Symposium Review: 25th Anniversary of Moral Boundaries by Joan Tronto

The 2020 report of The Lancet Countdown on health and climate change: responding to converging crises.

Primary objective: The study aim is to explore the perceptions and expectations of seniors in regard to 'smart home' technology installed and operated in their homes with the purpose of improving their quality of life and/or monitoring their health status. Research design and methods: Three focus group sessions were conducted within this pilot study to assess older adults' perceptions of the technology and ways they believe technology can improve their daily lives. Themes discussed in these groups included participants' perceptions of the usefulness of devices and sensors in health-related issues such as preventing or detecting falls, assisting with visual or hearing impairments, improving mobility, reducing isolation, managing medications, and monitoring of physiological parameters. The audiotapes were transcribed and a content analysis was performed. Results: A total of 15 older adults participated in three focus group sessions. Areas where advanced technologies would benefit older adult residents included emergency help, prevention and detection of falls, monitoring of physiological parameters, etc. Concerns were expressed about the user-friendliness of the devices, lack of human response and the need for training tailored to older learners. Conclusions: All participants had an overall positive attitude towards devices and sensors that can be installed in their homes in order to enhance their lives.

Older adults' attitudes towards and perceptions of ‘smart home’ technologies: a pilot study

This handbook presents guidelines for synthesizing findings of qualitative research.After discussing the importance of such synthesis for building knowledge, in the second chapter the authors introduce definitions of and types of qualitative research synthesis.They view the synthesis as a study comprising a series of steps, starting with the formulation of a problem and a statement of purpose. In chapter 3 the authors focus on the steps of retrieving all research reports and determining their relevance to the study domain. In chapter 4 they describe strategies for appraising individual study reports and for conducting a comparative appraisal. Comparative appraisal consists of displaying key elements of the studies included in the synthesis and comparing them in order to determine whether they confirm, extend, refute, or complement each other. In chapter 5 Sandelowski and Barroso discuss issues encountered in appraising the quality of qualitative studies and present a typology of findings that can be used to classify results. In chapters 6 and 7 they describe the process of implementing the two types of qualitative research synthesis, metasummary and metasynthesis. In chapter 8 the authors review strategies for maintaining validity of qualitative research synthesis and in chapter 9 they review content and format for presenting the results of the synthesis. Sandelowski and Barroso are to be commended for addressing a controversial topic, and for refining the types of qualitative research findings and procedures for conducting a synthesis of these findings.They clarify the arguments advanced by proponents and opponents of the qualitative research synthesis, thereby facilitating our understanding of the rationale underlying the two types of synthesis. Conceiving the synthesis as a study that is conducted in steps, similar to those entailed in a metaanalysis, helps us to view the process as a systematic one with a welldefined sequence of steps.The book is structured accordingly, starting with the formulation of a researchable problem, moving on to the conduct of an extensive search of the relevant literature, then to an appraisal and synthesis of findings across studies, and ending with CJNR 2008,Vol. 40 No 3, 179 –180

https://cjnr.archive.mcgill.ca/article/download/2146/2140

Handbook for Synthesizing Qualitative Research

Falls are a major health hazard for the elderly and a major obstacle to independent living. The estimated incidence of falls for both institutionalized and independent persons aged over 75 is at least 30 percent per year. In the SIMBAD (Smart Inactivity Monitor using Array-Based Detectors) project, we've developed an intelligent fall detector based on a low-cost array of infrared detectors. A field trial and user research indicate that SIMBAD could significantly enhance the functionality and effectiveness of existing monitoring systems and community alarm systems.

