Digital Care Program

AI assisted Dementia Care : A solution that provides  comprehensive recovery  and upgrades culture of care 

The Problem: 

As we see the global rise in the population of above 60 years we see the sprouting of twoopposite views and feelings in our heart. One that we can provide a medical support that make us live longer but at the same time, are we equipped to care the aging brains. We are definitely successful in providing physical health and also good palliative care for end stage diseases like cancer, heart and kidney failure, osteoporosis and fractures or for that matter post-surgical recovery in senior citizens , but what we find incapable of today is to  address the needs of those who are losing their grey matter due to a process of early aging caused by Dementia. 

The problem of Dementia can be seen as a threat, as a disability and as a curse acquired with longevity. The challenges are not restricted to the person with dementia, but they attack the whole ecosystem of the individual. It means the life of family members, caregivers and co-habitants is jeopardised by the plethora of dementia syndrome. The declining memory of a loved one is just one of the emotional challenges, to manage the daily living of such individual is additionally exhaustive and threatening. The behavioural problems are just the tip of the iceberg that can sink the family like the titanic.  Day today issues are confusing as the progress of disease is unstoppable. It is a challenge for the closest members to decide on how to respond, whether to admit, under whom and why ?The symptoms can arise due to anything. A brain with dementia can malfunction due to anything  that is in the mind, body or environment of the person with dementia. For example a person with dementia can become suddenly violent if there is silence in the house, or if there is a loss of orientation of place , or even if there is any physical pain. Persons with dementia have created ruckus on the streets or nightmares in their family members when they had lost their way back home due to memory loss. Many conditions (behavioural and physical) pose challenge for clinicians. Physicians find it difficult to manage the behavioural problems arising in their nursing homes when a person with dementia is admitted for a medical or surgical problem. It is difficult to explain the caregivers about the true cause of any physical or mental conditions in persons with dementia.  The cost of hospitalisation, emotional turmoil and inadequate interventional wisdom makes Dementia a global challenge. Livingston et al ( 2017) reported a sudden rise in Dementia in the last decade, showing 47 million people on the list of diagnosis with Dementia world wide and further predicted that the number shall be three times by 2050. Robinson et al ( 2015) reported another challenge of early onset and rising risk of lifestyle factors responsible for this irreversible condition. 

1. Livingston G, Sommerlad A, Orgeta V, Costafreda SG, Huntley J, Ames D, et al. Dementia prevention, intervention, and care. Lancet 2017;390:2673–734.
2. Robinson L, Tang E, Taylor JP. Dementia: timely diagnosis and early intervention. BMJ 2015;350:h3029.
   

This opens our discussion for addressing three basic needs of Dementia..

1. Early identification and intervention
2. The care model of this non-curable condition
3. Prevention of Dementia in younger population

What are the needs of Dementia?

• Early identification of the disease is difficult due to varied presentation
• Guidelines for management of various stages of dementia are fluidic
• Outcome is unpredictable and progress is guarded
• Caregivers’ agony, dilemma and burnout remains unattended
• Unmet needs of the person with dementia cause more challenging situations
• No policies or strategies for change of culture towards care model in medical professionals
• No Cohesive teamwork of Person with dementia, Caregiver and Medical support in society
• Connecting pathophysiology with behavioural symptoms and risk factor analysis or predictors of probable catastrophic outcomes is not available.
• Dealing with psychosocial domain, familyvalues  and cultural factors during treatment of dementia is not in the culture yet.
• Protecting the rights of the person with dementia , conservation of their cognitive reserve, preserving  their dignity in family and society and reaching their selfhood or personhood is not in the vison. Over the years it  has been disheartening process and an uphill task for the professionals working in dementia to reach out and attend the unmet needs in dementia. The reasons are
• Deficiency of awareness in society and specialists
• Stigma about the mental conditions associated with Dementia
• Lack of training amongst the stakeholders
• Connectivity with the treating physician
• Activities and problems of daily living are painful for the depleted caregivers 
• Biomedical model of cure failed in providing medical solutions
• Care model is not yet understood by medical fraternity 
• Social responsibility and public interests are yet to mature to become dementia friendly 
• What is commonly projected as the best beat solution?
• Integrative and inclusive approach is the best model under care of dementia. This means we need to come out from our rigid expectations to find cure, to feel pessimistic about outcome and to feel stigmatised about the condition of our love ones. So we need to integrate –

1. Awareness about dementia
2. Empowerment and supportof caregivers to become active partners in care model
3. Daily inputs of schedule regarding activity, diet, physiological needs and social interaction
4. Educating the physicians and caregivers regarding the precipitating/ risk factors for behavioural and physical problems 
5. A tool to identify early signs or onset of risk factors
6. Simple algorithms to reach the probable cause of abnormal behaviour and to provide the relief by simple home based remedies
7. Regular connectivity and bilateral faith of the doctor-patient team
8. Tool to study the total ecosystem with disease in person with dementia 

How to reach the needs and improve the outcome of Dementia care?

1. Dementia Outreach Program: Connecting caregivers with the knowledges and empowering them with the vision and wisdom of care.
2. Provide readymade solutions by audio-visuals for reorganising environment, physical activities and cognitive remediations for the persons with dementia
3. Daily inputs from family and person with dementia to upgrade the medical and mental conditions for the health professional.
4. Providing the reliable and valid guidelines and strategies for  the treating physician for the specific person with dementia
5. Motivational inputs for caregivers and person with dementia for regular medication, health check-ups and activities of daily living.
6. Improve vigilance over risk factors
7. Interpret the probable cause of threatening, challenging or dangerous behaviour of the persons with dementia
8. Integrating the clinical data, lab findings, psychosocial structure, cognitive deficiencies and personality traits to create a holistic picture of the Selfhood of the person with dementia.
9. Providing probable interventional strategies for correcting the the dents in the selfhood.
10. Guiding the caregivers, families and clinicians to address the personal needs and selfhood of humans .

What are the outcomes 

• To improve the availability of services to the community
• Decrease the burden of caregivers in search of  effective remedies
• Improve on the efficacy of medical care
• Prevention of threatening conditions and burnouts in community
• Decrease the stigma and pessimism associated with dementia
• Improving compliance for treatment, home based strategies, empathy for care
• Decreasing the psychological, psychosocial and psychosomatic disturbances in family of dementia
• Providing the fabric for further research and development on brain exercises, cognitive reserves, emotional strengths and regaining the dignity of the person with dementia

How will the technology work ?

Steps

1. Three dashboards defined for A) Family of Dementia B) involved Mental Health Worker C) Company managing the back office
2. The three are in sync to  serve the five basic  principles  of Dementia Care

• Awareness 
• Medical Management 
• Cognitive Remediation
• Cognitive Reserve 
• Selfhood and Self Respect         

    Caregivers Dashboard: 

    Interactivetool  for data collection from three sources 

• Chat Bot questionnaire
• Clinical notes and Reports by scan
• Measurements of cognitive and executive functions , if possible biometric and biofeedback sensors

Interpreted Data as a report card 

Integrated with responses from in-charge medical team or consultants 

Daily Schedule and Guidelines