The Impact on Ambulance Mobilisations of an Increasing Age Profile of Telecare Service Users Receiving Advanced Proactive, Personalised Telecare in Spain—a Longitudinal Study 2014–2018

Abstract

Advanced proactive personalised telecare services in Spain have helped service users to live independently in their own homes for longer. Concern was however noted regarding potential impacts on ambulance mobilisations as time in the service, and mean age at cessation, increased. The purpose of this study was to investigate these impacts.A longitudinal study of a telecare service user population in Spain (n = 202.1 k to 247.9 k) was undertaken using anonymised operational data collected in the delivery of proactive and personalised telecare services over the period 2014–2018.For the studied population, ambulance mobilisation on a per-person/per-annum (pp/pa) basis reduced despite the increasing age profile at cessation and with the characteristics of the population at registration remaining otherwise similar over the period. The study identified the positive correlation coefficient between ambulance mobilisations and service user’s dependency levels, and marginal negative correlation in older age bands.In conclusion, the increasing age at cessation has not correlated with an increased proportion of higher dependency service users. Indeed, the share of those over 85 years in the high dependency level decreased. This indicates that the changes in the telecare service which appear to have contributed to increased time living independently may also have helped ensure those continuing to live independently remain in lower risk bands.

Understanding the Value of a Proactive Telecare System in Supporting Older Adults’ Independence at Home: Qualitative Interview Study Among Key Interest Groups

“…In this study, family members and housing association staff reported that tracking forgetfulness patterns of when a user had forgotten to press their OK button may help to detect early health deterioration, such as a urinary tract infection, which can cause confusion quickly [ 41 ] and may present as an individual forgetting to press their button over a short period. Detecting the early indicators of illness may offer the potential to inform early and more tailored interventions to support well-being and resilience [ 25 ] and avoid age-related stressors [ 17 ]. In contrast, tracking forgetfulness patterns may also provoke anxiety in older adults [ 42 ] and diminish well-being owing to the stigma associated with memory loss [ 43 ], as demonstrated in our data by the dismay expressed by users when they forgot to press the button.…”

“…Participants saw social connections as important in maintaining independence [ 47 ]. Recent studies suggest that delivering outbound calls to older adults may foster strong relationships between users and service providers, helping to identify changes in people’s circumstances and provide more tailored support [ 17 ]. Similarly, in our study, proactive telecare users appreciated being connected to a network of support and valued the opportunity to disclose well-being issues, such as anxiety and loneliness.…”

“…Most telecare services available are predominately reactive in nature. Reactive telecare refers to sensors or pendant alarms that trigger an emergency response following an alarm raised by the user or detection of unusual behavior by ambient sensors [ 17 ]. Reactive telecare has several limitations.…”

“…The concept of proactive telecare has received interest among researchers [ 25 , 26 ] and policy makers [ 27 ]; however, research investigating such technology is still in its infancy, despite its existing use in countries such as Spain [ 17 ] and the United Kingdom [ 28 ]. Proactive telecare refers to providing proactive well-being calls or encouraging users to regularly confirm their well-being, with the aim of anticipating and preventing crises and facilitating strong social connections between older adults and social care services [ 17 ]. Having regular engagement with older adults may enable early identification of significant changes in needs [ 9 ], which could provide the user the opportunity to acquire resources to prolong independence or receive health care in a timely and preventive manner.…”

“…The concept of proactive telecare has received interest among researchers [25,26] and policy makers [27]; however, research investigating such technology is still in its infancy, despite its existing use in countries such as Spain [17] and the United Kingdom [28]. Proactive telecare refers to providing proactive well-being calls or encouraging users to regularly confirm their well-being, with the aim of anticipating and preventing crises and facilitating strong social connections between older adults and social care services [17].…”