Pre-frailty factors in community-dwelling 40-75 year olds: opportunities for successful ageing.

BACKGROUND: There is little known about pre-frailty attributes or when changes which contribute to frailty might be detectable and amenable to change. This study explores pre-frailty and frailty in independent community-dwelling adults aged 40-75 years. METHODS: Participants were recruited through local council networks, a national bank and one university in Adelaide, Australia. Fried frailty phenotype scores were calculated from measures of unintentional weight loss, exhaustion, low physical activity levels, poor hand grip strength and slow walking speed. Participants were identified as not frail (no phenotypes), pre-frail (one or two phenotypes) or frail (three or more phenotypes). Factor analysis was applied to binary forms of 25 published frailty measures Differences were tested in mean factor scores between the three Fried frailty phenotypes and ROC curves estimated predictive capacity of factors. RESULTS: Of 656 participants (67% female; mean age 59.9 years, SD 10.6) 59.2% were classified as not frail, 39.0% pre-frail and 1.8% frail. There were no gender or age differences. Seven frailty factors were identified, incorporating all 25 frailty measures. Factors 1 and 7 significantly predicted progression from not-frail to pre-frail (Factor 1 AUC 0.64 (95%CI 0.60-0.68, combined dynamic trunk stability and lower limb functional strength, balance, foot sensation, hearing, lean muscle mass and low BMI; Factor 7 AUC 0.55 (95%CI 0.52-0.59) comprising continence and nutrition. Factors 3 and 4 significantly predicted progression from pre-frail to frail (Factor 3 AUC 0.65 (95% CI 0.59-0.70)), combining living alone, sleep quality, depression and anxiety, and lung function; Factor 4 AUC 0.60 (95%CI 0.54-0.66) comprising perceived exertion on exercise, and falls history. CONCLUSIONS: This research identified pre-frailty and frailty states in people aged in their 40s and 50s. Pre-frailty in body systems performance can be detected by a range of mutable measures, and interventions to prevent progression to frailty could be commenced from the fourth decade of life.

Unintended Consequences of Tele Health and their Possible Solutions. Contribution of the IMIA Working Group on Telehealth.

OBJECTIVES: Assess unforeseen consequences of Telehealth and suggest solutions Methods: An outline was created collecting all possible ill effects classified into Clinical considerations, Administrative concerns including interpersonal relations, Technical issues, Legal / Ethical concerns and Miscellaneous. Each topic was assigned to a particular WG member to lead, gather opinion and review existing literature. RESULTS AND CONCLUSION: A wide array of problems have been described. Except for technical issues, literature on this topic is scant, so this article is based more on personal experience and data collected from surveys. Much can be done to prevent such problems, such as a need for standardization with related clinical studies for devices as well as processes used for telehealth is underlined, besides evaluation of outcomes of projects undertaken.

Using Personal Handheld Computing Devices for Personalizing Healthcare. A Contribution from the IMIA Working Group on Telehealth.

OBJECTIVES: Telehealth has an increasing role in future healthcare. This paper seeks to define and understand recent advances in provision of tele-healthcare through use of personal handheld computing devices, and suggests how such personalized solutions offer further opportunities for progress. METHODS: We considered the current status of personal handheld computing devices for personalizing healthcare, through review of examples in the literature and web sources. RESULTS: We have identified the following four generic roles for personal handheld computing devices in personalized healthcare: educational, social networking and games, monitoring with notifications/ reminders, and online/offline tele-consultations. We discuss examples of these in two settings: healthcare facilities and patient home. CONCLUSION: Advances in latest handheld computing devices have made tele-healthcare more personalized and increasingly possible even in the absence of the care provider.

Next generation telehealth. Contribution of the IMIA Telehealth Working Group.

OBJECTIVE: Telehealth has long been seen as a means of increasing access and quality of care while decreasing costs and logistical burden for remote health care delivery. Underlying technology to support Telehealth has been developed commercially. However, its widespread adoption has been hindered by numerous clinical, social, political, economic and management factors. This paper examines trends which may help to address this situation. METHODS: First we consider the current status of Telehealth based on some state-of-the-art reviews. Then we present some new future modes of Telehealth services, as described by various prominent authors. From these we identify some common directional themes and fundamental issues affecting the success of future Telehealth innovations. RESULTS: This position paper advances a view that Telehealth in the future will be much more driven by widespread pressure from two different drivers: more ubiquitous connectivity and related technological capabilities due to greater diversity in human communication practices, and new models of care emerging from diverse widespread movements towards health services reform. CONCLUSION: The IMIA Working Group on Telehealth work agenda will address some specific items within the areas described above.

Image enhancement for electronic visual prostheses.

This paper briefly describes the framework of artificial human vision systems and identifies several image processing techniques which could enhance the information content of artificially-induced images. We describe our own research in this area, which aims to assess the performance of proposed devices, specifically the usefulness of low quality images associated with electronic visual prostheses. Our subjective assessment studies using representative test patterns have investigated how much information and what types of information are needed to recognise or perceive a scene. 174 normally sighted subjects viewed a set of low quality (low spatial resolution and low grey-scale) static images. Results from this testing has identified informative image processing operations which lead to improved understanding of picture content.