Process Documentation - Wearable device
Wearable: some form of custom device that can be worn on the body, that either
senses something about the body or the environmental context of the wearer, or
gathers data from the internet and translates it into some form of communication/alert/action to/on the body, or
responds in some other way to the body, or the environment, or the relationship between the two
What elements contributes to agitation in an elderly person with a cognition impairment.
how can we use sensors to detect biometric information in a bid to reduce the use of chemical restraints and sedatives in an Emergency Department.
This neurocognitive decline can make it difficult for people living with dementia to process and manage environmental stimuli as they become more vulnerable to social and physical stressors (Kales et al., 2015; Smith et al., 2004)
As a result, up to 90% of people living with dementia will at some stage develop Behavioural and Psychological Symptoms of Dementia (BPSD) (Lagana et al., 2022), manifesting in various verbal and nonverbal behaviours, including apathy and depression (Tible et al., 2017). More overt forms of BPSD are referred to as ‘responsive behaviours’, understanding that they often reflect an attempt to communicate or respond to a situation or environment (Yous et al., 2019). Of these responsive behaviours, agitation and aggression are often considered the most distressing form, as they may compromise the safety of the person living with dementia and those around them (Tible et al., 2017).
Behavioural and psychological symptoms of dementia often present or are exacerbated during acute hospital admission. This is in response to common physical stressors, such as temperature, light and noise levels and social stressors, such as the inability to communicate and form therapeutic relationships (Caspar et al., 2018; Lourida et al., 2020).
Sundowning, also known as "sundowner's syndrome," refers to a phenomenon commonly observed in individuals with dementia, particularly during the late afternoon or evening. Here’s an overview of what it involves:
Characteristics of Sundowning
Increased Agitation: Individuals may become more restless, anxious, or agitated as the day progresses. This can manifest as irritability, confusion, or aggressive behavior.
Confusion: People may experience heightened confusion or disorientation during the evening hours, leading to difficulty recognizing familiar surroundings or people.
Mood Changes: Emotional swings can become more pronounced, with individuals exhibiting sadness, anger, or frustration.
Sleep Disturbances: Sundowning can also be associated with difficulties in falling asleep or staying asleep, contributing to overall fatigue and agitation.
While the exact cause of sundowning is not fully understood, several factors may contribute to its occurrence:
Circadian Rhythm Disruption: Changes in the body’s internal clock may lead to increased confusion during evening hours.
Fatigue: Accumulated fatigue throughout the day can contribute to heightened agitation and confusion.
Reduced Lighting: Diminished natural light in the evening can create shadows and unfamiliarity, leading to anxiety.
Overstimulation: A busy day with too much activity or noise may overwhelm the individual as the day winds down.
To help manage sundowning, caregivers can consider several approaches:
Establish a Routine: Maintaining a consistent daily schedule can provide a sense of security and predictability.
Create a Calm Environment: Dim lights and reduce noise in the evening to create a calming atmosphere. Soft music or familiar scents may help.
Encourage Relaxation: Activities such as gentle stretching, reading, or listening to soothing music can promote relaxation in the evening.
Limit Stimulants: Reducing caffeine or sugar intake later in the day may help decrease agitation.
Monitor Activity Levels: Ensure that the individual is engaged throughout the day but avoid overstimulation.
Provide Reassurance: Offering comfort and reassurance during episodes of confusion can help alleviate anxiety.
PITCHED - Pain, infection, Thirst, constipation, Hunger, Environment and Drugs.
Agitation in an emergency department is common for elderly people especially with dementia and delirium.
Unfamiliar Environment: The ED can be chaotic and disorienting, leading to increased anxiety and agitation.
Sensory Overload: Bright lights, loud noises, and the presence of many people can overwhelm elderly patients, causing distress.
Lack of Routine: Disruption of familiar routines can heighten feelings of insecurity and agitation.
Anxiety and Fear: Concerns about their health, treatment, or being in an unfamiliar environment can lead to heightened anxiety.
