Senior Health IE - Q3 2022

Accelerating health benefits and solutions for Irish citizens and economic growth

From a standing start, Ireland has made remarkable progress in establishing a vibrant digital health SME system.

Digital health is recognised as a new discipline providing great potential to transform the healthcare system. Despite outstanding performance in economic growth, digital deployment (Ireland is fifth in the EU DESI) and outstanding clinicians, the Irish healthcare system is ranked very low (number 80) in the ranking of global healthcare systems by CEO World.

Healthcare investment

Globally, digital health is seeing record levels of venture capital investment, and Ireland is seeing more entrepreneurial activity in the industry.

Ireland is building an Open Collaborative ecosystem to rapidly improve our healthcare system. Undirected innovation can lead to much waste, slow progress and inefficiencies. To orchestrate the efforts and innovation to fix the Irish healthcare system, we are using the Open Innovation 2.0 methodology. Additionally, we use the Stay Left, Shift Left 10X strategy and doctrine to help align, amplify and accelerate our collective efforts.

Historically, it has been very difficult for Irish Digital Health SMEs to penetrate the Irish Health Service. This has created at least two problems: lack of innovation in health services and Irish Digital Health SMEs being forced to go abroad.

Recognising leaders

A culture of openness and the adoption of the Open Innovation 2.0 (OI2) living labs approach has allowed effective collaboration and co-creation with a network of Irish Digital Health SMEs.

HSE Digital Transformation has worked closely with Enterprise Ireland, IDA, SFI, IDHLSG and others to foster an environment where digital health solutions and research can be successfully iterated in clinical settings.

Globally, digital health is seeing record levels of venture capital investment, and Ireland is seeing more entrepreneurial activity in the industry.

Together with Leo Clancy, CEO of Enterprise Ireland, we announced the First 25 at the UNGA Science Summit in New York on September 26th and at the Smart Health Summit in Croke Park on September 28th — the top 25 indigenous Digital Health companies and CEOs in Ireland for 2022 working with the Irish Health System. Five Irish companies were physically present in New York, sharing their solutions and 10X benefits, Silvercloud, PMD Solutions, Halocare, Redzinc and Phyxium. This list is prepared based on how well each company is helping enable the Irish Digital Health Strategy ‘Stay Left, Shift Left 10X’ and have been assessed based on 12 criteria. This includes better care, lower cost, better experience and better quality of life.

Digital health contribution

With companies collaborating in a vibrant ecosystem, the future is surely bright with lengthened lives and economic growth delivered in parallel. The digitalisation and virtualisation of care mean sustainability benefits, avoiding travel and minimising the risk of infection for patients.

Professor Martin Curley Chair, Irish

“With the infusions, I have already noticed a significant difference in my quality of life.”

Mary McAnea

Patient

“Effective therapies have recently emerged for both genetic and wildtype subtypes.”

Digital technology can support a holistic approach to healthy ageing

Since modern health systems were established, demographic ageing has substantially changed our healthcare needs. Acute care needs have been replaced by the growing prevalence of chronic diseases.

In2019, 35.7% of the EU population aged 16 and over reported having a long-standing illness. For many patients, the goal is not the cure — but getting back to living the best life possible.

Real health issues

Graham Armitage Managing Director, EIT Health Ireland-UK

Health should not be considered a standalone issue. As we age, it is intrinsic to our lives and the way we want to live. Health blurs with social care and our social interactions. Our care circle spreads beyond a handful of health professionals.

Chronic disease is complex, dynamic and enduring. Capturing, recording, processing and sharing detailed information — as it changes with time — creates huge flows of data. Too much to rely on paper records alone.

Digital health benefits

Digital health can provide a more holistic approach to meeting a patient’s needs while capturing data.

Often, the narrative has been one of cost savings, but digital health interventions also offer improvements in the quality of care and its outcomes. Making digital technologies more widely available means patient needs can be met with teleconsulting and remote monitoring — reducing the time and resources associated with attending in-person appointments.

Remote monitoring tools facilitate frequent and

An advanced device for glaucoma therapy can reduce eye pressure

Glaucoma is a serious and progressive eye disease which, left untreated, can lead to blindness. It can be difficult to detect without an eye test as most types of glaucoma have no symptoms.

real-time measurement of vital signs. Patients can track trends and changes in their data with artificial intelligence and securely share this data with carers. They could even predict a critical event to avoid crisis hospitalisation.

Assistive technology

EIT Health-supported startup MiiCare provides AI-based assistive technology to help elderly people living alone manage their health. They can set personalised medication alerts and reminders, track rest or body vitals and monitor hydration. The advanced AI predicts expected health problems, helping to prevent these via emergency voice command.

