Enabling social care services for older adults during periods of long-term social isolation: Service provider perspectives.

OBJECTIVE: To investigate how small, local organisations were impacted by and responded to COVID-19 in their delivery of social care services to older adults (70 years and older). Lessons learnt and future implications are discussed. METHODS: Six representatives from four social care services (five females and one male) participated in individual semistructured interviews. Responses were analysed thematically. RESULTS: The key themes identified were service providers' experience, perceived needs of older adults and adapting services. Service providers positioned themselves as front-line essential workers for their older adult clients, resulting in some emotional toll and distress for the service providers. They provided information, wellness checks and at-home assistance to keep their older adult clients connected. CONCLUSIONS: Service providers feel more prepared for future restrictions but flag the potential of training and supporting older adults to use technology to stay connected, as well as the need for more readily available funding to allow services to adapt quickly during times of crisis.

A 98-Year-Old Male With Paroxysmal Atrial Fibrillation Treated for COVID-19 at Home.

In the absence of evidenced-based guidelines for early home treatment of COVID-19, some Italian groups of volunteer physicians (both general practitioners (GPs) and hospital doctors) virtually gathered themselves to discuss the best available evidence and develop shared schemes of therapy. We present the case of a 98-year-old unvaccinated male on chronic anticoagulant therapy with dabigatran for paroxysmal atrial fibrillation (AF), who has been successfully treated for COVID-19 at home, according to one of the multidrug treatments proposed, since hospital admission was not feasible. At the very beginning of symptoms, anti-inflammatory drugs, vitamin D, and adjuvant dietary supplements (quercetin, vitamin C, zinc, and vitamin K2) were administered, followed by dexamethasone and antibiotic therapy, according to the evolving clinical conditions. Gastroprotection with omeprazole was added. Eventually, our patient fully recovered, thus suggesting that careful home assistance under strict medical supervision can be successful, even in a very old subject with comorbidities, particularly if early treatment simultaneously addressing inflammation, hypercoagulation, and viral replication is started.

On the Use of Assistive Technology during the COVID-19 Outbreak: Results and Lessons Learned from Pilot Studies.

As a consequence of the COVID-19 emergency, frail citizens felt isolated because of social isolation, suspended and/or strongly reduced home assistance, and limited access to hospitals. In this sense, assistive technology could play a pivotal role in empowering frail older adults reducing their isolation, as well as in reinforcing the work of formal caregivers and professionals. In this context, the goal of this paper is to present four pilot studies-conducted from March 2020 to April 2021-to promptly react to COVID-19 by providing assistive technology solutions, aiming to (1) guarantee high-quality service to older adults in-home or in residential facility contexts, (2) promote social inclusion, and (3) reduce the virus transmission. In particular, four services, namely, telepresence service, remote monitoring service, virtual visit, and environmental disinfection, were designed, implemented, and tested in real environments involving 85 end-users to assess the user experience and/or preliminary assess the technical feasibility. The results underlined that all the proposed services were generally accepted by older adults and professionals. Additionally, the results remarked that the use of telepresence robots in private homes and residential facilities increased enjoyment reducing anxiety, whereas the monitoring service supported the clinicians in monitoring the discharged COVID-19 patients. It is also worth mentioning that two new services/products were developed to disinfect the environment and to allow virtual visits within the framework of a hospital information system. The virtual visits service offered the opportunity to expand the portfolio of hospital services. The main barriers were found in education, technology interoperability, and ethical/legal/privacy compliance. It is also worth mentioning the key role played by an appropriate design and customer needs analysis since not all assistive devices were designed for older persons.

INTERNET OF MEDICAL THINGS (IOMT) AND INTEGRATED HOME ASSISTANCE

This article furnishes an overview of the actual IoT technology used in integrated home assistance. It delineates how the IoMT devices are improving the implementation of integrated home assistance services, and how the IoT technology can influence the global healthcare assistance in upcoming years aiding healthcare systems by supplying secure and effective cures in a complementary or alternative way, even during periods of crisis or health epidemics, like that of "COVID-19." Healthcare assistance based on IoT and the use of deep machine learning can in fact help healthcare workers by giving them new and improved diagnostic capabilities. The combination of machines and clinical experience improves the reliability of the services of integrated home assistance. Artificial intelligence and deep learning can also optimize disease management, provide large amounts of data, and generate analytics from IoMT devices. Transforming the delivery of integrated home assistance healthcare services in this way, thanks to IoT, is essential for improving self-management for people with chronic illnesses and providing specialized care for people located far away or at home. © EuroMediterranean Biomedical Journal 2021.

