As the number of older patients with cancer is increasing, oncology disciplines are faced with the challenge of managing patients with multiple chronic conditions who have difficulty maintaining independence, who may have cognitive impairment, and who also may be more vulnerable to adverse outcomes. National and international societies have recommended that all older patients with cancer undergo geriatric assessment (GA) to detect unaddressed problems and introduce interventions to augment functional status to possibly improve patient survival. Several predictive models have been developed, and evidence has shown correlation between information obtained through GA and treatment-related complications. Comprehensive geriatric evaluations and effective interventions on the basis of GA may prove to be challenging for the oncologist because of the lack of the necessary skills, time constraints, and/or limited available resources. In this article, we describe how the Geriatrics Service at Memorial Sloan Kettering Cancer Center approaches an older patient with colon cancer from presentation to the end of life, show the importance of GA at the various stages of cancer treatment, and how predictive models are used to tailor the treatment. The patient's needs and preferences are at the core of the decision-making process. Development of a plan of care should always include the patient's preferences, but it is particularly important in the older patient with cancer because a disease-centered approach may neglect noncancer considerations. We will elaborate on the added value of co-management between the oncologist and a geriatric nurse practitioner and on the feasibility of adapting elements of this model into busy oncology practices.

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How We Care for an Older Patient With Cancer

The concept of the augmented coaching ecosystem for non-obtrusive adaptive personalized elderly care is proposed on the basis of the integration of new and available ICT approaches. They include multimodal user interface (MMUI), augmented reality (AR), machine learning (ML), Internet of Things (IoT), and machine-to-machine (M2M) interactions. The ecosystem is based on the Cloud-Fog-Dew computing paradigm services, providing a full symbiosis by integrating the whole range from low level sensors up to high level services using integration efficiency inherent in synergistic use of applied technologies. Inside of this ecosystem, all of them are encapsulated in the following network layers: Dew, Fog, and Cloud computing layer. Instead of the “spaghetti connections”, “mosaic of buttons”, “puzzles of output data”, etc., the proposed ecosystem provides the strict division in the following dataflow channels: consumer interaction channel, machine interaction channel, and caregiver interaction channel. This concept allows to decrease the physical, cognitive, and mental load on elderly care stakeholders by decreasing the secondary human-to-human (H2H), human-to-machine (H2M), and machine-to-human (M2H) interactions in favor of M2M interactions and distributed Dew Computing services environment. It allows to apply this non-obtrusive augmented reality ecosystem for effective personalized elderly care to preserve their physical, cognitive, mental and social well-being.

Augmented Coaching Ecosystem for Non-obtrusive Adaptive Personalized Elderly Care on the basis of Cloud-Fog-Dew computing paradigm

Background: During the last decades, health-enabling and ambient assistive technologies became of considerable relevance for new informatics-based forms of diagnosis, prevention, and therapy. Objectives: To describe the state of the art of health-enabling and ambient assistive technologies in 1992 and today, and its evolution over the last 25 years as well as to project where the field is expected to be in the next 25 years. In the context of this review, we define health-enabling and ambient assistive technologies as ambiently used sensor-based information and communication technologies, aiming at contributing to a person's health and health care as well as to her or his quality of life. Methods: Systematic review of all original articles with research focus in all volumes of the IMIA Yearbook of Medical Informatics. Surveying authors independently on key projects and visions as well as on their lessons learned in the context of health-enabling and ambient assistive technologies and summarizing their answers. Surveying authors independently on their expectations for the future and summarizing their answers. Results: IMIA Yearbook papers containing statements on health-enabling and ambient assistive technologies appear first in 2002. These papers form a minor part of published research articles in medical informatics. However, during recent years the number of articles published has increased significantly. Key projects were identified. There was a clear progress on the use of technologies. However proof of diagnostic relevance and therapeutic efficacy remains still limited. Reforming health care processes and focussing more on patient needs are required. Conclusions: Health-enabling and ambient assistive technologies remain an important field for future health care and for interdisciplinary research. More and more publications assume that a person's home and their interaction therein, are becoming important components in health care provision, assessment, and management.

