A systematic review of the benefits of home telecare for frail elderly people and those with long-term conditions (original) (raw)
Related papers
2013
Background: Systematic reviews and meta-analyses of home telemonitoring interventions for patients with chronic diseases have increased over the past decade and become increasingly important to a wide range of clinicians, policy makers, and other health care stakeholders. While a few criticisms about their methodological rigor and synthesis approaches have recently appeared, no formal appraisal of their quality has been conducted yet. Objective: The primary aim of this critical review was to evaluate the methodology, quality, and reporting characteristics of prior reviews that have investigated the effects of home telemonitoring interventions in the context of chronic diseases. Methods: Ovid MEDLINE, the Database of Abstract of Reviews of Effects (DARE), and Health Technology Assessment Database (HTA) of the Cochrane Library were electronically searched to find relevant systematic reviews, published between January 1966 and December 2012. Potential reviews were screened and assessed for inclusion independently by three reviewers. Data pertaining to the methods used were extracted from each included review and examined for accuracy by two reviewers. A validated quality assessment instrument, R-AMSTAR, was used as a framework to guide the assessment process. Results: Twenty-four reviews, nine of which were meta-analyses, were identified from more than 200 citations. The bibliographic search revealed that the number of published reviews has increased substantially over the years in this area and although most reviews focus on studying the effects of home telemonitoring on patients with congestive heart failure, researcher interest has extended to other chronic diseases as well, such as diabetes, hypertension, chronic obstructive pulmonary disease, and asthma. Nevertheless, an important number of these reviews appear to lack optimal scientific rigor due to intrinsic methodological issues. Also, the overall quality of reviews does not appear to have improved over time. While several criteria were met satisfactorily by either all or nearly all reviews, such as the establishment of an a priori design with inclusion and exclusion criteria, use of electronic searches on multiple databases, and reporting of studies characteristics, there were other important areas that needed improvement. Duplicate data extraction, manual searches of highly relevant journals, inclusion of gray and non-English literature, assessment of the methodological quality of included studies and quality of evidence were key methodological procedures that were performed infrequently. Furthermore, certain methodological limitations identified in the synthesis of study results have affected the results and conclusions of some reviews. Conclusions: Despite the availability of methodological guidelines that can be utilized to guide the proper conduct of systematic reviews and meta-analyses and eliminate potential risks of bias, this knowledge has not yet been fully integrated in the area of home telemonitoring. Further efforts should be made to improve the design, conduct, reporting, and publication of systematic reviews and meta-analyses in this area.
Telemedicine journal and e-health : the official journal of the American Telemedicine Association, 2015
From 1992 to 2008, older adults in the United States incurred more healthcare expense per capita than any other age group. Home telemonitoring has emerged as a potential solution to reduce these costs, but evidence is mixed. The primary aim of the study was to evaluate whether the mean difference in total direct medical cost consequence between older adults receiving additional home telemonitoring care (TELE) (n=102) and those receiving usual medical care (UC) (n=103) were significant. Inpatient, outpatient, emergency department, decedents, survivors, and 30-day readmission costs were evaluated as secondary aim. Multivariate generalized linear models (GLMs) and parametric bootstrapping method were used to model cost and to determine significance of the cost differences. We also compared the differences in arithmetic mean costs. From the conditional GLMs, the estimated mean cost differences (TELE versus UC) for total, inpatient, outpatient, and ED were -$9,537 (p=0.068), -$8,482 (p =...
