Information Technology Reference
In-Depth Information
Optimal use of OAD's gerontechnological platform
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relies on the specific compe-
tences as represented by respective professionals and professional groups. Elderly
care includes personnel of various fields, skills and expertise e.g. social workers,
nurses, gerontologists, therapists, psychologists and physicians, general practition-
ers, neurologists and geriatricians. It should be noted that the home care staff in its
vast majority consists of a selected mix of social workers and nurses, and thus social
care becomes comparably important together with health care. Also in residential
and nursing homes, social and health care should be in balance, while in hospital
wards the provision of health/medical care is usually seen more important.
In comparison with the working population, older people are more likely to suf-
fer from a wider range of diseases. Public diseases, including problems caused by,
and related to metabolic syndromes, diabetes, obesity, malnutrition and sleep depri-
vation, usually appear accompanied with cardiovascular diseases (cardiac failure,
atherosclerosis, vascular disease and hypertension). Ageing then comes more and
more with cerebrovascular disease, COPD (Chronic Obstructive Pulmonary Dis-
ease), and various frailty syndromes including osteoporosis and sarcopenia, with
the risk of a potential fall to be on the increase, having severe effects on the care
levels. For instance after a fall, the need for physical exercise and rehabilitation
increases. Furthermore, various forms of cancer appear more frequently, and pallia-
tive treatment in the last stages of cancer is one of the main reasons why a transfer
to domestic environment is often preferred by the patient.
While monitoring of health condition and follow-up of interventions can be sup-
ported by devices and ubiquity (e.g. glucose meters for diabetes and monitoring
sleep disorders by using sensors implanted in beds), the detecting and monitoring
of cognitive decline and psycho-geriatric diseases require assessment scales.
Cognitive decline in MCI (Mild Cognitive Impairment) stages and as appearing
in different severity degrees in Alzheimer's disease and other dementia types are
typical for old age, and are further accompanied by psycho-geriatric problems such
as depression, delirium, and various non-cognitive
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symptoms.
Figure 26.1 illustrates the minimal set of assessment scales, which usually
comprises of some ADL (Activities of Daily Living) scales combined with suit-
able cognitive scales like MMSE [11].
Combination scales, like the CDR [16]
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http://www.fourcomp.com/oad/
3
We prefer the neutral and widely accepted term “non-cognitive symptoms of dementia”,
even if the concept of Behavioral and Psychological Symptoms in Dementia (BPSD) has
been defined e.g. by the International Psychogeriatric Association (IPA). BPSD was in-
tended to cover a heterogeneous range of psychological reactions, psychiatric symptoms,
and behavior occurring in people with dementia of any aetiology. However, BPSD has
became controversial as it invites to treating a syndrome or disorder, thus neglecting dis-
tinctions between individual symptoms. Aetiological homogeneity in these respects is now
seen to be rather unlikely. Research and trials on BPSD might even lack external valid-
ity since pharmacological trials showing the effectiveness of psychotropic drugs in treat-
ing these symptoms have been based on summations representing the variety of BPSD
symptoms rather than using particular scales. Notably, BPSD is not included as a term in
medical databases.
