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Vivago Care Watch Case Studies and Activity Graphs

The following series of case studies show how the Vivago system is used to assess and measure the outcome following intervention in a diverse and comprehensive range of conditions.

Within the information below you can also find statements from care workers and healthcare professionals on their experiences with the Vivago Watch system.

Click on a case study below for the full story:

Lisa - 80-year-old Suffering from Frailty

Lisa is an 80-year-old woman with frailty syndrome. A care person visits her once a day in the morning to administer her daily medicine. Lisa is able to move around her home and complete her daily tasks independently. Her daughter helps by doing her shopping once a week.

As Lisa's memory loss disorder deteriorated, her daily circadian rhythm weakened. Lisa often slept for long periods (this can be seen in the left-hand chart below) in the afternoon and stayed up at night-time. Her daily rhythm disappeared, functional ability diminished and her ability to take care of her own daily routines weakened. Lisa's nurse was notified of the circadian rhythm change by the Vivago system. The weak day-night rhythm was noticeable in the weekly view and was picked up by Vivago's automatic alert system. Lisa needed to be stimulated and encouraged to do outdoor activities under the supervision of a nurse.

The chart on the right shows Lisa's status half a year later. Her situation is much better and her daily circadian rhythm has been recovered. She is active in the daytime while her sleeping periods are constant and only take place at night-time. Overall, Lisa is much more content and has a general feeling of wellbeing with regards to her abilities, functionality and memory loss.

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Before alarm

Lisa Chart One

After alarm

Lisa Chart Two

George - Bipolar Disorder

George is an 81-year-old man. He has bipolar disorder that is treated by medication. He takes care of his own medication and goes about his daily activities independently. With George's condition, regular circadian rhythm, good sleep patterns, avoiding the overuse of alcohol as well as pro-actively identifying symptoms are important.

In the manic phase of the disorder (the left-hand chart below) George's amount of sleep usually decreases significantly. The Vivago system recognises this and notifies George's nurse and relatives that George is exhibiting a change in functional ability - "Circadian rhythm weak". General restlessness and activity have increased significantly, which is noticeable on the activity curve as high activity, in addition to an increase in outdoor activities (the red lines on the chart). In the manic phase of the disorder George also takes off the Vivago watch which alerts his nurse.

In the depressive phase of the disorder (right-hand chart below) George's amount of sleep increases and daily activity decreases. The system reacts to the change and a "Daytime activity low" notification shows up on the nurse's phone (and those of his relatives).

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Manic phase

George Chart One

Depressive phase

George Chart Two

Jack - Parkinson's Disease

81-year-old Jack has Parkinson's Disease. When Jack moved to a nursing home Vivago's information was used to analyse the effects of his medication.

Stiffness clearly restrained Jack's daily activities and he needed help from staff to function normally, typically needing two nurses to care for him. Jack's nurse and neurologist used information provided by the wellbeing report in following up the changes of his medication. This information was invaluable as Jack was not able to inform staff about the changes by himself.

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Before medication change

Jack Chart One

After medication change

Jack Chart Two

Ann - Diabetes in Sheltered Accommodation

Ann is a 77-year-old woman who lives in her own apartment in a sheltered house. She is an active woman who takes care of her own medication. Ann has diabetes that is treated with insulin.

On the day of the event Ann had eaten less food than usual but injected the normal dose of insulin. Her blood sugar level had decreased during the early hours of the morning and Ann fell unconscious while asleep. This is visible on the fourth night on the chart. As Ann had been still for a longer period than usual, the Vivago system sent an automatic "Deterioration Alarm" to Ann's nurse. The nurse immediately went to check on Ann's condition and measured her blood sugar level, which was under 2 mmol/l. The nurse then alerted the ambulance service.

Ann was in hospital under observation for a while and returned back home on the same day. It is clearly seen on the chart how the day's events affected Ann's sleep on the night following the incident. It is apparent that she has stressed sleeping resulting in a restless night, recognisable by the disjointed blue lines on the fifth day. The activity curves over the next two nights show that Ann's sleeping rhythm was returned to normal.

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Before medication change

Ann Chart One
  • On the fourth night we see Ann's activity curve completely disappear when she falls unconscious.
  • On the fifth night we see a lot of activity with broken sleep patterns.
  • The remaining two nights show a clear return to normal sleep quality.

