Investigating the Suitability of Agile Methods for Requirements Development of Home Care Systems

The ageing population in developed countries brings many benefits but also many challenges, particularly in terms of the development of appropriate technology to support their ability to remain in their own home environment. One particular challenge reported for such Home Care Systems (HCS) is the identification of an appropriate requirements development technique for dealing with the typical diverse stakeholders involved. Agile Methods (AMs) recognize this challenge and propose techniques that could be useful. This paper examines the desirable characteristics identified for requirements development in HCS and investigates the extent to which agile practices conform to these. It also sets out future work to improve the situation for the non compliant points found.

Sleeping Conditions of Older Adults with Delirium Receiving Home Care

We aimed to clarify the sleep status before delirium onset among older adults receiving home care. The sleep status of 21 participants aged ≥65 years was monitored while they slept with a sensor placed under their bedding, after ruling out insomnia and dementia. The incidence of delirium was 28.6%;delirium onset occurred within an average of 2.7 (SD = 12) days after the start of home care among those whose care environment was changed due to hospital discharge or moving. Increased interrupted sleep and activity during sleep indicated that sleep fragmentation occurred before delirium onset. In conclusion, individuals aged ≥65 years and those whose care environment has changed should be screened for delirium because the time to delirium onset is short. Further, interventions to monitor the sleep status and prevent delirium onset should be implemented from the day home care begins.

Association between Geographic Accessibility of Home Care Clinics and Hospitalization in Japan Using Geographic Information Systems and Insurance Claim Data

Measuring and improving home care clinic resource volume and geographic allocation are an important public health issue regarding prolonging home care system usage among disabled elderly people. This study examined clinic volume and accessibility’s association with hospitalization duration among disabled elderly people in 13 municipalities in Japan;additionally, this study compared clinic volume and accessibility’s ability to explain hospitalization duration in this population. Home care clinics’ service volume and geographic accessibility were calculated for 17 municipalities using public data and geographic information systems. We analyzed medical claim data from October 2012;the sample included 22,662 persons who were aged ≥75 years, certified as disabled in daily living, and lived in 13 municipalities regarding which data could be obtained for all examined municipality characteristics. Multilevel logistic models with random intercepts were constructed for municipalities and individual- and municipality-level independent variables in order to examine home care clinic volume and accessibility’s correlation with hospitalization duration. Clinic volume ranged from 0 to 9.53 per 10,000 elderly people;clinic accessibility ranged from 0% to 83%. Clinic volume and accessibility were both significantly negatively correlated with hospitalization duration of ≥10 days (odds ratios, 0.944 and 0.713;confidence intervals, 0.914 - 0.974 and 0.553 - 0.921, respectively). Clinics were not homogeneously geographically distributed;clinic accessibility explained hospitalization duration better than clinic volume. Clinic accessibility may more accurately indicate care clinic allocation appropriateness than clinic volume.

Analysis of home care-based multi-level old-age service system

With the deepening of China＇s aging, China＇s social pension problem more obvious each day, and gradually become the focus of attention of the whole society. On the one hand, China entered the aging society, old-age needs to grow exponentially. The sixth national census shows that in our country, the population aged 60 and 13.26% of the total population over the total number of 179 million, 65 years and older the proportion of 8.87% of the total population, the absolute number of nearly 120 million. Hundreds of millions of older age groups will produce a growing demand for care services, which is the original old-age service system and the whole economic and social development is a huge pressure. On the other hand, with the economic and social transformation, the traditional model of family pension has been unable to adapt to the profound changes in modem employment, family structure, the concept of retirement, since most parts of China, ＂old before getting ricE＂ the situation, how to solve the elderly the pension problem is related to the overall situation of China＇s economic and social development, related to the overall situation of building a harmonious society in China. Under current national conditions, the emphasis on the development of a single individual body to meet the growing demand for pension service is not realistic, we must mobilize the enthusiasm of all aspects of the element, multi-service integration of resources subject to their commitment to a different responsibilities and tasks provide a full range of care services according to different types, different levels of the actual needs of the older age groups. On the aging problem is that the whole community to face, you need to multi-government body, families, communities, institutions combine effectively starting from the actual needs of the elderly population, according to the financial assistance, life care, spiritual consolation three set the specific needs of services, through a government-led, home-based care services, community care services for the core and supplementary services for institutions focused on pension and other means to provide a full range of pension services.