Cognitive Decline: Patients with dementia or cognitive impairment may struggle to understand their situation, leading to frustration and agitation.
Social Isolation: Feelings of loneliness or separation from caregivers or loved ones can contribute to agitation.
Social and Emotional Factors
Loss of Independence: The perception of losing control or independence can provoke agitation.
Past Trauma or Experience: Previous negative experiences in medical settings can trigger anxiety and agitation in similar situations.
Smart Devices and Wearable Technologies to Detect and Monitor Mental Health Conditions and Stress: A Systematic Review - PMC (nih.gov)
Vital signs, neural activity (electroencephalogram ((EEG)), heart rate (electrocardiogram ((ECG)), skin temperature, and skin conductance response (electrodermal activity) can provide important information about an individual’s health status.
Devices that can sense increased agitation typically rely on various types of sensors and technology. Here are some common examples:
Wearable Devices: Smartwatches and fitness trackers often have sensors that monitor heart rate, skin temperature, and galvanic skin response, which can indicate stress or agitation.
Mobile Apps: Some apps analyze voice tone and speech patterns to detect changes in emotional states, potentially indicating agitation.
Environmental Sensors: Cameras with facial recognition software can assess changes in facial expressions that may signal agitation.
Biometric Sensors: Devices that measure physiological responses like blood pressure, heart rate variability, and respiration can indicate heightened agitation.
Smart Home Devices: Certain smart home systems can integrate multiple sensors (like cameras and environmental sensors) to monitor behavior and detect signs of agitation.
Therapeutic Robots: Some robots designed for emotional support can sense agitation through vocal and visual cues and respond accordingly.
What already currently Exists on the market
Dementia-friendly wearable devices designed to detect agitation focus on user-friendliness, comfort, and reliability. Here are some options:
Apple Watch: Features like heart rate monitoring and fall detection can help caregivers notice signs of agitation.
Fitbit: Models with heart rate and sleep tracking can alert caregivers to unusual patterns.
Garmin Vivosmart: This tracker monitors activity levels and can provide insights into changes in behavior or agitation through activity patterns.
Mindset: A device designed specifically for older adults that monitors stress levels and can alert caregivers if agitation is detected.
Seniors’ Comfort Devices: Some wearables focus on providing calming stimuli, which can help in managing agitation.
Certain textiles integrated with sensors can monitor heart rate and stress levels, providing data to caregivers.
While not specifically for agitation, devices like the AngelSense can help caregivers monitor location and movement patterns, which can indicate agitation or wandering.
Emotion-Sensing Wearables:
Devices like Empatica Embrace can detect physiological signs of stress and send alerts to caregivers.
When selecting a device, consider ease of use, comfort, and the specific needs of the individual with dementia to ensure it fits seamlessly
Lots of work has been done however they are all facing the similar issues in which many of them test the prototype and get not so good feedback about the size, shape, design, and so on.
IoT-Based Wearable Devices for Patients Suffering from Alzheimer Disease - PMC (nih.gov)
Galvanic skin response (GSR) is generally considered a useful measure of physiological arousal, but its accuracy can vary based on several factors:
Sensitivity to Changes: GSR is sensitive to emotional and physiological changes, making it good for detecting arousal related to agitation, stress, or excitement.
Individual Differences: Responses can vary significantly between individuals due to factors like skin type, hydration levels, and baseline stress levels.
Context: Environmental factors, such as temperature and humidity, can influence GSR readings, affecting accuracy.
Calibration: Accurate interpretation often requires proper calibration and context-specific understanding, as GSR alone doesn’t provide insights into the specific emotions being experienced.
Supplementary Data: For improved accuracy, GSR is often used alongside other physiological measures (like heart rate or respiration) and behavioral observations.
While GSR can be a valuable tool in monitoring emotional states, it's best used as part of a broader assessment strategy rather than in isolation.
What vital sign is the biggest predictor of agitation
The heart rate is often considered the most significant predictor of agitation. Elevated heart rates can indicate increased physiological arousal, which is commonly associated with agitation, anxiety, or stress.
