Presentation at UCAmI&IWAAL 2012.

1. A model to develop frailty diagnosis
tools through mobile devices and a
service-oriented approach
J. Fontecha, R. Hervás, J. Bravo, F.J. Navarro
MAmI Research Lab Geriatric Services
Castilla-La Mancha University Residencia Asistida de Ancianos
Ciudad Real, Spain Ciudad Real, Spain

2. What is Frailty?
• Woodhouse, 1988
“elderly people more than 65 years old who
depend on other people to perform their basic
needs”.
• Gillick, 1989
“old debilitated individuals who cannot survive
without substantial help from others”.
What is Frailty? 1 2 3
Assessment methods
Decrease resistance
New Technologies Impact Cumulative Adverse health
and physiological
The proposed model wear effects
Conceptual Design
reserves
Functional Design
2
Conclusions & Discussions

3. Assessment methods
1. Global scores from standardized questionnaires filled by
physicians.
Barthel Index Tinnetti MMS Lawton&Brody
…
2. Overview of the elder and his environment.
3. Measures from medical instruments.
Dynamometer Scale Blood pressure meter
…
What is Frailty?
Assessment methods
New Technologies Impact 4. Analysis of lab reports from the elderly patient.
The proposed model
Conceptual Design
Functional Design
3
Conclusions & Discussions

4. New technologies impact
• New technologies for Frailty diagnosis
BMI
Total water ADL level
Age Lean mass
Need help
Drug number Tinetti balance score Weight
Fat mass
Tinetti gait score Size Leukocytes Depression
Blood iron
Barthel index Gender Ferritin Vitamin B12
MMS Total protein Malnutrition CRP Calcium
Polypharmacy
Centralized Assessment
Combination with accelerometer results*
Standard deviation
What is Frailty?
Arithmetic mean
Assessment methods Pearson’s coefficient of variation
New Technologies Impact Amplitude Absolute mean difference
Variance
The proposed model
Acceleration mean
Conceptual Design
Functional Design * Elderly Frailty detection by using accelerometer-enabled smartphones and clinical information records.
4
Conclusions & Discussions Jesús Fontecha, Fco. Javier Navarro, Ramón Hervás, José Bravo. Personal and Ubiquitous Computing Journal.

5. The proposed model
• Goal:
“Facilitating the implementation of automated systems to be run on
mobile devices in order to get a centralized & objective frailty
assessment”.
• Consideration:
The technology used to implement our model depends on developers
Two Parts
Which? Conceptual Functional How?
What is Frailty?
(structure) Design Design (functionality)
Assessment methods
New Technologies Impact
The proposed model
Conceptual Design Entities Roles Services Functionalities
Functional Design
5
Conclusions & Discussions

6. Conceptual Design (I)
• Identification of entities and roles
-Service deployment
Mobile Phone - Interaction & Visualization
- Accelerometer data acquisiton
Devices
Accelerometer - Accelerometer data acquisiton
Server - Providing services to mobile device
- Process deployment
- Providing the patient record
Patient
What is Frailty? - Carrying the accelerometer to the waist
Assessment methods
Users
New Technologies Impact
The proposed model Physician - Interacting with mobile device
Conceptual Design
- Making a final diagnosis
Functional Design
6
Conclusions & Discussions

7. Conceptual Design (II)
• Identification of entities and roles
Questionnaires - Measures fromclinical indicators
Artifacts
Medical
-Measures from clinical equipment
Instruments
Patient Record - Values of frailty risk factors
Patient Stack - Frailty data storage
Procedures & Acquisition - Getting data from entities
What is Frailty?
Services
Processing - Analyisis and processing data
Assessment methods
New Technologies Impact
The proposed model
Storage - Data storage
Conceptual Design
Functional Design Result - Providing final results on mobile device
7
Conclusions & Discussions

8. Conceptual Design (III)
What is Frailty?
Assessment methods
New Technologies Impact
The proposed model
Conceptual Design
Functional Design
8
Conclusions & Discussions

9. Functional Design (I)
• Service-Oriented Approach  Procedures & Services
• Requirements and Functions
SERVICES
Mobile Web
- Accelerometer data acquisition - Patient record extraction
- Accelerometer data processing - Comparison and analysis procedure
What is Frailty? - Visualization of frailty assessment - Setting up a built result
Assessment methods - Storage into patient stack
New Technologies Impact
The proposed model
Conceptual Design
Functional Design
9
Conclusions & Discussions

10. Functional Design (II)
• Inputs and Outputs
Service Type Inputs Outputs
Accelerometer data Mobile Accelerometer signal Accelerometer
acquisition values (x,y,z)
Accelerometer data Mobile Accelerometer Accelerometry
processing values (x,y,z) indicators
Patient record Web Patient record, Frailty risk factors
extraction accelerometry
indicators
Analysis procedure Web Frailty risk factors, Frailty assessment
patient stack
Setting up a built result Web Frailty assessment Frailty assessment
formalized
What is Frailty? Visualization of frailty Mobile Frailty assessment Information, tips &
Assessment methods assessment formalized charts
New Technologies Impact Storage into patient Web Risk factors from the Patient stack with
The proposed model stack new patient new patient
Conceptual Design
Functional Design
10
Conclusions & Discussions

11. Conclusion and Discussion
• Model to support frailty diagnosis in a ubiquitous environment
• A centralized system valid for physicians
• Mobile devices (mobile phones) as the core of these systems
• Providing a conceptual and functional framework.
• Evaluation of efficiency & usability: Entities and Services
• Comparison
• Frailty tools based on our model vs. other
What is Frailty?
Assessment methods
New Technologies Impact
The proposed model
Conceptual Design
Functional Design
11
Conclusions & Discussions

12. A model to develop frailty diagnosis
tools through mobile devices and a
service-oriented approach
J. Fontecha, R. Hervás, J. Bravo, F.J. Navarro
MAmI Research Lab Geriatric Services
Castilla-La Mancha University Residencia Asistida de Ancianos
Ciudad Real, Spain Ciudad Real, Spain