There are many innovative digital health companies in Europe, supported by organisations like EIT Health, working hard to leverage new technology that optimises the ageing experience. By placing the patient at the centre of the design process, it becomes much simpler for the elderly or those less digitally savvy to adopt these tools into everyday life.

To support digital health companies as they continue developing solutions for healthy ageing, we must provide speedy and efficient methods for evaluating and reimbursing them. Nations that already have mechanisms in place to do this will benefit not only through improved care and efficiencies but also economic growth through innovation.

Glaucoma

is most frequently caused by an increase in eye pressure when the fluid produced cannot drain out adequately. Damage to the optic nerve is irreversible, so early diagnosis is crucial. Lowering eye pressure is the most effective way to control glaucoma and the only proven treatment.

What happens after diagnosis?

Once diagnosed, the most common treatment is prescription eye drops, which will help to either reduce fluid production or increase the drainage of fluid from the eye. However, a significant proportion of glaucoma patients may have poor adherence to their eye drops. This can be due to side effects of the medication,

complicated dosing requirements or a lack of understanding about the need to continually treat this disease.1

Treatment with iStent® inject W, a trabecular micro-bypass surgery, at the same time as cataract surgery has the triple benefit of improving sight — reducing eye pressure and helping the comfort and health of the ocular surface.

Treatment for glaucoma Trabecular micro-bypass surgery comprises microscopic 0.36mm stents which are implanted into the eye. The surgery is quick, safe and can be performed under needle-less anaesthetic at the same time as cataract surgery or as a separate procedure. It can be a good alternative treatment.

Lowering eye pressure is the most effective way to control glaucoma and the only proven treatment.

The stents work by helping to restore the eye’s natural fluid outflow which, in turn, reduces eye pressure. An international study has shown that 72% of patients who were treated with this no longer need to take glaucoma medication after 12 months.

Mr Eamonn O’Donoghue Consultant Ophthalmic Surgeon and Glaucoma Specialist at University Hospital, Galway

Paid for by Glaukos

Increasing recognition of ATTR cardiac amyloidosis can improve outcomes

Transthyretin Amyloidosis (ATTR) is a multisystemic condition, typically presenting with heart and/or neuropathy symptoms. It is being increasingly recognised in older people due to heightened awareness and advances in cardiac imaging techniques for diagnosis.

Amyloidosis is a general term used to describe a group of diseases where a particular protein ‘misfolds’ and subsequently accumulates into ‘amyloid fibrils’ which get deposited into various tissues and organs, interrupting their normal function and causing progressive disease.

Risk in older people

In ATTR amyloidosis, transthyretin — a normally occurring protein with important roles in the body — misfolds into fibrils as it exits the liver which deposit in the heart and nerves. It is subdivided into two types: genetic (which we call hereditary ATTR) or acquired (which we call wild-type ATTR).

Wild-type ATTR typically affects older adults, presenting after the sixth decade of life and most commonly in those above 70 years.

Symptoms and signs

WRITTEN BY Professor Emer Joyce Consultant Cardiologist, Mater University Hospital

The heart and nervous system are the most frequently involved organs. Patients can present with heart failure syndrome or rhythm problems such as irregular heartbeat or slow heartbeat, which can lead to collapse or dizziness. In the nervous system, the ATTR amyloid fibrils can cause numbness and tingling.

Frequently, patients will have a history of carpal tunnel syndrome (trapped nerve-causing pins and needles) in both hands — often many years before their ATTR amyloidosis diagnosis.

The heart and nervous system are the most frequently involved organs.

Because many of its initial manifestations can overlap with more common cardiac conditions such as high blood pressure, it has historically been underdiagnosed.

Hereditary ATTR amyloidosis is caused by a genetic mutation in the TTR gene. While rare, there is a particular variant dominant in Ireland (‘T60A’ or ‘Donegal Amy’). However, over 120 mutations have been described across the world.

Effective therapies have recently emerged for both genetic and wild-type subtypes.

The ‘autonomic’ nervous system can also be affected. Low blood pressure, diarrhoea or constipation and erectile dysfunction can occur.

How is it diagnosed?

The initial suspicion of ATTR amyloidosis is typically based on an echocardiogram (heart ultrasound) and/or cardiac MRI scan.

A definitive diagnosis can then be made through a non-invasive pathway, using blood tests to out-rule any blood cell abnormalities, followed by a special type of bone scan known in short-hand as a ‘DPD scan.’ In more complex cases, a biopsy-led diagnosis may be required.

Photo posed by model. PP-UNP-IRL-0143

Breakthrough with new treatments for cardiac amyloidosis

Cardiac amyloidosis is a long-described disorder where a waxy, protein-like substance is deposited on the heart muscle making it stiff and, ultimately, weak.

Cardiac amyloidosis can cause breathlessness (labelled as ‘heart failure’) and heart rhythm problems that can lead to death. It has two main types: one is driven by proteins made by the bone marrow and the other by proteins made in the liver.