Healthcare Sector - Rehabilitation and Hospital Services

The city of Pori, Finland, renovated an old hospital building and took advantage of the opportunity to simultaneously overhaul its technological infrastructure. Of the chosen technologies, Vivago's nurse call system received the biggest focus. The technology provided by Vivago supports care in a number of ways including discharge planning. The Vivago care watch further enables monitoring of patient rehabilitation at home. Vivago helped design and plan the comprehensive hospital nurse call system for the city of Pori.

The hospital's objectives were as follows:

  • To find a modern and practical safety solution
  • To allow for safe discharge from hospital
  • To cut costs of home care without affecting care quality
  • To better anticipate care
  • To provide staff with a valuable tool for analysing the wellbeing of patients
  • To provide and reassure relatives of patients with accurate and comprehensive information

The Vivago nurse call system platform was chosen as the safety solution for the rehabilitation and hospital services in Pori. The patients used the Vivago watch solution for its unique features such as automatic alarms, monitoring of wellbeing data and reports that aid with discharge planning.

Project Artturi Kotikunnas - Turku City Outpatient Service, Finland

Project Artturi Kotikunnas was a project completed by Vivago in co-operation with the Finnish City of Turku outpatient services. The goal of the project was to support elderly individuals at home for as long as possible. Vivago watches were given to those in need of more safety, in particular to the elderly living alone at home. The watches were also used to collect data about the sleep of the residents, functional ability and wellbeing.

During the project, several home visits were made to the customers wearing the watch. Particular attention was paid to service, care, supporting, listening and the role of relatives.

The Automatic Alarm Brought Help to an Unconscious Person

A diabetic taking insulin treatment who had a poor sugar balance and, at times, used alcohol heavily, went unconscious because of her low sugar level. She could not call for help herself. The Vivago Watch noticed the abnormal immobility and called for help.

On day four at approximately 4:30pm, the customer's mobility was unusual for that time of day, which is where the alarm was triggered. Note that the periods underlined in red and showing no curve represent the wearer being out of the house.

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Turku Graph One

Vivago in the Case of Infarction

The customer had a severe coronary disease and heart malfunction. He had a stroke at home and the Vivago Watch sent an alarm automatically.

When help arrived, the person was still conscious but died later. The daughter of the customer was grateful that they had tried to save her mother and that she had not been alone at the time of her death.

The customer's daughter had been planning to visit her mother the next morning and without intervention she would have found her mother dead.

Vivago Helped in Palliative Care

A cancer patient wanted to be treated at home during Palliative Care. The Vivago watch was part of the treatment and made it possible for the patient to live at home. The home care staff visited during the daytime and Vivago guaranteed safety during the night-time, when the customer was alone at home.

The Vivago system was in use almost to the very end of the customer's life, shortly before which the customer's relative informed the care team that they would remove the watch from the patient as they would be with him from that moment on until his death.

A Grandmother Was Helped by the Watch When She Had a Seizure

The customer had Alzheimer's disease as well as a heart malfunction. Her youngest grandchild was visiting and he helped his grandmother to the toilet. While doing so, the patient had a heart attack.

The patient's grandchild naturally realised the urgency of the situation and called for help using the Vivago manual alarm on the watch. After this the child called Kotikunnas by phone in order to receive additional instructions. The ambulance arrived and took his grandmother to the hospital.

Later, the patient's grandchild called Vivago and Kotikunnas to thank them for the help and support given to his grandmother.

Looking at the chart below, it is clear that the patient suffered from fragmented sleep, frequently waking during the night-time. On the right-hand side of the graph, one can see that the patient's sleep-wake rhythm worsens significantly on day three - identified by a move to the right - and remains that way for the following days.

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Turku Graph Two

Vivago Helped a Fallen Patient

The patient suffered constant dizziness. One day, she fell in her own home and broke her hip.

She was unable to get up herself so she called for help using the Vivago manual alarm.

Vivago's Activity Curves Added Credibility to a Customer's Story

The wearer had Alzheimer's disease and it was sometimes difficult for her to speak clearly. She complained about hip pain, saying that she was uncomfortable during movement. Her relatives were not convinced at first. Tarja Norrbacka, head of the Artturi Project, printed out activity curve documentation for the previous two months and took them with her to a home visit when the relatives were also visiting.

As seen on the first graph, the customer was able to function as normal with frequent high-activity levels. In the second graph taken a few months later, however, it is clear that her activity had significantly decreased. In the third graph, taken a further two months later, when the patient began to communicate her discomfort, one can see a clear, significant decline.

The customer went to see her doctor for examination with her relatives and received physiotherapy to relieve her suffering.