Circumstances of falls and fall-related injuries among frail elderly under home care in China

This exploratory study investigated the circumstances of falls and fall-related injuries among frail elderly people under home care.A convenience sample of 500 frail elderly(60 e99 years old)from the Wanshoulu and Yuyuantan communities in Beijing's Haidian District during February 2013 and March 2014.Fall circumstances and related injuries were characterized by detailed interviews and questionnaires.The article reports the results of a study that the overall fall incidence was 41.5%,and higher for females than males.Falls mainly occurred in individuals who were over 80 years old(50.0%)and indoors(67.9%).The percentage of subjects who experienced a combined injury after the fall was 56.3%,whereas 19.0%fell causes a fracture.Approximately 35%of the subjects were hospitalized,and 27.6%of the subjects recovered more than 30 days.Results indicate that,falls in the frail elderly caused serious damage,and fall-related circumstances should be a great concern in this population.

Assessment of Quality of Life, Family Function and Family Empowerment for Families Who Provide Home Care for a Child with Severe Motor and Intellectual Disabilities in Japan

Background: About 70% of Japanese children with severe motor and intellectual disabilities (SMID) live at home, and the number is increasing. Family members have an enormous burden of daily physical care for these children. A top priority is to understand quality of life (QoL), family function, and family empowerment to effectively support these families. We aimed to assess current living situations of families with a SMID child, and to reveal the relationships between QoL, family function, and family empowerment. Methods: Sixty-five family members from 34 families with a SMID child participated in this study. We assessed 5 parameters using the Japanese versions of the following instruments: World Health Organization Quality of Life 26 (WHOQOL26), Kinder Lebensqualitats Fragebogen (KINDL), Family Assessment Device (FAD), Family Adaptability and Cohesion Evaluation Scale KG-4 (FACESKG-4), and Family Empowerment Scale (FES). Correlation and multiple regression analyses were conducted;QoL score was the objective variable. Results: Participants included 54 parents (34 mothers, 20 fathers) and 11 siblings. The mean age of SMID children was 10.4 ± 5.03 years. Twenty-two children needed multiple types of medical care. The mean age of parents and siblings was 41.5 ± 6.16 years and 15.5 ± 2.35 years, respectively. The mean QoL score (3.28 ± 0.5) was similar to the Japanese average. The mean KINDL score (77.2 ± 12.1) was higher than those of previous studies. The mean FAD score was 1.97 ± 0.32. For FACEKG-4, the score of adaptability was correlated with WHOQOL score (r = 0.459, p < 0.05). The mean score of FES was 113.6 ± 14. As the result of multiple regression analysis, lower family FAD scores ([sb] = ?0.61, p < 0.01) indicated higher family function and greater age of participants (sb = 0.495, p < 0.01) was correlated with higher WHOQOL scores (F = 15.208, p < 0.01). Conclusions: Our results indicated that the individual QoL depended on the age of participants (equals the years of experience caring for a SMID child) and the recognition of family function as a whole. Thus, to improve family members’ QoL, we should focus on individuals and also approach the family as a whole.