Article Commentary: Home Telehealth and an Aging Population
Canadian Journal of Nursing Research Archive, 2013
An aging population is driving increased demand for health services and a shift in care from hospital to home. Concerns about the high costs of acute care and the realization that hospitals are "bad places" (e.g., nosocomial infections, functional loss) for old, frail people have focused attention on treating people in their homes, which is for the most part where they prefer to be. Fortunately, technology has the potential to reduce health-care costs, enhance access to services, and improve management of chronic diseases (Center for Aging and Health, 2013). Home telehealth programs have documented positive outcomes, including reduced health-care costs, fewer hospitalizations and readmissions, improved quality of care, and better chronic disease management (Broderick & Lindeman, 2013; Chetney, 2008). A study of home telehealth implemented in several regional health-care systems in the United States found that health-care utilization decreased 20% for diabetes, 30.3% for hypertension, and 25.9% for congestive heart failure (Broderick & Lindeman, 2013). Another study demonstrated a 50% reduction in hospital readmissions related to heart failure and a total net savings of $8,155 per patient (Broderick, 2013); the findings indicate high levels of patient satisfaction, reduced hospitalization and readmission, decreased length of hospital stay, and decreased emergency department visits. What, then, is holding back the wider adoption of home telehealth? Most of the home telehealth programs brought to scale have required development of software unique to each health-care organization, which limits access to data across levels of care (e.g., acute care, home care, primary care). The home health consumer market has seen a proliferation of standalone devices that address specific needs (e.g., personal medical alert systems, medication dispensing devices, blood glucose meters). Home activity sensors (e.g., Lively) that "learn" personal routines and use built-in wireless service to alert caregivers when help may be needed are the latest product to enter the market. However, the usefulness of these
Background: Two primary objectives when caring for older adults are to slow the decline to a worsened frailty state and to prevent disability. Telemedicine may be one method of improving care in this population. We conducted a secondary analysis of the Tele-ERA study to evaluate the effect of home telemonitoring in reducing the rate of deterioration into a frailty state and death in older adults with comorbid health problems. Methods: This trial involved 205 adults over the age of 60 years with a high risk of hospitalization and emergency department visits. For 12 months, the intervention group received usual medical care and telemonitoring case management, and the control group received usual care alone. The primary outcome was frailty, which was based on five criteria, ie, weight loss, weakness, exhaustion, low activity, and slow gait speed. Participants were classified as frail if they met three or more criteria; prefrail if they met 1-2 criteria; and not frail if they met no criteria. Both groups were assessed for frailty at baseline, and at 6 and 12 months. Frailty transition analyses were performed using a multiple logistic regression method. Kaplan-Meier and Cox proportional hazards methods were used to evaluate each frailty criteria for mortality and to compute unadjusted hazard ratios associated with being telemonitored, respectively. A retrospective power analysis was computed. Results: During the first 6 months, 19 (25%) telemonitoring participants declined in frailty status or died, compared with 17 (19%) in usual care (odds ratio 1.41, 95% confidence interval [CI] 0.65-3.06, P = 0.38). In the subsequent 6 months, there was no transition to a frailty state, but seven (7%) participants from the telemonitoring and one (1%) from usual care group died (odds ratio 5.94, 95% CI 0.52-68.48, P = 0.15). Gait speed (hazards ratio 3.49, 95% CI 1.42-8.58) and low activity (hazards ratio 3.10, 95% CI 1.25-7.71) were shown to predict mortality. Conclusion: This study did not provide sufficient evidence to show that the telemonitoring group did better than usual care in reducing the decline of frailty states and death. Transitions occurred primarily in the first 6 months.
JBI Database of Systematic Reviews and Implementation Reports, 2017
Background: The aging population will lead to a rise in the number of people with age-related diseases, and increasing demand for home care services. Telecare is seen as a solution to this challenge by promoting aging in place. Nevertheless, there is still a poor understanding of older adults' experiences with the actual use of telecare. Objective: The aim of this review was to identify and synthesize the best available qualitative evidence of community-dwelling older adults' experience with the use of telecare in home care services. Inclusion criteria: This review considered studies that focused on qualitative data, examining older adults' experiences with the use of active and passive technology devices, such as personal alarms and sensor technology, in the context of home care services.