A smart sensor to detect the falls of the elderly

Background: On March 12, 2020, the World Health Organization declared the coronavirus disease (COVID-19) outbreak a pandemic. On that date, there were 134,576 reported cases and 4981 deaths worldwide. By March 26, 2020, just 2 weeks later, reported cases had increased four-fold to 531,865, and deaths increased five-fold to 24,073. Older people are both major users of telehealth services and are more likely to die as a result of COVID-19.
Objective: This paper examines the extent that Australia, the United Kingdom, and the United States, during the 2 weeks following the pandemic announcement, sought to promote telehealth as a tool that could help identify COVID-19 among older people who may live alone, be frail, or be self-isolating, and give support to or facilitate the treatment of people who are or may be infected.
Methods: This paper reports, for the 2-week period previously mentioned and immediately prior, on activities and initiatives in the three countries taken by governments or their agencies (at national or state levels) together with publications or guidance issued by professional, trade, and charitable bodies. Different sources of information are drawn upon that point to the perceived likely benefits of telehealth in fighting the pandemic. It is not the purpose of this paper to draw together or analyze information that reflects growing knowledge about COVID-19, except where telehealth is seen as a component.
Results: The picture that emerges for the three countries, based on the sources identified, shows a number of differences. These differences center on the nature of their health services, the extent of attention given to older people (and the circumstances that can relate to them), the different geographies (notably concerned with rurality), and the changes to funding frameworks that could impact these. Common to all three countries is the value attributed to maintaining quality safeguards in the wider context of their health services but where such services are noted as sometimes having precluded significant telehealth use.
Conclusions: The COVID-19 pandemic is forcing changes and may help to establish telehealth more firmly in its aftermath. Some of the changes may not be long-lasting. However, the momentum is such that telehealth will almost certainly find a stronger place within health service frameworks for each of the three countries and is likely to have increased acceptance among both patients and health care providers.

/pdf/telehealth-in-the-context-of-covid-19-changing-perspectives-sn3n27lcpx.pdf

Telehealth in the Context of COVID-19: Changing Perspectives in Australia, the United Kingdom, and the United States.

Introduction Social theory and social alarms Literature review The origins of social alarms Social alarms in England and Wales Social alarms in Scotland Social alarms in Ireland Social alarms in North America Social alarms in the rest of the world International comparisons Social alarms and smart homes Social alarms, telemedicine and telecare Falls, lifestyle monitoring and dementia care Conclusions.

Social alarms to telecare: Older people's services in transition

This paper explores some of the experiences of older people living in residential settings (sheltered, very sheltered housing and residential care), in the context of theories of participation, consumerism and citizenship. It draws on material from personal interviews undertaken with over 100 older people in England and Wales, and also from discussions with staff. Two-thirds of respondents were aged over 85. A significant minority of residents expressed some concerns about the routines of life, such as meals and social contact. Staff expectations of social participation were often unrealistic : for many residents, social contact was more a matter of adjustment than of friendship. Residents did not participate in deciding how the residential settings where they lived should be organised and managed, except for helping with simple domestic tasks. There is a need to change both attitudes and practice to enable older people to participate more fully in these settings.

Social and democratic participation in residential settings for older people: realities and aspirations

Purpose – The purpose of this paper is to consider the use of surveillance technologies in care homes and the way in which they can help protect older people. It signals an ethical way forward for their use that de-fuses the heightened rhetoric associated with concerns about the abuse. Totally, seven principles are put forward by which the use of surveillance technologies can be supported. Design/methodology/approach – The paper recognises the significance of technological developments and the key part that they now play in helping people live more independently. Surveillance technologies have a part in this within care homes, but there are important ethical considerations – notably around the way in which concerns for privacy are balanced with those about people’s safety and autonomy. Findings – The paper points to an approach that can guide the use of surveillance technologies within care homes. The seven principles put forward will be built on through further work in 2015 including care home residents,...

Surveillance technologies in care homes: seven principles for their use

The extensive disruption to and digital transformation of travel administration across borders largely due to COVID-19 mean that digital vaccine passports are being developed to resume international travel and kick-start the global economy. Currently, a wide range of actors are using a variety of different approaches and technologies to develop such a system. This paper considers the techno-ethical issues raised by the digital nature of vaccine passports and the application of leading-edge technologies such as blockchain in developing and deploying them. We briefly analyse four of the most advanced systems – IBM’s Digital Health Passport “Common Pass,” the International Air Transport Association’s Travel Pass, the Linux Foundation Public Health’s COVID-19 Credentials Initiative and the Vaccination Credential Initiative (Microsoft and Oracle) – and then consider the approach being taken for the EU Digital COVID Certificate. Each of these raises a range of issues, particularly relating to the General Data Protection Regulation (GDPR) and the need for standards and due diligence in the application of innovative technologies (eg blockchain) that will directly challenge policymakers when attempting to regulate within the network of networks.

/pdf/the-digital-network-of-networks-regulatory-risk-and-policy-413cxr7fx5.pdf

Malcolm Fisk

Papers

Telehealth in the Context of COVID-19: Changing Perspectives in Australia, the United Kingdom, and the United States.

Social alarms to telecare: Older people's services in transition

Social and democratic participation in residential settings for older people: realities and aspirations

Surveillance technologies in care homes: seven principles for their use

The digital network of networks: Regulatory risk and policy challenges of vaccine passports