Stiff heart syndrome

Both reproduce the same, stiff heart that looks overgrown or too thick on cardiac ultrasound. It can cause neuropathy when protein is deposited in nerves. This leads to tingling in the arms and legs and, sometimes, loss of control on bowel and bladder function.

The bone marrow variety is essentially a type of low-grade cancer requiring chemotherapy to control it. The liver-driven process is often a genetic disorder.

Available treatment

Until the last two years, there was little available treatment, apart from a liver transplant that can sometimes be done if caught early enough. The liver version (TTR amyloid) can also occur in the elderly even if they don’t have the gene disorder or a family history of it.

Thankfully, there has been a sudden treatment breakthrough using a variety of novel technologies (including ‘gene-silencing’ drugs with possible long-term effects). Two new medications are now licenced in Ireland: a tablet-a-day and another involving intermittent infusion injections.

Helping families

We now have viable treatment to halt the deposition of these proteins. Large-scale clinical studies published years ago suggest that the earlier the patient receives treatment, the better the long-term outcome.

We must find affected families and pick up cases that are still early in development — to increase the amount of genetic testing and offer some hope for a disorder that, for so long, had no treatment.

How Mary found support living with hereditary amyloidosis

My initial diagnosis didn’t happen overnight.

Amyloidosis is often overlooked as signs and symptoms mimic other diseases.

WRITTEN BY Dr Ross Murphy Consultant Cardiologist, St James’ Hospital

Istarted

with breathlessness, fatigue and a feeling of a weight on my chest. In 2010, I had a stent put in my artery. I returned to work on my usual medications and felt like a new woman. Five years after, I had pains all over.

I was in and out of hospital and experienced a heart attack. Three years later, after many procedures, I was diagnosed with Cardiac Amyloidosis.

The mutation is known as Donegal Amy — with a 50% chance of passing the gene to our children.

I was under the care of Professor Emer Joyce and her team. Dr Joyce ordered genetic testing and medications were changed.

Infusion medication started in March 2022 then home infusions in May. Recently, I was told I am stable with no side effects.

The support after my diagnosis from ATTR: Amyloidosis all Ireland Support group was tremendous. The group is like my second family. With treatment available, early diagnosis is the answer. With the infusions, I have already noticed a difference in my quality of life. Hopefully, it will be a game-changer for the future.

WRITTEN BY Mary McAnea (Dugan) Amyloidosis Patient

Large-scale clinical studies published years ago suggest that the earlier the patient receives treatment, the better the long-term outcome.

Essential information about vitamin D and your health

From Halloween to St Patrick’s day, we cannot make vitamin D from sunlight and are reliant on meeting our requirements from our diet.

Vitamin D is an essential micronutrient that is needed for bone health and has been linked with reduced risk of cardiovascular disease, cancers and cognitive impairment.

Morerecently, vitamin D has been linked with the immune system’s function, with low levels leading to a higher risk of severe symptoms from respiratory infections, which could also include Covid-19.

Getting the necessary nutrients

Vitamin D is made in the skin by exposing the body to just 10–15 minutes per day of sun. In Ireland, however, vitamin D can only usually be produced between late March and early October. From Halloween to St Patrick’s day, we cannot make vitamin D from sunlight and are reliant on meeting our requirements from our diet.

Only a few foods are rich in vitamin D (oily fish, eggs, mushrooms), and these are not frequently consumed. Only a few foods are fortified with vitamin D (eg. some cereals, milk, etc.), and these tend to be more expensive and not widely available. The lack of a vitamin D food fortification policy in Ireland, coupled with inadequate sunlight, means we experience some of the highest deficiency rates in Western Europe.

In the Irish Longitudinal Study on Ageing, a nationally representative sample of older adults in Ireland, we found that:

• 47% of all adults over 85 are vitamin D-deficient in winter

• 1 in 8 adults over 50 are deficient all year round

• Only 4% of men and 15% of women take a vitamin D supplement

Those most at risk of deficiency include:

• People who get little sun exposure or eat low amounts of fortified foods, especially housebound people

• People who are obese or physically inactive, have asthma/chronic lung disease or inflammatory conditions

• Those from poorer backgrounds

• Males and those who live alone

• Ethnic minorities/non-Caucasians

Some recommendations

New recommendations from the Department of Health and the Food Safety Authority of Ireland in 2020 advise that ‘all older Irish adults aged 65 and older take a vitamin D supplement of 15 micrograms (μg)/600 International Units (IU) every day to ensure they get the vitamin D needed for bone and muscle health.’

This can be either through a multivitamin, a calcium and vitamin D supplement or a vitamin D-only supplement. Older adults are also encouraged to try and eat vitaminrich foods such as oily fish which can infer additional health benefits.