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Turku Graph Three

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Turku Graph Four

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Turku Graph Five

A Person Who Regularly Fell Was Able to Stay at Home

The watch wearer had cancer and rheumatism as well as several other conditions, regularly falling over. However, she wanted to remain in her home for as long as possible. After one such fall, the customer hit her head and fell unconscious. The Vivago Watch called for help automatically.

The customer was able to stay in her home for a long time, even though she was falling up to three times a day. Without the device it would not have been safe for her to remain at home for so long.

Security and Peace of Mind with the Help of Vivago

The customer had Alzeimer's disease and was worsening. She also suffered from spells of dizziness. She had no friends or relatives in the district she was living in. She was restless, scared and often called the doctor's practice.

She heard about Vivago and had the device installed in her home. She calmed down due to an increased sense of security, even cancelling all supporting help including home care and the help from the local Deaconess centre.

The device made her feel comfortable because she knew that, with the help of automatic alarms, she would be safe at all times. She told Vivago that she wasn't afraid of death but of lying on the floor, unable to call for help and nobody knowing she was there.

Vivago Helped Avoid Unnecessary Doctor's Appointments and Hospital Admissions

The customer had coronary artery disease and chest pain was frequent. She would go to the emergency department often.

She herself said that within a short period of time of wearing the watch, she had had at least three cases in which she had felt the pain starting. However, she hadn’t gone to the emergency department but instead taken her medication and stayed at home to wait for them to take effect.

The patient said that without this device she would not have dared to stay at home and wait, but would have gone immediately to hospital. These would have been unnecessary appointments.

Activity Level Decreased; Vivago Reported It

The customer had epilepsy and, among other conditions, symptoms of heart disease.

According to her own wishes, her sleeping medication was ended in order for her to have a glass of wine at night. As a result of this, her activity fell dramatically: during the daytime she was nearly motionless, which is clearly visible on the graph below. This triggered automatic alarms from the Vivago watch.

During home visits the staff went through, together with the customer, the activity curves, which showed the consequences as a result of the medication change.

Without Vivago, the activity change would most certainly not have been detected, but thanks to mutual understanding the customer resumed her medication.

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Turku Graph Six

Customer's Awareness was Inhibited; Vivago Called for Help

The customer had a difficult coronary artery disease and suffered from depression. She accidentally overdosed on medication, inhibiting her awareness. She was unable to call for help herself.

Vivago informed care workers and relatives of the abnormal immobility and the customer received help from hospital.

A Night-time Wanderer was Identified Using Vivago's Activity Graph

The customer had Alzheimer's disease, among other diseases. Her diurnal rhythm was severely confused; something which is quite common in dementia patients. She wandered around in the corridors of the assisted living home during the night-time and used the elevator constantly.

Other inhabitants spoke of night-time voices but nobody had seen the wanderer. When studying the activity curves, staff were able to identify the person wandering the assisted living accommodation during night-time hours. The curve indicated that she was up all night.

In a staff meeting, the customer's activity curves were analysed and arrangements were made which would help her to balance and maintain her rhythm. With the help of different kinds of support actions, she was able to live in the sheltered home for another year.

Deceased Customers

Two customers in a sheltered home had passed away. In both cases, Vivago sounded an 'abnormal immobility' alarm which alerted staff who were able to go to them immediately rather than discovering them potentially much later.

Circadian Rhythm Study of Nursing Home Residents - University of Tampere, Finland

Summary

Quality of sleep is associated with the wellbeing of elderly people. Dementia affects sleep and sleeping problems are common in those suffering from dementia. Efficient treatment requires tools for long-term monitoring of sleep quality. The School of Public Health at the University of Tampere, Finland, carried out this study with VTT Information Technology, Tampere, IST International Security Technology, Helsinki, and Haaga Neurological Research Centre, Helsinki.

Introduction

Sleeping disorders and disturbed sleep/wake rhythm commonly occur in demented elderly subjects. These problems are significant factors in the decision to seek nursing home placement. Monitoring sleep/wake patterns would improve the diagnosing of sleep problems and assessing the efficacy of treatments. Wrist actigraphy has been used for the monitoring of circadian rhythm at home. However, traditional wrist actigraphs are not suited for true long-term monitoring. The Vivago system provides similar performance in sleep/wake pattern detection as actigraphy.

Objectives

In this paper, the researchers studied how the activity signal measured by Vivago differs in non-demented and demented subjects and developed parameters for quantifying the quality of sleep/wake rhythm and circadian patterns in long-term recordings.