Testing of the Content Validity of a Modified OPCq Instrument—A Pilot Study in Norwegian Home Health Care

Aim: To test the content validity of a modified Oulu Patient Classification instrument (OPCq), part of the RAFAELA Nursing Intensity and Staffing system in home health care (HHC) in Norway. Background: Due to the growing number of patients in HHC, a Patient Classification System (PCS) whereby the systematic registration of patients’ care needs, nursing intensity (NI) and the allocation of nursing staff can occur is needed. The validity and reliability of the OPCq instrument have been tested with good outcomes in hospital settings, but only once in an HHC setting. In this study, the OPCq is tested for the first time in HHC in Norway. Methods: A pilot study with a descriptive design. The data were collected through a questionnaire (n = 44). Both qualitative and quantitative analyses were used. Results: The OPCq fulfills the requirements for validity in HHC, but the manual may need some minor adjustments. Discussion: The OPCq seems to be useful for measuring nursing intensity in HHC. Staff training and guidance, high-quality technological solutions and that all technology works satisfactorily are important when implementing a new PCS. Further research is needed in regard to NI and the optimal allocation of nursing staff in an HHC setting.

End-of-life home care of an interstitial pneumonia patient supported by high-flow nasal cannula therapy:A case report

BACKGROUND High-flow nasal cannula(HFNC)therapy and morphine continuous subcutaneous infusion(CSI)have been used to ameliorate dyspnea in non-cancer patients with end-stage respiratory diseases,including chronic obstructive pulmonary disease and interstitial pneumonia,primarily in hospital settings.However,it is rare to perform home-based medical treatment using these.We observe a case to assess the feasibility of this treatment strategy.CASE SUMMARY Here,we report a case of a 75-year-old man who was diagnosed with interstitial pneumonia 11 years ago and was successfully nursed at home during his terminal phase for over 10 mo without hospitalization,by introducing domiciliary uses of HFNC and morphine CSI with a patient-controlled analgesia device.CONCLUSION Active utilization of HFNC and morphine CSI with patient-controlled analgesia device would substantiate successful end-of-life palliative home care of idiopathic interstitial pneumonia patients.

Desired Lifestyle of Older Adults with Dementia Living at Home from Their Perspective and That of Their Families with Support from Care Providers

Objective: This study aimed to determine the lifestyle of older adults with dementia living at home, how their families perceive them, and how care providers support their desired lifestyle. Methods: Semi-structured interviews were conducted with 12 pairs of older adults with dementia, their families, and care providers followed by a qualitative descriptive study. Results: Older adults with dementia described their lifestyle as follows: “I continue to take pride in the way I have lived so far,” “I want to do what I can now even if I cannot do it well,” “I live peacefully with my family,” “I go out and interact with people,” and “I live this time today with care.” Families regarded the lifestyle of older adults with dementia as a desire “to continue living at home peacefully,” “to live on their own,” and that they “probably do not want anything.” Care providers’ support was based on “respect (for an older adult with dementia) as a person,” “drawing out and making use of what they can do with their current abilities through providing care,” “supporting families and confirming their sense of satisfaction with life,” and “predicting the future course and supporting decision-making.” Conclusions: To support the lifestyle of older adults with dementia, it is important to ensure that they continue to have dignity and are comfortable living with their families and in their communities without intimidation.

Changes and Development of Home and Community Based Elderly Care Service Policies in China

This paper analyzes the current situation of the development of home and community based elderly care service in China,points out the existing problems,and puts forward improvement measures,aiming to deepen the understanding of HCBS and promote the theoretical research and practice of community home-based elderly care service.