Dr Eamon Laird Bsc, PgDIP, Phd Research Scientist, University of Limerick, Physical Education and Sports Science, Visiting Nutrition Senior Research Fellow TCD

Professor Rose Anne Kenny, MD, FRCP, FRCPI President IGS, Professor Medical Gerontology Trinity College and St James Hospital, Director MISA, founding PI TILDA Irish longitudinal study on Ageing

maintenance of normal bones

normal function of the immune system

maintenance of normal muscle function

Head of Advocacy, Research and Public Affairs, Alzheimer’s Society

Continuous support for people with dementia across Ireland

Dementia is the name for a range of conditions that cause damage to the brain. This damage can affect memory, thinking, language and the ability to carry out everyday tasks.

There

are many conditions that cause dementia.

Alzheimer’s is the most common cause. Vascular dementia, dementia with Lewy bodies and Frontotemporal dementia are other causes.

Symptoms of the disease

Alzheimer’s disease is the most common and well-known cause of dementia, and it is thought to cause over half of all cases. Short-term memory loss is often one of the first symptoms of this disease. However, there is a range of early signs and symptoms including:

• Getting stuck for words

• Misplacing things regularly

• Losing track of time

• Changes in mood and behaviour

• Difficulty in finding the way, even in familiar places

It is important to remember that symptoms vary from person to person as everyone’s experience with the disease is unique.

Support for dementia

For anyone who is concerned about their own health or that of a loved one and is looking for support, advice or help, The Alzheimer Society of Ireland (ASI) operates the

Why sensory tech can bring light into the lives of people with dementia

People living with dementia can be mentally stimulated by purposeful play activities, including sensory technology that projects interactive games onto a tabletop or floor.

Alzheimer National Helpline. It offers information and support to anyone affected by dementia at 1800 341 341.

Our vision is an Ireland where people on the journey of dementia are valued and supported. Our mission is to advocate, empower and champion the rights of people living with dementia and their communities to quality support and services.

A national nonprofit organisation, the ASI is personcentred, rights-based and grassroots-led with the voice of the person with dementia and their carer at its core.

Being part of a community

The ASI provides support and services to people with dementia and their carers across Ireland including Day Care, Day Care at Home, Home Care, Family Carer Training, Dementia Advisers, Alzheimer Cafes and Social Clubs.

We celebrate 40 years this year, and there have been many milestones achieved since 1982 when carers Winifred Bligh and Imelda Gillespie held their first meeting and changed the face of dementia care in Ireland forever.

Forty years on, we are now a national organisation providing support, services and care for the 64,000 people living with dementia and their family carers in Ireland today.

ImageprovidedbyHomecareMedical

the table may not do anything at first. But then they see the images and realise that they can touch them and play with them. There’s a sparkle in their eyes when they understand that this is something exciting and new.”

Developed in the Netherlands, Tovertafel’s games are co-designed with people living with dementia, carers and relatives. Tover’s usercentred designer, Marije Seinen, explains how it works: “All our game ideas are based on suggestions from the field. We try our designs together on-site, observe the gameplay very closely, record it on video and gather valuable information for developing the prototypes, which we then test again with everyone.”

Adults

living with dementia or intellectual disabilities can benefit hugely from purposeful play, says Alena Ulicka, Senior Activity Leader at CareChoice Montenotte nursing home in Cork. As its name suggests, purposeful play is done for a reason: to stimulate minds and enrich lives.

Stimulating patients with purposeful play

“When people hear the word ‘play,’ they tend to think of children in a playground,” says Ulicka. “But purposeful play is different. It’s something that senior residents can join in with and be cognitively

stimulated by, which is especially important for those living with advanced dementia.”

Ulicka and her team provide a range of supervised activities including painting, baking and gardening. Crucially, all are interactive.

Another way of providing mental stimulation for those living with dementia is with sensory technology called a Tovertafel — Dutch for ‘magic table.’ This projects interactive games onto a tabletop or floor which can provoke powerfully positive reactions in people. “We call these reactions sparkle moments,” explains Ulicka. “A resident sitting at

Making connections helps to spark reminiscence

The Tovertafel can also help people reminisce. One of its games involves ‘decorating’ a Christmas tree, which can lead to memories of past Christmases.

“Some residents with dementia don’t always recognise members of their own family, so the Tovertafel will be a fun and stimulating way to bring them together,” she says.

“People can make connections with each other through this type of play. And if we’re not successful at first, we keep trying until we are. Because that’s the challenge with dementia. The person is there. We just need to ‘find’ them.”

Marjie Seinen User-Centred Designer, Tover

supplies.ie

WRITTEN BY Tony Greenway

Alena Ulicka Senior Activity Leader, CareChoice Montenotte Nursing Home

Cormac Cahill