This is an Ageing Well Service Development Funded project delivered as part of a multi-layered with partnership working programme run by the Bristol, North Somerset and South Gloucestershire (BNSSG) Clinical Commissioning Group (CCG). This project was initiated by Bristol Health Partners, who will be monitoring its progress. The project delivery partner is Age UK Bristol with project co-ordination being undertaken by Age UK Bristol and Fitness For Life. The technology trialled will include an Alexa skill for exercise prompts and reminders and telepresence robots which will be provided to the participants by Age UK Bristol and supported by Robotics for Good CIC. The project will be evaluated by University of Nottingham and Bristol Health Partners, NHS.
Every year more than one in three people over 65 have a fall, which can cause serious injury and even death. The costs to the NHS and social care from hip fractures alone are an estimated £6 million per day or £2.3 billion per year. Falls are the main cause of a person losing their independence and going into long term care. After a fall, the fear of falling can lead to more inactivity, loss of strength and confidence, and a greater risk of social isolation, further falls and risk of death. There are few health and social care services to help older people to attain a level of physical activity and fitness in order to get out of the house and return to their social activities.
A recent survey found that almost no local authorities in England were using telecare to address loneliness in older people (Woolham et al., 2018). Some charities have volunteer visitor schemes for socially isolated people, however these do not include an aim to improve the physical fitness of the older person. It has also been found that there is poor engagement with physical activity groups and other community-based programmes amongst older, isolated people due to low self-confidence
In addition, there is significant digital exclusion. The main determinant of digital exclusion is age but other significant factors, often combined with low income, include disability, learning disabilities, ethnic origin, location, culture and language (Chartered Institute of Taxation, 2020).
Project Aim and Objectives:
There are many ‘touchpoints’ or ‘teachable moments’ in people’s care pathways, when they are receptive to reviewing and making positive changes in terms of physical activity. The NHS response to COVID has accelerated the use of digital technologies for clinical interactions.
In this project we will use technology to play a key part in supporting a volunteer service to encourage older people to engage in more physical activity to build their strength and confidence and ultimately to get them going out of the house to resume social contact.
The key aim will be to set up and evaluate a framework for using telepresence and smart digital assistant technology, so that they augment the human contact offered by volunteer schemes to further build self-confidence and self-reliance.
We have designed this project in line with the developing BNSSG ICS Prevention Framework, to cultivate culture change across the system, such that prevention, including through physical activity, is considered a priority by everyone working and engaging in it. Investing in prevention aligns with Value-based Health and Care. It requires a change in the approach of health practitioners to their interactions with patients/service users, re-focussing conversations and encouraging/supporting people to incorporate movement into their daily lives. We will manage this project alongside the Active Hospitals project to ensure that all health and social care staff know about it and have the opportunity to refer people who might benefit.
Age UK Bristol will be working with local service providers to develop sustainable models of using consumer technology to integrate a physical fitness programme within a volunteer visiting scheme. Older people may have concerns that technology might be used to replace face to face contact, however if it can be used as part of a partnership with a volunteer visitor, then it could actually increase interaction and contact whilst encouraging more self-efficacy in physical activity.
The scope of this project is to evaluate the use of an Alexa skill for exercise prompts and reminders, and telepresence robots to fit within a volunteer visitor scheme in order to increase physical activity and fitness levels and to promote social engagement for socially isolated older people. If people can achieve enough fitness and confidence through working with the volunteer and using the technology, then the vision is that they may then seek community engagement as an option for ongoing and sustainable support.
Within this project we will find out how service users and voluntary services could benefit from technology and how they foresee the technology being used. The technology that will be considered within this project will include off the shelf products for home use: digital assistant (Amazon Alexa) and a telepresence robot through which people could have more frequent social interaction with other people. The digital assistant will be set up to give reminders and prompts to promote physical activity to prevent a slide into inactivity. These will help to supplement interaction with the community to help to reduce social isolation.