Page 262 - Handbook of Electronic Assistive Technology

Chapter 8 • Assisted Living 251

The role of technology in assisted living is central. People can be supported effec-
tively through the appropriate use of technology, but only if the support structures are
in place.
Since the initial proposal by the UK government to build telecare in England
(Department of Health, 2005), the landscape of the deployment and envisaged benefits
of telecare and telehealth have been given scant attention. There is considerable inter-
est in the WSDAN project which purported to be a RCT of telecare and telehealth, yet its
reporting has been less than regular and the context of the RCT has changed to focus on
telehealth rather than telecare.
Evidentially, there are considerable amounts of tacit knowledge about the WSDAN
project and the uptake of telecare and telehealth. Often, the fact that these systems are
used so widely is given as evidence for the value and effectiveness of the systems, while
omitting to note that local councils and health trusts were required to implement them
and paid to do so or fined should they fail to do so. Brownsell et al. (2008) cites the lack of
published information about cost and clinical effectiveness as a major reason why telecare
has not become a routine service.
Telehealth interventions are built with the intent of improving the care delivered to
patients. Individual studies of specific telehealth trials can often demonstrate benefits.
However, almost all the independent large-scale systematic reviews and meta-analyses of
telehealth produce mixed to negative results. These reviews often are unable to find evi-
dence of benefit (absence of evidence), rather than identifying evidence for lack of benefit
(evidence of absence).

Concluding Remarks

Telecare and telehealth have limited objective and evidence-based research to support
their effectiveness and cost saving. The majority of the evidence has been undertaken
by or sponsored by the manufacturers of the devices and therefore the results are often
called into question. The issue of cost savings is an almost impossible one to quantify
experimentally, as there are savings which are evident from a person who has fallen
using telecare to call for assistance, but how is this measured when they do not fall or
do not use the devices to trigger an alert? Similarly, telehealth is excellent for supporting
self-care and relies on algorithms that produce alerts when readings are out of the nor-
mal range. This does save money all around as there is no cost to medical practitioners
unless the readings have triggered actions and there is also no associated cost to the per-
son with the long-term condition. There are no evidence/studies that have considered
the misdiagnosis or incorrect readings that caused hospitalisation for people using the
devices incorrectly.
It is therefore difficult to determine the efficacy of either telecare or telehealth. The
majority of the evidence has not been written up by practitioners and this causes a num-
ber of difficulties for academics and the medical/health profession. The WSDAN project
sought to determine the effectiveness of telecare and telehealth, but almost as soon as its