Engineering Systems Design in Healthcare : Smart mobile and wearable technology for support and monitoring in dementia rehabilitation

Abstract

Healthcare systems are undergoing a paradigm shift driven by growing demands on resources due in part to an ageing population and by opportunities presented by rapidly advancing technology. The vision for future healthcare is a decentralised model supported by technology and encapsulated by the P4 healthcare framework of predictive, preventative, personalised and participatory care, a vision yet to be realised in practice. This PhD project addresses the complex task of designing future healthcare systems by bringing together engineering design, technology and health sciences, focusing on dementia care as a representative case example and important challenge for society. Specifically, this work examines the potential role of mobile and wearable technology in dementia care for supporting both patient quality of life and care practices, fulfilling three main objectives: First, opportunities for personal mobile and wearable technology to meet needs of the dementia care network are identified through a field study at a dementia clinic and review of literature. Second, a novel technological solution is developed to perform the dual purpose of providing adaptable, personalised support for people with dementia in everyday life and generating continuous, objective measures of mobility and activity for behavioural monitoring. Third, the technological solution is implemented in a real-life setting among people with early-stage dementia in six eight-week case studies to evaluate its feasibility for augmenting rehabilitation interventions in practice. Findings show the potential for pervasive technologies to address functional, psychosocial and safety needs among people in the early stages of dementia, for example through support with remembering tasks, appointments or information, recalling faces/names, navigating home independently, facilitating communication and motivating physical activity – all of which contribute to overall function in everyday life and social engagement. Familiarity and personalisation are highlighted as key factors for user acceptance. Lifespace mobility and activity features calculated from location, activity and step-count data were able to reveal patterns and trends in behaviour, potentially enabling timely and targeted intervention and collaborative care. A core contribution of this work is the application of mobile/wearable technology and the data this generates in dementia rehabilitation using an engineering systems perspective to improve patient quality of life and advance personalised, participatory, predictive and preventative (P4) healthcare. This work offers a set of analytical tools for understanding human behaviour to inform the design of engineering systems, or for monitoring in a range healthcare applications including for active ageing, lifestyle-related illnesses, rehabilitation or mental health. Furthermore, this work presents knowledge regarding available tools to support everyday life among people with dementia and factors influencing their acceptance, and provides evidence describing the feasibility of using personal mobile and wearable devices for goal-oriented dementia rehabilitation. Through these contributions and in answering related research questions, this PhD projects advances progress towards realising envisioned healthcare systems of the future.