Tele-care and Tele-alarms for the Elderly: Preliminary Experiences in Mexico

OBJECTIVE: To analyze the effect of a pilot program of tele-assistance and tele-alarms on the elderly's self-perception of health status and to identify the satisfaction with and acceptance of the program. METHODS: Cross-sectional study that included interviews with 378 elderly individuals, 294 caretakers/relatives and 53 health care professionals. The program was run in Mexico City in 2010. The variables were socio-demographic characteristics, self-rated health, satisfaction and acceptance of the program. The information was gathered through a standardized questionnaire. The statistical analysis included descriptive analysis and nonparametric tests. RESULTS: Significant effects on self-perception of health were observed, 6.17 (SD 17.9 p < 0.05) points above the average. The program was well received and accepted by the elderly, family caregivers and health professionals. CONCLUSIONS: The program helps to maintain or improve quality of life, allows preventive care and is an ideal means of providing psychosocial support to the elderly. 2 Tele-care for the elderly in Mexico Giraldo-Rodríguez L et al Demographic, epidemiological, social and economic changes have led to huge transformations in lifestyle, housing and family dynamics, leading to family members becoming increasingly involved in caring for the elderly. Health care systems in the majority of countries face significant challenges due to increased demand for medical care from the growing number of elderly individuals , increased demand for care within the home, the need for more efficient, higher quality and more equal health care services and the difficulty contracting personnel to provide health care and home care services. 3 The information and communication technology has developed in parallel with these changes, which makes it possible to face the abovementioned challenges. Health care services, especially medical care, are developing innovative foci to deal with patients who need home care. This is the case with tele-care and tele-alarms, which constitute health and social care within the home. Initiatives to provide home care services have started in Mexico. The Instituto Mexicano del Seguro Social (IMSS-Mexican Social Security Institute) initiated an Ageing Program in 2009, including the development of a pilot program of tele-care and tele-alarms consisting of providing health care within the home (via telephone , 24 hours a day). It is a social and health care intervention which ensures a rapid response to crisis or emergency situations through information, guidance and referral activities. The service users are individuals aged 60 and over, living alone or being alone most of the time, or those living …

Demographic, epidemiological, social and economic changes have led to huge transformations in lifestyle, housing and family dynamics, leading to family members becoming increasingly involved in caring for the elderly.Health care systems in the majority of countries face significant challenges due to increased demand for medical care from the growing number of elderly individuals, increased demand for care within the home, the need for more efficient, higher quality and more equal health care services and the difficulty contracting personnel to provide health care and home care services. 3e information and communication technology has developed in parallel with these changes, which makes it possible to face the abovementioned challenges.Health care services, especially medical care, are developing innovative foci to deal with patients who need home care.This is the case with tele-care and tele-alarms, which constitute health and social care within the home.
Initiatives to provide home care services have started in Mexico.The Instituto Mexicano del Seguro Social (IMSS -Mexican Social Security Institute) initiated an Ageing Program in 2009, including the development of a pilot program of tele-care and tele-alarms consisting of providing health care within the home (via telephone, 24 hours a day).It is a social and health care intervention which ensures a rapid response to crisis or emergency situations through information, guidance and referral activities.The service users are individuals aged 60 and over, living alone or being alone most of the time, or those living with another individual in similar conditions; without serious hearing problems or mental disorders that limit ability to communicate.
The aim of this study was to analyze the effect of the pilot program on self-perceived health in the elderly and to identify satisfaction and acceptance of the program from these individuals, their caregivers/relatives and health care professionals.

METHODS
This was a cross-sectional study consisting of a household survey of users of the program and interviews with health care professionals in three family health care units belonging to the IMSS, located in Mexico City.Three standardized questionnaires were used, one for each target population: 378 elderly individuals who had been registered with the program for over six months in June 2010; 294 caregivers/family members and 53 health care professionals (heads of clinical departments, family doctors and social workers).

INTRODUCTION
Two scales were used: The European Quality of Life-5 Dimensions (EuroQol-5) and the short geriatric depression scale (GDS).These scales had been validated for the Hispanic population.Data were collected during July 2010.The visual analogical scale and the GDS scale were applied to the elderly individuals on entering the program, time zero (t0), and after six months, time one (t1).
The list of service users for June 2010 was 404 elderly individuals, and a response rate of 94% was reached, due to: illness, death of spouse, refusal to respond and being away on holiday.
Mean age was 78.4 years (SD 6.5 years); 65.9% were women, half of whom had no partner, mainly due to being widowed (42.3%), 14.2% had no caregiver/relative and in 8.0% of cases two service users had the same caregiver/relative; 66.7% of caregivers/relatives were women, the majority aged between 40 and 59 (46.9%), usually children (56.5%), followed by spouses/partners (20.7%) or other family members (11.6%).
Data analysis included simple frequencies, contingency tables and intragroup analysis for dependent samples using the Wilcoxon test.Stata 11 software was used.
The protocol was approved by the Research and Ethics Committee of the Instituto Mexicano del Seguro Social (IMSS) Project No. FIS/IMSS/PROT/257; all participants signed a consent form.