The COVID Era Unveils Flaws in Pain Treatment

The definition of the word “pain”has recently been changed by the International agency for the studies of pain (IASP), to include also non-verbal and pre-verbal people. During the COVID pandemic, we have seen a new category of people who cannot speak: in many countries, anxiety and isolation and the cuts to home-assistance and to many hospital services, have brought to de-crease the explicit request for healthcare. This is a problem to be solved and an important alert about what is still an unsatisfactory response given by the national healthcare systems: the care of those who are most frail and voiceless. In this article, this scenario is described, and proposals for a future improvement of pain treatment for those who cannot speak are described. The first is to create a “Medicine of Abundance”: it is possible to avoid wastes in healthcare, and with these funds, a better welcoming of people in hospitals, a better stay, and more motivated personnel can be provided. Abundance is a right of the poorest and sickest even more than the general population;when people are at their ease, they can express better their wishes and their sufferings. The hospital should become a place of hospitality, its walls should be the first care for the sick: now in too many cases it is a cold hub/container of services. The second proposal is having caregivers always measure the pain level in hospitalized patients before taking decisions on implementing or withdrawing medical treatments, in particular those that can accelerate their end-of-life;this is called the “pain principle”.

Spousal dementia caregivers' use of technology during the COVID-19 global pandemic: Lessons learned from the NYU family support program

Background Daily routines have been drastically impacted by COVID-19, including healthcare appointments, home services, and many recreational opportunities. Spousal dementia caregivers (CGs) are particularly vulnerable during COVID-19, as many rely on family members, daycare, in-home assistance, and other respite opportunities. We conducted qualitative interviews in May/June 2020 to understand the impact of COVID-19 on dementia CGs and how they experienced the switch of all the NYU ADRD Family Support Program (FSP) services to telehealth. Method A total of 10 spousal CGs participated in videoconference interviews about their COVID-19 experiences and the FSP?s transition to the telehealth format. Semi-structured interviews were conducted by one of two interviewers who were external to the FSP to encourage freedom of discussion. All sessions were recorded and transcribed. De-identified transcripts were coded by two independent coders using NVivo, with discrepancies resolved by a third researcher. Result CGs ranged in age from 54 to 86;7 were female, 8 were non-Hispanic White, and 2 were Black. All were New York City residents living with the person with dementia;2 households had additional adult family members. Qualitative analysis revealed several major themes related to COVID-19 experiences: fears surrounding COVID-19 and staying healthy;changes in daily routines;the impact of reduced respite and support services;adaptation to technology that enabled increased contact with family/friends. Feedback about the telehealth adaptation of the FSP included observations about new group dynamics and decreased barriers to involvement due to the ability to participate from home, reducing the need for transportation and other logistics related to traveling. Conclusion Despite significant challenges due to COVID-19, CGs reported benefit and support from the FSP in the new telehealth format. One participant described the FSP as ?indispensable? and expressed how much members relied on each other during COVID-19. In addition, we learned that the telehealth FSP not only served as a source of support during the crisis but that there were perceived advantages to this format, including reductions in barriers to in-person services (finding transportation, travel time, getting respite care for the person with dementia). We recommend continuing the option of telehealth services for dementia CGs after the COVID-19 crisis.

Support Needs and Interventions for Family Caregivers of Patients with Amyotrophic Lateral Sclerosis (ALS): A Narrative Review with Report of Telemedicine Experiences at the Time of COVID-19 Pandemic.

Family caregivers of people with amyotrophic lateral sclerosis (ALS), a severely disabling neurodegenerative disease due to the degeneration of both upper and lower motor neurons, have a very demanding role in managing their relatives, thereby often experiencing heavy care burden. Previous literature has widely highlighted that this situation reduces caregivers' quality of life and increases their psychological distress and risk of health problems, but there are relatively few studies that focus on psychological interventions for these situations. Family support is more-not less-important during crisis. However, during the COVID-19 pandemic, maintaining public safety has required restricting the physical presence of families for hospitalized patients. Caregivers of ALS patients felt increased sense of loneliness and experienced greater difficulties in the access to both hospital and home assistance. In response, health systems rapidly adapted family-centric procedures and tools to circumvent restrictions on physical presence. In this regard, internet-based and telehealth solutions have been adopted to facilitate the routine, predictable, and structured communication, crucial to family-centered care. This narrative review aims at addressing more current matters on support needs and interventions for improving wellbeing of caregivers of ALS patients. In particular, we aimed at highlighting several gaps related to the complex needs of caregivers of ALS patients, to the interventions carried out in order to respond to these needs, and to the changes that COVID-19 pandemic caused from 2020 to nowadays in clinical managing of ALS patients. Finally, we report ongoing experiences of psychological support for family caregivers of ALS patients through telehealth solutions, which have been reinforced in case of needing of physical distancing during the COVID-19 pandemic.