Focus on Undernutrition in Care Homes： A Retrospective Service Evaluation

“Let them eat cake”： a retrospective service evaluation of Focus on Undernutrition in care homes. Introduction： Undernutrition is a major cause and consequence of poor health in older people, affecting 35% of residents in care homes. Focus on Undernutrition （FoU）, a dietetic service delivered by dietetic assistants uses a multifaceted approach to undernutrition management. This study aims to evaluate FoU’s impact on undernutrition outcome measures in care homes; including FoU’s influence on weight change in residents “at risk” of undernutrition, and prevalence of undernutrition and pressure ulcers （PU）. Methods： A retrospective pragmatic service evaluation was undertaken using pseudonymised data collected over 13 years on weight, undernutrition risk and PU from long-stay residents’ notes before and six months after training （FoU）. Results： Analysis completed on 104 homes, 4,315 residents （71.3% female; mean stay 10.8 （1-278） months） in County Durham. Following FoU a significant difference was identified for： improved rate of weight change for “at risk” residents （p 〈 0.001）. Undernutrition risk significantly influenced weight change （low： B1.04 kg, E0.01 kg; moderate： B-1.79 kg, E-0.38 kg; high： B-0.83kg, E1.00 kg, Bp 〈 0.001, Ep = 0.001）. Reduced undernutrition prevalence （p 〈 0.001） from 32.7% to 29.1% residents “at risk” of undernutrition （moderate： B13.1%, E8.9%; high： B19.6%, E15.9%）. Nutrition screening significantly improved （B76.3%, E98.7%, p 〈 0.001）, reduced prevalence PU （51%, p 〈 0.001）. PU prevalence significantly increased with undernutrition severity at baseline （p 〈 0.001）, but not following FoU （p = 0.233） （low： B5%, E2.3%; moderate： B6.9%, E1.6%; high： B10.5%, E3.9%）. Odds of developing PU reduced 53% （OR： 0.47）. B：baseline; E：evaluation; OR： odds ratio. Conclusion： These results demonstrate dietetic assistants delivering FoU significantly improves weight, undernutrition and PU prevalence in care homes. Indicating FoU is an effective model for improving undernutrition outcomes, with the potential of reducing possible harm, such as PU in care homes.

Can Video Conferencing Be as Easy as Telephoning?—A Home Healthcare Case Study

In comparison with almost universal adoption of telephony and mobile technologies in modern day healthcare, video conferencing has yet to become a ubiquitous clinical tool. Currently telehealth services are faced with a bewildering range of video conferencing software and hardware choices. This paper provides a case study in the selection of video conferencing services by the Flinders University Telehealth in the Home trial (FTH Trial) to support healthcare in the home. Using pragmatic methods, video conferencing solutions available on the market were assessed for usability, reliability, cost, compatibility, interoperability, performance and privacy considerations. The process of elimination through which the eventual solution was chosen, the selection criteria used for each requirement and the corresponding results are described. The resulting product set, although functional, had restricted ability to directly connect with systems used by healthcare providers elsewhere in the system. This outcome illustrates the impact on one small telehealth provider of the broader struggles between competing video conferencing vendors. At stake is the ability to communicate between healthcare organizations and provide public access to healthcare. Comparison of the current state of the video conferencing market place with the evolution of the telephony system reveals that video conferencing still has a long way to go before it can be considered as easy to use as the telephone. Health organizations that are concerned to improve access and quality of care should seek to influence greater standardization and interoperability though cooperation with one another, the private sector, international organizations and by encouraging governments to play a more active role in this sphere.

The Practical Dilemma and Optimization Path of Smart Home-Based Care in Hengshui City, China

Smart home-based care for elderly is the product of the “Internet+” era, along with the information technology and the growing needs for a better elderly life. In order to understand the influencing factors of smart home care in Hengshui city, this paper selected 183 elderly people through a questionnaire survey. The conclusion of the study showed that education level, economic status, sleep quality and residence conditions are the influencing factors affecting the needs of smart home care of the elderly (p 0.05). Smart home care products for the elderly have a high willingness to use them, especially in terms of life care, medical services and emotional talk, but the compliance still needs to be improved. Development countermeasures suitable for Hengshui city can be put forward through the publicity of smart elderly care services, promoting the construction of demand-oriented big data, and promoting the participation of various forces.

Study on Supply and Demand of Intelligent Home-based Aged Care in Shanghai

The 21st century is an era of aging population. With the accelerated aging of the population in our country, and the grim form of population aging, intelligent home-based care has become a concern for the elderly in the area of ？？care. This paper starts from the new concept of intelligent home-based care services and defines intelligent home care services. It also summarizes the current theoretical researches related to domestic research, which is of great significance for the investigation and research conducted in the later stage of research.