RESULTS
Differences were observed between time zero and time one with regards a better perceived level of health on the part of the elderly individuals, with a mean of -6.17 (SD 17.90; p < 0.000).
Among the various services the program offers, the ambulance scored most highly (48.9% from the elderly individuals and 51.0% from caregivers/relatives); followed by immediate care 22.5% and 20.4% from the elderly individuals and caregivers/relatives respectively); 48.4% of the elderly individuals and 26.2% of caregivers/relatives had used the alarm button for various reasons, with the following reasons standing out among the former: pressing it by mistake (29.0%), in an emergency (16.9%, of which 38.2% was for falls), to chat (14.2%) or to check it was working (13.7%).Caregivers and family members used the button in emergencies (40.3%, of which 32.3% was for falls), to check it was working (14.3%), by mistake (13.0%) or to ask for information (7.8%).Among the elderly individuals who did not use the alarm button (51.6%), 89.2% had no need of it.The reported need was offset by the calls from the service operators: 96.5% reported constantly receiving calls from the operators to check that the button was working (30.7%) or to monitor an illness of treatment (26.8%) (Table ).
The elderly individuals (81.7%) and the caregivers/ relatives (86.1%) considered that the responses they received from the operators helped them resolve the problem.The majority considered that the operators had provided a good service.The program became an important service in day-to-day life; 78.8% of the elderly individuals and 93.2% of the caregivers/relatives noticed improvements in the elderly individual's quality of life attributable to the program.They felt less dependent (32.0%), a perception that was shared by the caregivers/relatives (21.2%).Peace of mind regarding the increase in care after the elderly individual entered the program: 68.8% of the service users and 84.7% of the caregivers/relatives considered that since the elderly individual had entered the program the family had become more involved and supportive in care and 89.8% that the program provided a daily security for the elderly and their family with regards the care.Among the carers, 52.0% perceived improvements in health.
The health care professionals observed positive changes in the health of the patients (41.5%), decreased in prescribed medication (18.9%) and in demand for health care services (24.5%), attributing this mainly to adherence to treatment and following medical recommendations.These recommendations were supervised by the operators of the service.In total, 94.3% deemed the program to be valuable in monitoring and caring for patients.

DISCUSSION
For the first time in Mexico the effects on health and the satisfaction with and acceptance of a social and health care program within the home, using low cost technology, have been analyzed.This study made various important findings: a) the pilot program achieved significant improvements in the service users' perception of their own health; b) tele-care contributed to improvements in quality of life, the elderly individuals becoming less dependent and to the peace of mind of themselves and their families; and c) that it is feasible to develop social and health care services for the elderly within the home using technology, as there is good acceptance on the part of the elderly, their caregivers/ relatives and of the health care professionals.
Tele-care was shown to influence improvements in levels of depression, 4 in quality of life, 5 decreasing visits to the emergency room and greater adherence to medical recommendations, 1 support in the case of falls, giving a feeling of security and reduction in anxiety, 2 the perception of more independent life and, with relation to the caregiver/relative, more free time, peace of mind and security. 5Give the effects that the tele-care program had, the majority recommended the use of these services. 5e program meets the needs of individuals with concerning growing old within their own homes.Using technology in health care services is a viable resource for developing long-distance social and health care service programs for the elderly.Although there was good acceptance from all of the service users and from the health care professionals, greater adaptability to existing systems and the individual needs of the service Health care services within the home using such technologies are emerging in Mexico, thus in this field of research no previous data exists on the effects it may have on the physical, psychological and social health of the elderly and their caregivers/relatives.A limitation of this study was the lack of a complete foundation which would have enabled the impact on the elderly individuals' health and quality of life to be measured.Another was the lack of economic analysis that would have enhanced the study, providing better information on the impact of programs of this type on health care service costs.

Table .
Satisfaction and acceptance of the TATA pilot program on the part of the elderly individuals (n = 378), of their caregivers/ relatives (n = 294) and of the health care professionals (n = 53).Mexico City, Mexico, 2010.Would you recommend this program and do you think all elderly individuals should have access to it?For the caregivers/relatives column, indicate whether the elderly individual's quality of life has improved since entering the program d For the caregivers/relatives column, indicate whether the program helped the elderly individual be more, the same or less dependent users themselves is required.Only then will the program contribute to improving the health care provided by health care institutions to the ageing population.
a Number of observations by elderly individuals b Number of observations by caregivers/relatives c