While other vital signs like blood pressure and respiration rate can also signal agitation, heart rate changes tend to be more immediate and responsive to emotional states. Monitoring heart rate variability can provide further insights into a person’s stress levels and overall emotional well-being.
Combining heart rate data with observations of behavior can enhance the understanding of agitation in individuals, especially in those with conditions like dementia.
heart rate data and irratic movement predictor of agitation
Heart Rate: An elevated heart rate is often a direct indicator of physiological arousal associated with stress or agitation. Sudden spikes in heart rate can signal acute agitation.
Erratic Movement: Increased physical activity, such as pacing, fidgeting, or other restless movements, often correlates with agitation. These behaviors can indicate discomfort, anxiety, or a need to escape a stressful situation.
When monitored together, these two factors can provide a clearer picture of a person's emotional state:
Correlation: A simultaneous increase in heart rate and erratic movement can reinforce the idea that the individual is experiencing significant agitation.
Timeliness: Changes in heart rate can occur quickly, allowing caregivers to respond promptly to signs of distress.
Behavioral Context: Observing erratic movements alongside heart rate data can help caregivers interpret the situation more accurately, allowing for tailored interventions.
In practice, devices that track both heart rate and movement (like smartwatches or fitness trackers) can be useful tools for monitoring agitation in real-time, especially for individuals with conditions such as dementia.
Wearable Biosensors: An Alternative and Practical Approach in Healthcare and Disease Monitoring - PMC (nih.gov)
Would using a sensory Therapy device with the monitor inside work?
Sensory therapy is a helpful way to calm and soothe without using medication. It’s an effective way to reduce anxiety, calm nerves, and provide comfort.
what are the best materials to use?? fur?
Nonpharmacological tactile activity interventions for reducing behavioural and psychological symptoms of dementia in the acute hospital setting: An integrative review - Davis - 2023 - Journal of Clinical Nursing - Wiley Online Library
Most effective - Pharmocological interventions.
There is limited evidence exploring tactile activity interventions for reducing behavioural and psychological symptoms of dementia in acute hospital settings. Individualised approaches in combination with staffing expertise appear central to implementation.
5 Textile Considerations When Designing For Dementia - Materialised
The cognitive and sensory impairments people living with dementia may encounter can affect their experience of the world. This means that visual cues, surface texture and patterning are extremely important for signalling where they are, promoting independence and dignity.
One of these is clothing – finding comfortable, easy-to-wear garments that don’t exacerbate confusion or agitation can be a real pain point.
It’s important to choose soft, breathable material that won’t irritate their skin or cause discomfort.
Consideration should be given to contrast, Tactility, patterns, durability and colour.
Wearable Textiles may be more appropriate for dementia patients because they are less bulky.
Building a platform so a caregivers and families can have up to date information about the wellbeing of the patient.
There are some already available -
A platform that provides health tracking, medication reminders, and alerts for caregivers.
Offers wearable devices and a corresponding app that tracks health metrics and sends alerts to caregivers.
A comprehensive system that combines health monitoring, communication, and reminders for seniors and their caregivers.
4. Dementia Care App by CareConnect
Designed specifically for caregivers, it includes features for tracking daily activities, medication schedules, and mood tracking.
An AI-powered voice assistant that offers reminders, alerts, and companionship while keeping caregivers informed.
A mobile app designed to help caregivers track and manage the health and wellbeing of dementia patients.
Can I change the application or look at modifying it?
These apps more focus on a broader range of services. Like a virtual health provider.
I am looking at a more focused interface just on a couple of modalities. Heart rate and movement.... ? noise activity?
