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Seeing people living with dementia through the lens of technology: pain assessment and clinical impact
- Kreshnik Hoti
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- Journal:
- International Psychogeriatrics / Volume 35 / Issue S1 / December 2023
- Published online by Cambridge University Press:
- 02 February 2024, p. 37
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- Article
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Objective:
Due to communication difficulties, pain assessment in people living with dementia (PLWD) is challenging. In this study we explore vocalisations and facial expressions during assessment of pain and provide evidence in regards to clinical impact of pain assessment, as part of a targeted care program.
Methods:In order to determine key facial and vocalisation features and their relationship with pain we analysed a total of 22,194 pain assessments in PLWD (n = 3,144) from 34 different Australian residential aged care homes. Pain assessments were conducted using PainChek, which is a technology-based system comprised of three key components: point-of-care AI-powered application, training and digital analytics. Additionally, we examine the 6-months clinical impact of introducing this system, as part of a wider psychosocial care intervention (i.e., the Reconnect program) in the UK care home setting. Here we focus on how this pain assessment system contributed to the use of psychotropics and issues such as safeguarding.
Results:Likelihood of vocalization feature presence varied based on the intensity of pain. In this regard, sighing and screaming were more likely during experience of higher pain (eight times). During experience of severe pain eyelid tightening was the most frequent facial expression (48.6%) whereas higher pain levels were mostly predicted by horizontal mouth stretch feature. Use of PainChek system as part of the Reconnect program contributed to a more consistent pain management approach, benzodiazepine reduction (29%) and cessation (46%) and reduction of antipsychotic prescribing (22%). Compared to the 6 monthly period from the year prior to implementation of the Reconnect program, a 92% reduction in safeguarding events was reported.
Conclusion:In this study we demonstrate the potential to digitally phenotype key pain behaviours such as vocalizations and facial expressions using the PainChek system. We also evidence the positive impact of pain assessment combined with psychosocial care, on use of psychotropics and safeguarding incidents.
S11: Digital Health and Artificial Intelligence (AI) in Psychogeriatrics: Opening Multiple Frontiers
- Ipsit Vahia, Ana F. Trueba, Kreshnik Hoti, Bettina Husebø
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- Journal:
- International Psychogeriatrics / Volume 35 / Issue S1 / December 2023
- Published online by Cambridge University Press:
- 02 February 2024, p. 36
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- Article
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- You have access Access
- Export citation
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Symposium OverviewOverall Abstract:
The past decade has seen an explosion in the growth of technologies in mental health. Particularly, the scaled adoption of virtual care catalyzed by the COVID-19 pandemic has opened up new frontiers in how digital tools can be incorporated into psychiatry. No area of mental health care is as ripe for digital innovation as psychogeriatrics. In this session, an international group of clinicians and researchers will demonstrate how digital health in psychogeriatrics represents multiple cutting edges of innovation.
Our symposium will include 4 presentations, that represent original research from the USA, Ecuador, Norway, Kosovo and Australia. We will highlight clinical applications of these digital tools and aligned issues such as improved care access in low- and middle-income countries, the ethics of digital data collection and the potential for creating new liabilities.
We will focus on four distinct technologies and applications. Dr. Ipsit Vahia will discuss passive environmental sensing supported by signal processing and artificial intelligence (AI) in guiding treatment decision making, especially in dementia care. His presentation will include discussions on how AI can be incorporated into care while also preserving autonomy. Dr. Kreshnik Hoti will discuss the application of AI on voice-based signals to determine changes in pain levels and psychopathology. His presentation will include research conducted in collaboration between teams based in Australia and Kosovo and through a public-private partnership with a digital health startup. Dr. Ana Trueba will focus on digital interventions, specifically virtual reality (VR). She will present data from two studies, one from McLean hospital In the US, and the other from Ecuador that explore how VR can deliver evidence-based non-pharmacologic interventions. Dr. Bettina Husebø will present data from a project she oversees in Norway. Her talk will discuss how care in nursing homes can be improved by incorporating a range of digital approaches into nursing home care paradigms. A particular focus will be on the relationship between pain and behavior symptoms and dementia among nursing home dwelling older adults.
Thus, the symposium will address diagnostics, treatment and systems level care and how New technologies are shaping the evolution of psychogeriatrics worldwide.
8 - Person- and relationship-centred care in dementia
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- By Kreshnik Hoti, Curtin University, Jeffery Hughes, Curtin University
- Dawn Forman, Curtin University, Perth, Dimity Pond, University of Newcastle, New South Wales
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- Book:
- Care of the Person with Dementia
- Published online:
- 06 August 2018
- Print publication:
- 15 September 2015, pp 115-134
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Summary
Learning outcomes
Understand the principles of person-centred care of a person with dementia.
Understand who is the person in person-centred care.
Discuss approaches aimed at achieving person-centred care.
Understand the principles of relationship-centred care of a person with dementia.
Discuss the importance of the interprofessional team to collectively identify remaining abilities and the care pathway for the individual.
Key terms
interprofessional practice (IPP)
patient-focused care
person-centred care
relationship-centred care
Introduction
In this chapter, we discuss two key concepts involved in the care of patients with dementia: person-centred care and relationship-centred care. In addition to explaining the meaning and origins of person-centred care as a term, key emphasis is placed on principles and achievement of person-centred care. We also discuss the specifics of those with dementia that need consideration and the benefits of providing person-centred care in dementia patients. Relationship-centred care is explained in the context of interplay between collaboration, communication and relationships, and key interactions involved in dementia patients are also highlighted. We discuss relationships between various stakeholders involved in care of patients with dementia from the perspective of the agency theory. The chapter concludes with a consideration of interprofessional practice (IPP) in the provision of patient-centred care in dementia and the interprofessional team work is illustrated in a case study.