resource Centers
• http//www.mmrs.fema.gov/
• Baylor College of Medicine American Medical
• Association Best Practices for Managing
  Elderly
• Disaster Victims
• http//www.bcm.edu/pdf/bestpractices.pdf

46
Summary

• Healthcare workers must have mitigation training
  
• for all disasters, natural human-caused
• HCWs need to have training for each vulnerable
• population the young, the old, the
  disabled
• HCWs need to remember that were always in the
• pre-event mode of the next disaster
• GEPR planning frequent exercises required
• Need reverse alert capability via PERS

47
Smart Homes of the Future Aging Trekkie
Welcomes R2D2

48
Contact Information for GEPR/PERS Issues

• Dr. Robert E. Roush
• Huffington Center on Aging
• Baylor College of Medicine
• One Baylor Plaza, MS230
• Houston, Texas 77030
• [phone] www.bcm.edu/hcoa
• rroush_at_bcm.edu