Monitoring the effects of traumatic brain injury in older adults using a remote home monitoring system
File(s)
Author(s)
Parkinson, Megan
Type
Thesis
Abstract
The prevalence of traumatic brain injury (TBI) among older adults is rising rapidly, with outcomes often complicated by multimorbidity and frailty. Despite this, research in this population remains limited. Minder, an in-home monitoring system developed by the UK DRI Centre for Care Research and Technology, uses infrared sensors and a bed-mat to passively collect sleep and activity data. While similar systems have monitored dementia, none have tracked the effects of TBI in older adults.
This thesis explores the potential of home monitoring technology to assess TBI effects during the period after hospital discharge. Chapter 3 presents a cross-sectional study describing older adult TBI admissions to my recruitment centre, identifying factors relevant to larger trials. Chapter 4 reports a case series analysing passively collected sleep and activity data, cross-referenced with assessments and weekly calls. Chapter 5 evaluates an alert scoring system that detects potential acute health events by identifying deviations from individual baselines. Chapter 6 examines participants’ and caregivers’ experiences, focusing on acceptability. Chapter 7 explores healthcare professionals’ perspectives on sustainable adoption. Chapter 8 evaluates the protocol’s feasibility, including recruitment, adherence, and sensor data capture.
Recruitment was feasible but requires expansion beyond major trauma centres to ensure equitable inclusion. Passive monitoring generated substantial data, with activity changes aligning with health status shifts. Few clinical events occurred, limiting evaluation of event-detection algorithms. Passive systems were acceptable, particularly for those with cognitive impairment or low technology use and offered a low-burden option for continuous monitoring. Greater flexibility, simplified assessments, and tailored support would improve participation. Healthcare professionals recognised potential benefits for safety and early intervention but cited concerns around integration, data management, and access equity.
Overall, this work demonstrates the feasibility, acceptability, and potential utility of passive home monitoring for older adults with TBI, highlighting adaptations needed for future large-scale studies.
This thesis explores the potential of home monitoring technology to assess TBI effects during the period after hospital discharge. Chapter 3 presents a cross-sectional study describing older adult TBI admissions to my recruitment centre, identifying factors relevant to larger trials. Chapter 4 reports a case series analysing passively collected sleep and activity data, cross-referenced with assessments and weekly calls. Chapter 5 evaluates an alert scoring system that detects potential acute health events by identifying deviations from individual baselines. Chapter 6 examines participants’ and caregivers’ experiences, focusing on acceptability. Chapter 7 explores healthcare professionals’ perspectives on sustainable adoption. Chapter 8 evaluates the protocol’s feasibility, including recruitment, adherence, and sensor data capture.
Recruitment was feasible but requires expansion beyond major trauma centres to ensure equitable inclusion. Passive monitoring generated substantial data, with activity changes aligning with health status shifts. Few clinical events occurred, limiting evaluation of event-detection algorithms. Passive systems were acceptable, particularly for those with cognitive impairment or low technology use and offered a low-burden option for continuous monitoring. Greater flexibility, simplified assessments, and tailored support would improve participation. Healthcare professionals recognised potential benefits for safety and early intervention but cited concerns around integration, data management, and access equity.
Overall, this work demonstrates the feasibility, acceptability, and potential utility of passive home monitoring for older adults with TBI, highlighting adaptations needed for future large-scale studies.
Version
Open Access
Date Issued
2025-01-30
Date Awarded
01/09/2025
Advisor
Fertleman, Michael
Publisher Department
Department of Bioengineering
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Medicine (Research) MD (Res)