Home Assistance Technologies for Elderly People: A Brief Evaluation and Software Architectural Proposal

As life expectancy is growing all around the world, a critical issue for many governments is how to deliver good health assistance to a great amount of elderly people, without affecting their daily life. Due to the COVID Pandemia, this problem becomes more urgent, and many new solutions are required for helping them. In this context, Home Care Systems (HCS) can proactively help people in preventing problems, e.g., supporting them in critical situations, such as loss of consciousness or physical disabilities. HCSs consist of services for health-cares and relatives, in a trustful and friendly way, combining both software and hardware technologies. They also should provide a valid approach that reduces the probability of false-positive or false-negative alarms. In this work, we propose drivers that should be taken for the designing of such a system. For that reason, we design an architecture that combines both computer vision algorithms and signal analysis, in order to detect home accidents and abnormal situations. One of the main issues is that integrated sensors should be easily handled and maintained, so we carry out a usability and technological study, detecting which features are necessary for these kinds of solutions. © 2021, The Author(s), under exclusive license to Springer Nature Switzerland AG.

On the Suspension Design of Paquitop, a Novel Service Robot for Home Assistance Applications

The general and constant ageing of the world population that has been observed in the last decade has led robotics researchers community to focus its aims to answer the ever-growing demand for health care, housing, care-giving, and social security. Among others, the researchers at Politecnico di Torino are developing a novel platform to enhance the performance offered by present-day issues, and to assess many others which were not even taken into consideration before they have been highlighted by the pandemic emergency currently in progress. This situation, in fact, made dramatically clear how important it is to have reliable non-human operators whom one can trust when the life of elderly or weak patients is endangered by the simple presence of other people. The platform, named Paquitop, features an innovative architecture conceived for omni-directional planar motion. The machine is designed for domestic, unstructured, and variously populated environments. Therefore, the mobile robot should be able to avoid or pass over small obstacles, passing through the capability to achieve specific person tracking tasks, and arriving to the need of operating with an high dynamic performance. Given its purpose, this work addresses the design of the suspension system which enables the platform to ensure a steady floor contact and adequate stability in every using condition. Different configurations of such system are then presented and compared through use-case simulations.

Caring Advanced Cancer Patients at Home During COVID-19 Outbreak: Burnout and Psychological Morbidity Among Palliative Care Professionals in Italy.

CONTEXT: Providing palliative care (PC) at home for patients with advanced cancer has become essential during the COVID-19 emergency. Nevertheless, the home PC professionals (PCPs) faced a challenging situation because of increased number of discharged patients, reduced availability of health-care facilities, and physical/relational barriers between them and patients. OBJECTIVES: This study aimed to investigate the impact of COVID-19 pandemic on burnout and psychological morbidity among home PCPs in Italy. METHODS: One hundred and ninety-eight PC physicians and nurses working in home assistance in Italy were invited to participate. The results obtained by the investigation conducted during the COVID-19 emergency (COVID2020) were compared with data collected in 2016 in the same setting (BURNOUT2016). The questionnaires (socio-demographics, Maslach Burnout Inventory and General Health Questionnaire-12) were the same for both the surveys. The PCPs participating in COVID2020 survey (n = 145) were mostly the same (70%) who participated in the BURNOUT2016 study (n = 179). RESULTS: One hundred and forty-five PCPs participated in the study (response rate 73.2%). During the COVID-19 emergency, home PCPs presented a lower burnout frequency (P < .001) and higher level of personal accomplishment than in 2016 (P = .047). Conversely, the risk for psychological morbidity was significantly higher during the pandemic (P < .001). CONCLUSIONS: In the age of COVID-19, the awareness of being at the forefront of containing the pandemic along with the sense of responsibility toward their high-risk patients may arouse PCPs' psychological distress, but, on the other hand, this condition may improve their sense of professional satisfaction and personal accomplishment.