Fully Integrated, Stretchable, Wireless Skin-Conformal Bioelectronics for Continuous Stress Monitoring in Daily Life
Current Evidence for Continuous Vital Signs Monitoring by Wearable Wireless Devices in Hospitalized Adults: Systematic Review - PMC (nih.gov)
it would be really difficult to actually play someone's favourite song as we may not know them or have any previous history. There are many similar devices out there but I want it specifically to be to the ED. The ED is noisy and the nurses are really task focused and can be very busy and chaotic. It would be better for the device to display lights on an interface or a set of lights or something.
There are alot of wearable devices but not really sure that it would work in the ED due to infection control and the idea of it being disposable or how we would manage that.
Exploring the ideas of washable materials or disposable materials
How to monitor pulse rate:
Living electrodes based on green algae in hydrogels
May in the future to be able to use seaweed gel to conduct a circuit - reading the biometric data.
Dorset: AI socks trial could help people with dementia and autism (bbc.com)
these socks are machine washable and detect temp, movement, heart rate and sweat. Then sends the data to AI to interpret and alert carers that the person is escalating.
The machine washable socks are paired with an app, installed on a smartphone.
A sensor embedded in one of the socks collects data from the foot and the ankle of the wearer which is sent to the AI, which estimates whether the person is distressed.
The care team would then be alerted through the app.
Dr Zeke Steer, Milbotix founder, was inspired to make the product after his grandmother began to show signs of early onset dementia.
He said partnering with the council meant the company could "hear the expert voices of people providing and receiving care".
"We are committed to building a product that genuinely help carers and improves wearers' overall wellbeing," he added.
Design Concept 1
Agitation wrist band/arm strap that played music to calm the patient.
Agitation is a common problem in the Emergency Department with high stimulus for a dementia patient. The idea was to identify agitation early and use music therapy to assist with reduction in stressors.
Pros - reduction in stress and agitation. Calmer patient. Reduction in the risks of developing delirium, reduced hospital time and reduction in Medication managment.
Cons - Unaware of patients favourite songs. Would need to consider hearing impairment and disruption to other patients. Need device or sound system linked in to facilitate.
Wearable clothing that detected agitation early but was attached to an interface that could alert Nurses in the ED that the patient was getting agitated. Similar to cardiac monitoring.
Pro- Displays on stationary computer continuous monitoring interface so that the nurse could see whilst monitoring cardiac output.
Cons - The clothing may be removed. The nurse isn't always monitoring the stationary computer. So potentially elevations would be missed. Not all patients are accepting of clothing or items unless they are familiar in advanced dementia/alzheimers.
Wearable clothing that detected agitation early but was attached to a light or alert system that could alert Nurses in the ED that the patient was getting agitated. through a bright visual cue outside the patients room
Pro - easy visual cue for the nurses to establish who was escalating and provide some intervention.
Con - the wearable clothing may still be an issue....
Maybe a biopatch could be attached to the patient on their back instead so as to not agitate or aggravate them as it may not be felt. ??
In the future seaweed gel could be used as a conductor to create electronic components in wearable design instead of metal.
Code to play music if the motion and heart rate exceed the threshold
couldn't get the sats prob pulse monitor to work but did have the microbit. Just keeps playing music because the heart rate monitor is not attached.
now going to change it so it lights up instead...
but there are already socks on the market that can be reappropriated - will try and recreate those and then attach it to the interface.
Another code tried where both the movement and the heartrate were visible. The movement needs to be adjusted to mimic normal body movements and then what would be outside that.
Microbit Blue tooth - Agitation Detector.
Where to place the device
Hands - pull them off or pick at them, Arms - same issues. So placing the microbit in a pair of socks would have been a great iteration and in the future may work however through the process have found that there are too many contributing factors that would actually hinder the data.
Including peripheral vascular diseases therefore limiting blood flow to the peripheral areas.
Another issue I found was the use of medication to control blood pressure and heart rate could also impede the signals putting into a pair of Socks.
In the future a wearable patch would be ideal but for the moment still a work in progress.