Methods

26 subjects (2 men and 24 women) with a mean age of 83 years living in a nursing home volunteered for the study, which was approved by the local ethical committee. 14 subjects were non-demented (Clinical Dementia Rating equal to or less than 0.5) and 12 subjects demented (Clinical Dementia Rating of over 0.5). The demographics of the groups were similar with the exception of cognitive performance.

The activity signal was recorded for 10 days. Factors monitored were the duration of sleep, self-assessed quality of sleep as well as daytime and evening alertness (self assessed by non-demented subjects, assessed by the nurse in the case of demented subjects).

The activity signal was processed by the calculation of parameters on a daily basis. Day was defined from 9am to 9pm and night from 12pm to 6am. Mean, median and standard deviation of activity for the whole 24 hours, for day and for night, were computed. Rhythmicity was studied by night/day ratio. Poincare analysis was used as a method for quantifying the existence of circadian rhythm in activity.

Results

Measured activity signal and computed parameters differed significantly between non-demented and demented subjects, as seen in Table 1 to the right. Functional capacity assessed by Barthel scores correlated with the WristCare activity signal (Spearman rank order partial correlation controlled for MMSE, r=-0.46 between Barthel scores and night/day activity ratio). Subjective assessments of sleep quality and alertness did not differ between groups.

Discussion

The activity signal produced by Vivago differed significantly in non-demented and demented elderly people. It shows deprived circadian rhythm in demented subjects. Self-assessments did not detect the differences as effectively as the device. The results also suggest a potential association between functional capacity and diurnal pattern.

The activity signal provides good opportunities for both elderly care and research to assess sleep/wake patterns and sleep problems. Activity monitoring integrated to a social alarm system enables long-term (up to several years) follow-up of the general wellbeing of elderly people as poor circadian rhythm may be associated with various health problems and conditions of elderly people. A great advantage of the Vivago system is the integrating of activity monitoring in the social alarm system device, hence providing motivation for wearing it.

Conclusions

The Vivago system provides a useful and promising instrument for monitoring sleep/wake patterns and the overall wellbeing of demented elderly persons both in institutions and at home.

References

  • [1] Philips B. & Ancoli-Israel S. (2001). Sleep Disorders in the Elderly. Sleep Med, 2, 99-114.
  • [2] Bliwise D.L. (1993). Sleep in Normal Aging and Dementia. Sleep, 16, 40-81.
  • [3] Särelä A., Korhonen I., Lötjönen J, Sola M. & Myllymäki M. (2003). IST Vivago® - An Intelligent Social and Remote Wellness Monitoring System for the Elderly. ITAB 2003, Birmingham, UK, 24-26 April, 2003.
  • [4] Lötjönen J., Korhonen I., Hirvonen K., Eskelinen s., Myllymäki M. & Partinen M. (2003). Automatic Sleep-Wake and Nap Analysis with a New Wrist Worn Online Activity Monitoring Device Vivago® WristCare. Sleep, 26, 86-90.

Acknowledgements

The study was supported by IST International Security Technology Oy, Finland and TEKES the National Technology Agency, Finland.

Example Activity Graphs - Wearers Exhibiting Various Conditions

Based on the results of a study, the activity signal may describe both positive and negative changes in health status. The wearer's health records and the circadian rhythm derived from the signal usually show a very strong correlation. The results suggest that the signal may be used to monitor changes in health status and to follow up on the effects of treatment in elderly care institutions, and hence support nursing practises.

Case 1 - Normal, Good Circadian Rhythm

Case One Chart
  • 84-year-old woman, mild memory disorders, MMSE score 21 and CDR class 0.5
  • Good functional capacity, Barthel score 90
  • No diseases. Uses tranquilizers
  • Generally sleeps well and feels good
  • Clear circadian rhythm visible in the activity signal, low night-time activity indicates good sleep, daily naps after lunch

Case 2 - Changes in Health Status Visible in Night-time Activity Level and Ratio of Day and Night Activities

Case Two Chart
  • 83-year-old Woman with basic Myastenia Gravis disease
  • Functional capacitity score poor because of the basic disease, Barthel score 45
  • No dementia. Mild memory disorders. MMSE score 23, CDR class 0.5

Case 3 - a Demented Person

Case Three Chart
  • No circadian rhythm
  • Activity continuously at a high level

Case 4 - Multiple Conditions

Case Four Chart
  • 86-year-old woman with coronary heart disease, cardiac insufficiency and asthma. Poor functional capacity, Barthel score 20
  • Vascular dementia, MMSE score 20 and CDR class 1. Dementia advances during winter where an MMSE score of 15 is recorded