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Health-Enabling and Ambient Assistive Technologies: Past, Present, Future

The concept of the augmented coaching ecosystem for non-obtrusive adaptive personalized elderly care is proposed on the basis of the integration of new and available ICT approaches. They include the multimodal user interface (MMUI), augmented reality (AR), machine learning (ML), Internet of Things (IoT), and machine-to-machine (M2M) interactions. The ecosystem is based on the Cloud-Fog-Dew computing paradigm services, providing a full symbiosis by integrating the whole range from low-level sensors up to high-level services using integration efficiency inherent in synergistic use of applied technologies. Inside of this ecosystem, all of them are encapsulated in the following network layers: Dew, Fog, and Cloud computing layer. Instead of the "spaghetti connections", "mosaic of buttons", "puzzles of output data", etc., the proposed ecosystem provides the strict division in the following dataflow channels: consumer interaction channel, machine interaction channel, and caregiver interaction channel. This concept allows to decrease the physical, cognitive, and mental load on elderly care stakeholders by decreasing the secondary human-to-human (H2H), human-to-machine (H2M), and machine-to-human (M2H) interactions in favor of M2M interactions and distributed Dew Computing services environment. It allows to apply this non-obtrusive augmented reality ecosystem for effective personalized elderly care to preserve their physical, cognitive, mental and social well-being.

Augmented Coaching Ecosystem for Non-obtrusive Adaptive Personalized Elderly Care on the Basis of Cloud-Fog-Dew Computing Paradigm

Background The field of digital technologies being developed or applied to support nursing care is extensive. The aim of this scoping review is to provide an overview on technologies for which results on positive or negative effects on persons in need of care, caregivers or care institutions are available and to appraise the reliability of these results. Methods A scoping review design has been used to identify studies focussing on the effectiveness of digital technologies in nursing care for persons in need of care, caregivers or care institutions. The screening process included 19,510 scientific publications from 9 databases. Results A total of 123 single studies and 31 reviews were subjected to the analysis. The included technologies comprise nursing and health information technologies, such as assistive devices, information and communication technologies, sensors and robotics. The results show that there are many studies that demonstrate positive effects, but the level of evidence is mostly low and study sizes are often small. Hardly any technology has been researched intensively enough to produce conclusive results. Studies on a high level of evidence (RCTs) lack for most technological areas. Heterogeneous results in some areas indicate that effects may depend strongly on the mode and specific context into which the technologies are introduced. Conclusion Due to the limited evidence on effectiveness of digital technologies in nursing care, it is not surprising that care institutions are reluctant to put innovative technologies into practice. The scoping review indicates technology areas that should be subject to future research with higher quality studies. Research on outpatient, informal and cross-sectoral care should be intensified to further exploit the potential of digital technologies with a view to improving independence of care-recipients and unburdening formal and informal carers.

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Effectiveness of Digital Technologies to Support Nursing Care: Results of a Scoping Review.

Many societies across the world are confronted with demographic changes, usually related to increased life expectancy and, often, relatively low birth rates. Information and communication technologies (ICT) may contribute to adequately support senior citizens in aging societies with respect to quality of life and quality and efficiency of health care processes. For investigating and for providing answers on whether new information and communication technologies can contribute to keeping, or even improving quality of life, health and self-sufficiency in ageing societies through new ways of living and new forms of care, the Lower Saxony Research Network Design of Environments for Ageing (GAL) had been established as a five years research project, running from 2008 to 2013. Ambient-assisted living (AAL) technologies in personal and home environments were especially important. In this article we report on the GAL project, and present some of its major outcomes after five years of research. We report on major challenges and lessons learned in running and organizing such a large, inter- and multidisciplinary project and discuss GAL in the context of related research projects. With respect to research outcomes, we have, for example, learned new knowledge about multimodal and speech-based human-machine-interaction mechanisms for persons with functional restrictions, and identified new methods and developed new algorithms for identifying activities of daily life and detecting acute events, particularly falls. A total of 79 apartments of senior citizens had been equipped with specific "GAL technology", providing new insights into the use of sensor data for smart homes. Major challenges we had to face were to deal constructively with GAL's highly inter- and multidisciplinary aspects, with respect to research into GAL's application scenarios, shifting from theory and lab experimentation to field tests, and the complexity of organizing and, in our view, successfully managing such a large project. Overall it can be stated that, from our point of view, the GAL research network has been run successfully and has achieved its major research objectives. Since we now know much more on how and where to use AAL technologies for new environments of living and new forms of care, a future focus for research can now be outlined for systematically planned studies, scientifically exploring the benefits of AAL technologies for senior citizens, in particular with respect to quality of life and the quality and efficiency of health care.

Information and communication technologies for promoting and sustaining quality of life, health and self-sufficiency in ageing societies--outcomes of the Lower Saxony Research Network Design of Environments for Ageing (GAL).

Meyer Zu Schwabedissen H

Papers

Information and communication technologies for promoting and sustaining quality of life, health and self-sufficiency in ageing societies--outcomes of the Lower Saxony Research Network Design of Environments for Ageing (GAL).