PREVENTION OF ACUTE EVENTS OF OLDER PEOPLE

Currently in the Netherlands, about 800.000 older adults visit the emergency department (ED) each year, and they are at high risk of unplanned revisits. Using various digital tools, the PROACT research team wants to test and measure how older adults can remain self-reliant for longer and what interventions are needed to prevent admission to the ED.  

The number of older adults visiting the ED each year, will increase to about 1.1 million and 390.000 acute hospital admissions in 2040. Older patients that frequently visit the ED have multiple chronic conditions, more severe illness, and more complex care questions. Approximately 10-23% return to the ED unexpectedly within the first month. This is a strong predictor of adverse outcomes in older adults such as functional decline and mortality.

No quick fix

Based on literature, the PROACT research team knows that risk factors for re-admission are both patient- and system related. Experts from Eindhoven University of Technology, Utrecht University and University Medical Center Utrecht empathize that developing effective preventive interventions is therefore not a quick fix. So far, interventions focusing on discharge planning, transitional care and phone calls after discharge have not effectively reduced ED revisits.

Approach

Effective preventive interventions require in-depth knowledge of patient-related, environmental, and healthcare-related factors. The first step is to identify a deterioration of health and functioning and the so-called tipping points. Using technology such as sensors and monitoring tools has the potential to early detect deterioration of the health status of patients. Various monitoring strategies (i.e. technologies) have been evaluated in the home situation. However, several challenges exist and more knowledge is needed.

Therefore, the PROACT research team will focus on:

1. Testing the feasibility and usability of different monitoring strategies (technology) such as wearables (i.e. smart watch), sensors in the house and/or apps among older adults at risk for an ED re-admission.
2. Evaluating which technology works for which groups of older adults and why. Exploring the willingness of older adults to use these technologies and reasons for non-participation and non-adherence, especially for those with low (digital) literacy.
3. Evaluating the efficacy of these strategies on preventing an acute re-admission among older adults, developing risk prediction models and explore barriers and facilitators for implementing this technology.
4. Developing proactive interventions to prevent acute (re-)admissions.

In doing so, the research team will combine the knowledge of the three institutes involved. UMCU research group Nursing Science has knowledge on clinical practice and developing and testing complex interventions. UU has expertise on smartphone sensors and passive data collection using mobile devices, nonresponse and willingness to share novel types of data. TU/e has expertise on AI, process mining, data-driven healthcare processes improvement.

Pilot study and larger grant

On the short term, the team will start with a small-scale pilot study to explore:

1. if and how the adapted ‘Covidtherapy@home’ app can be used in this population and if the data has the potential for the prediction of a deterioration of health,
2. if data from sensors in the home environment can predict a possible acute event,
3. the willingness of older adults who experienced an acute event to use this technology.

This pilot study will be conducted among older adults (aged 70 and older) who have recently been admitted to the emergency department (ED) in Utrecht region and who have a high risk of an ED readmission. Hospital data on patient characteristics and potential determinants of willingness to use the technology will be collected.

In 2022 the PROACT research team received seed funding from the Institute for Preventive Health. This will be used in 2023 for the pilot and for setting up a larger consortium, working on a larger grant and for building a strong research line on this topic. During this phase, the team will share its findings, a.o.  through i4PH’s communication channels.

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