Technology Integrated Health Management for dementia

TIHM (Technology Integrated Health Management) for dementia is an ‘internet of things’ technology system using artificial intelligence to remotely monitor the health of people with dementia living at home.

It is led by mental health trust, Surrey and Borders Partnership NHS Foundation Trust, in partnership with the Centre for Vision, Speech and Signal Processing at the University of Surrey and smart home monitoring provider, Howz.

The aim of TIHM is to identify health problems early on to ensure people with dementia receive timely support, reducing pressure on carers and the healthcare system.

A network of digital devices is installed in the home, comprising sensors, smart plugs, interactive monitors, a GPS tracker and tablet, continuously measuring physiological and environmental data. The data streamed by these devices is integrated and analysed in a back-end system, and machine learning algorithms used to identify important changes in a person’s health or behaviour that could signal they are becoming unwell.

If the technology identifies a problem, an alert is triggered, flagged and prioritised on a digital dashboard and followed up by a centralised monitoring team. In the first instance, they are most likely to contact the carer. If necessary, they will also liaise with other health and social care services.

How was it developed?

The first phase of TIHM for dementia was a randomised control trial involving 408 people with dementia and their carers from across Surrey and North East Hampshire.  Half of the group received the technology for six months, the remaining half formed the control group and received care as usual. Both groups were interviewed at the start of the six-month period, midway and at the end.

Who is using it?

A second TIHM for dementia study was launched in April 2019, involving 120 people with dementia and their carers. While the first phase focused on people with mild to moderate dementia, the second phase also involves people with more advanced forms of the condition.  The second phase will be completed in September 2019. The TIHM system is about to be piloted by Birmingham Community Healthcare NHS Foundation Trust and GPs in Middlesex.

Case study: Tracker reduces risks

A 77-year-old man, who we call Mr W, has vascular dementia and lives in Surrey with his wife, who is also his main carer. This man also has a number of other conditions including diabetes, hypotension and sleep apnoea.

Mr W has a history of walking from his home in the evenings and is at high risk of falls. This significantly affects his carer’s anxiety.

When Mr W left home unannounced one day, the monitoring team received a GPS (global positioning system) alert and they contacted Mrs W. She confirmed her husband had left home and the team worked with Mrs W and the police (as part of a partnership agreement) to locate her husband using the GPS tracker.

Based on the latest location readings for Mr W and his known history, the team made a clinical decision to call for an ambulance to meet Mr and Mrs W at their home – and a 24-hour follow-up phone call was organised.

On contacting Mrs W, she reported a muscle strain had been diagnosed. During the call, Mrs W described her husband’s poor sleep pattern and disorientation and the impact of these symptoms on their wellbeing. To support Mr and Mrs W, the team made a referral to social services for a carer’s assessment and an occupational therapy home assessment for Mr W.

Outcomes

• people with dementia who received the technology experienced a statistically significant and sustained reduction in neuropsychiatric symptoms associated with dementia, including depression, agitation, anxiety and irritability
• prototype machine learning algorithms were developed to identify signs of a urinary tract infection (a top five cause of hospital admission among this group) and agitation, irritation and aggression, with good sensitivity
• of the 108 people with dementia and their carers who were interviewed, 76 were overwhelmingly positive, saying they would recommend TIHM for dementia to others while a further 20 participants said they would recommend TIHM provided the user-friendliness and reliability of some devices was improved
• overall, carers said TIHM reassured them about the health of the person they were supporting and helped to reduce the pressure on them.
• carers valued being able to share TIHM data with their GP to support more informed clinical decision making

In commenting on outstanding practice, CQC’s April 2019 report of the trust said: ‘The trust, working in partnership with the Alzheimer’s Society, the University of Surrey and Royal Holloway University of London has developed an innovative system called Technology Integrated Health Management (TIHM) for dementia. This system enables people with dementia to stay in their own homes for longer and avoid readmissions to hospital. A network of internet-enabled devices has been installed in people’s own homes which remotely monitor the health, wellbeing and environment of the person with dementia. If the technology identifies a problem, an alert is flagged, and a clinical monitoring team of healthcare practitioners decides on the necessary follow-up support. The system is part of the NHS England Test Beds programme and won the Health Service Journal award 2018 for improving care through technology’.