JBI Database of Systematic Reviews and Implementation Reports, 2017
Review question/objective: The objective of this systematic review is to identify and synthesize the best evidence on the home-dwelling elderly's experiences with the use of telecare in home care services. Furthermore, the study will identify experiences with telecare devices and examine what beliefs the home-dwelling elderly hold regarding the impact of telecare on the ability to age in place. Review question 1: How do the home-dwelling elderly experience the use of telecare in the context of home care services? Review question 2: How do the home-dwelling elderly experience telecare devices? Review question 3: What beliefs do the home-dwelling elderly hold regarding the impact of telecare on the ability to age in place?
BMC Health Services Research, 2010
Background: Older adults with multiple chronic illnesses are at risk for worsening functional and medical status and hospitalization. Home telemonitoring may help slow this decline. This protocol of a randomized controlled trial was designed to help determine the impact of home telemonitoring on hospitalization. The specific aim of the study reads as follows: to determine the effectiveness of home telemonitoring compared with usual care in reducing the combined outcomes of hospitalization and emergency department visits in an at-risk population 60 years of age or older. Methods/Design: Two-hundred patients with the highest 10% Mayo Clinic Elder Risk Assessment scores will be randomly assigned to one of two interventions. Home telemonitoring involves the use of a computer device, the Intel Health Guide, which records biometric and symptom data from patients in their homes. This information is monitored by midlevel providers associated with a primary care medical practice. Under the usual care scenario, patients make appointments with their providers as problems arise and use ongoing support such as a 24-hour nurse line. Patients will have initial evaluations of gait and quality of life using instruments such as the SF-12 Health Survey, the Kokmen Short Test of Mental Status, and the PHQ-9 health questionnaire. Patients will be followed for 1 year for primary outcomes of hospitalizations and emergency department visits. Secondary analysis will include quality of life, compliance with the device, and attitudes about telemonitoring. Sample size is based on an 80% power to detect a 36% difference between the two groups. The primary analysis will involve Cox proportional time-to-event analysis. Secondary analysis will use t-test comparisons for continuous variables and the chi square test for proportional analysis. Discussion: Patients randomized to home telemonitoring will have daily assessments of their health status using the device. Registered nurse monitoring will assess any change in status followed by videoconferencing by a midlevel provider. We obtained trial registration and Institutional Review Board approval.
Perspective Chapter: Telehealth Technologies for the Elderly People
Geriatric Medicine and Healthy Aging [Working Title]
Home telehealth technology delivers a telemedicine tool for elder adults to take an active role in the management of their chronic diseases. This study aimed to determine the requirements and applications of home telehealth systems to monitor health parameters of the elderly. Electronic databases including PubMed, Scopus, Web of Science complemented by Google Scholar were searched. This systematic review was conducted based on preferred reporting items for systematic reviews and meta-analyses. In this study, 21 articles met the inclusion criteria and were included in the final review. There were 80 different requirements and 15 types of applications to create a home telehealth system specifically for the elderly. The highest frequency of applications element was related to the “blood pressure” (18%) and the lowest frequency related to items such as blood coagulation (1%) monitoring. Other systems` elements were “alert system” (12%), “information analysis” (12%), smartphone (20%), an...
Journal of telemedicine and telecare, 2009
We compared the effects of evidence-based disease management guidelines delivered to patients with heart failure and diabetes using three different modalities: in-person visits alone (Control), in-person visits and a telephone intervention (Telephone), and in-person visits and telemonitoring (Telemonitoring). Patients were randomized to the three groups. There were 112 patients in the Control group, 93 in the Telephone group and 98 in the Telemonitoring group. During the first 60 days, 10% of the Control group were rehospitalized, 17% of the Telephone group and 16% of the Telemonitoring group. Having heart failure and receiving more in-person visits were significantly related to readmission and time to readmission. However, after adjusting for diagnosis and visits, the differences between the three groups were non-significant. There was a trend for increased risk of readmission for the Telephone group compared to Control alone (P = 0.07, risk ratio 2.2, 95% CI: 0.9 to 5.2) and for r...