Initially I was looking at the best method for detecting agitation is movement and heart rate. However detecting irregular or irractic moving in a mobile patient would be extremely difficult and could be only applied to a select cohort of patients particularly those who are non ambulatory. This being the case for the purpose of task 3 I have pivoted slightly and am just going to use heart rate to indicate the changes in agigation. An acceleromotor also is not that affective unless it is used in conjunction with another piece of biometric data. Heart rate is the most responsive and will give a good indicator of agitation.
Connecting the microbit and have the styling responsive to the mobile phone/computer interface.
Every time I tried to create the semi circle and changed the background conic gradient in the CSS Styling I woul put the starting point of the wedges in the middle of the semicircle or it would turn it upside down.
I had to change it multiple times to try and figure out how to get the gradient responding or looking the way I wanted them to look. I was definately trial and error. Eventually I was able to use the code below to visually represent the alert levels. I was many hours of trial and error to establish the right code. It was really difficult to achieve as the way I wanted it set up the coding wasn't the way you would normally do it so made it so complicated to actually achieve the results.
However I am still having difficulty converting the raw data even though I have added the parse int......
it just doesn't want to work.... But on the plus l have been able to blue tooth to my computer making it much easier to work with the interface. '
Have been using a similar code but would not work on the interface as it won't change the data or parse it properly to activate the agitation levels.
I am going to try this one and see if I am able to get it to work based on the raw and smoothed pulse rate data.
Unfortunately I lost both access to the computer and the raw data was still not being read correctly and with this code I lost the simulator as nil serial write code commands were in there. I recompleted the code.
I was able to see the heart rate via the pulse monitor. But wasn't able to convert the heart rate to respond to the interface correctly. It wouldn't work and certainly wouldn't respond to the interface how I wanted it too.
So I just used simulated data to start with so I could get the corresponding styling to work appropriately on the interface.
I wanted the heart rate to be visually represented on the interface by highlighting the wedge of the corresponding colour.
Really difficult to achieve to begin with. So I started with just having the different levels and the heading illuminate proving much harder than intended as I was trying to place the headings on the curve of the semicircle.
The names eneded up skewed and in all different positions. So I settled for placing the corresponding name under the different colours. I was able to get these to highlight easily enough and respond to the heart rate.
I added the flashing alert so as nursing staff could identify if the heart rate was at extreme and each of the levels now are visual corresponding the the heart rate.
As documented you can see that the heart rate is moderate . I may have to change the names as it is supposed to be an agitation detector....... This seems a little catastrophic when it is supposed to be referring to an agitation level.
Flashing - for severe agitation.
I was able to get the styling working based on the simulated heart rate.
However it meant that the wearable device would effectively not have worked.
After some debugging it was found that the incoming message from the microbit was too long and therefore crashing out the system.
Changing the microbit code allowed the smoothed heartrate only to come through and there was also an issues with the javascript that has also been fixed.
The new code for the microbit.
The heartrate is now displaying and am able to connect to the bluetooth on the computer.
I have just realised the the very high visual doesn't actually high light the word very high?
Not sure what is happening there.
All the levels are identified there.
Seems to be nominated there too!!
Will now check the html :
In each section it appears to be mentioned so I am not sure why that level is not being highlighted.
After a little bit of research I changed a few things -
just made the level - very-high active
I initially tried out this to see if I could get it too work. Still not happening - Then checked the developer tools and it says :
just went through all the code and found :
That in this part of the code it doesn't match to the rest of the description of very high due to the underscore between the words as all the other descriptions are very-high.
I went ahead and changed the code.
The problem is fixed. It is all now working as initially intended in the concept.
But I think it would be better to change the names of the levels - to be more indicative of escalating behaviour rather than catastrophise it all and be a cause of concern to patients, nurses and doctors in the department.
Updated the code...... the names look better.
With changing from the socks I had to come up with another idea the would both be able to house the microbit, battery pack and pulse sensor. Research suggest that tactile/sensory items can have a positive effect on a patient with dementia. So I have decided to house the microbit in a material called tubi - grip common to ED in like a wrist guard fashion and add some sensory elements so the patients can fiddle with those instead.