How can home care realize people-based, local and global consciousness of the organic unity of vision

Under the background of China＇s aging population, home care service system in line with China＇s traditional family pension, pension also incorporates community features, is widely used in China at this stage of pension model. However, the home care service research stage and the organic unity of the people did not do standard, local awareness and global perspective, often blindly follow the tide of globalization. Article by home care services, people-based, local and global vision of the concept of consciousness and its relationship to reports, summarized the research stage of home care service should be how to achieve unity of the three.

Study on social support system of urban Empty Nester old-age home

Empty nester are elderly people who have special needs. With the evolution of the aging society and family structure, empty nest family is rapidly increasing. The Empty Nester is the result of a combination of factors of population transformation, economic development, intergenerational relations change etc. We need to build a multi-level, three-dimensional social support networks, to ensure that this part of the elderly can happily spend their twilight years.

Is perioperative home the future of surgical patient care?

Perioperative home （PH） or perioperative surgical home （PSH） is a patient centered medical service or primary care provider aimed at share decision-making and seamless continuity of care for the surgical patient. The goal is to improve operational efficiency, decrease resource utilization, reduce length of hospital/intensive care unit （ICU） stay and readmission, and to decrease complication and mortality rates. PH is an innovative model of delivering health care during the entire patient surgical/procedural experience. This model is centered around patient from the time of the decision for surgery till the patients have recovered and returned to the care of themselves.

An Introduction to Home Care for Esophageal Cancer

Esophageal cancer is a common tumor of the digestive tract and is a malignant tumor which affect one’s health and is potentially life threatening.The incidence and mortality rate of esophageal cancer in China is relatively high,with the incidence rate being the sixth highest and the mortality rate being the fourth highest among all malignant tumors.The lesion often occurs in the middle segment of the epithelium of the esophagus,often showing a family tendency,and is more likely to occur in middle-aged and elderly men.The typical symptom of esophageal cancer is progressive dysphagia,first with dry food,then with semi-liquid food,and finally with water and saliva.Treatment is divided into surgical treatment,radiotherapy,chemotherapy,and combination therapy.Apart from malnutrition and pain,the treatment can also cause great psychological stress to patients with esophageal cancer.Therefore,diet,pain,and psychological care for patients with esophageal cancer are crucial.Therefore,it more care is given to the patients by medical and nursing staff during hospitalization.However,not much have been discussed about home care for patients with esophageal cancer.In this article,we will talk about the home care of esophageal cancer patients from the following aspects:dietary,pain management,and psychological care.

Validation of LPD Scale for the Assessment of Pressure Ulcer at Home

Objectives: This study was designed to test and validate the new LPD scale in a home care setting. The specific objectives are to validate the LPD scale for subjects cared for at home;and to compare LPD to the Braden scale for internal validity. Method: This multicenter, cross-sectional study was conducted in the domestic environment of subjects cared for Home Care services from North to South of Italy. Data collection lasted 8 months, between June 2018 and September 2020, and consisted of the simultaneous compilation of the new LPD, and the Braden scale. Home Care Expert nurses could interface with the recruited subjects and/or caregivers. The parameters considered to validate the new scale were sensitivity (Se), specificity (Sp), positive predictive values (PPV), odds ratio (OR), and the area under the receiver operating characteristic (ROC) curve. Results: Of the 679 recruited subjects, 63.2% were women, and more than 50% did not have a pressure ulcer. 48.2% of the sample aged over 85 years old;69% was affected by multiple disease, and 76.6% took a lot of drugs. 91.6% of the subjects were affected by a partial or total functional dependency. Around 50% of subjects presented double incontinence, and 43% were conscious and collaborated. 85.4% of subjects lived in a healthy environment. The predictive validity parameters showed: Se 77.25%, Sp 84.04%, PPV 91.37%, and the area under the curve (AUC) 0.88% with a confidence interval (CI) 95%. These values mean a moderately accuracy of the test. Conclusions: The new LPD scale has demonstrated a good capacity for identifying the subjects at risk of pressure ulcer and had a better discriminatory power rather than Braden scale.