The FrailSafe study is taking place in three different pilot sites: Patras (Greece), Nicosia (Cyprus) and Nancy (France). A medical team, composed of general practitioners (GPs), psychologists, neurologists, and nurses, follow the volunteers that signed up for the study. This time, we wanted to have the perspective of the nurses working on FrailSafe. Rafaela Tsela, from the Patras site, and Anne Freminet, from the French site INSERM, were interviewed to know what their work consists in in the framework of FrailSafe and what they think about the potential of the project.

What is your background?
Rafaela: I studied to be a nurse and I am currently attending a master programme in medicine school in Athens. Being part of FrailSafe is my first experience in a European environment, and I really enjoy it. It’s really rewarding and interesting to see how we collaborate with other EU partners.
Anne: I had been working as a nurse for a couple of years before completing a master degree in public health. I am currently studying for a university degree to work as a clinical research associate. Frailsafe is also my first experience in research.

What is your role in FrailSafe?
Rafaela: I am a nurse working 100% on FrailSafe. My week is summarized as follows: On Monday, I make appointments with the volunteers in Patras (I visit 40 people every 2 months); on Tuesday I visit them and proceed with the FrailSafe sessions – meaning giving them the FrailSafe devices, helping them putting on or off the smart vest, explaining the virtual games; in between, I pick up the devices from each participants and on Sunday I upload the collected data to the FrailSafe’s Electronic Case Report Form (eCRF). I remain available for the volunteers throughout the week; they know they can call me whenever they need help, e.g. in case of a problem with the tablet, smart vest, blood pressure monitor. In other words, I am their direct contact person when it comes to the FrailSafe study. I take on many roles, as I am recruiting the volunteers, going to the older persons’ place, present them with the FrailSafe devices, carry on the clinical assessments, do the follow-up, upload the data, and report to the technical partners if there is a problem with the devices.

How have you recruited volunteers in Nancy for the study and how do you proceed with the evaluations?
Anne: We don’t have any recruitment centre. We have held information meetings within older people associations, senior residences and several town halls, and we have displayed and distributed the FrailSafe leaflets in the hospital. M Bénétos also took part in a local television programme, as well as in one on the radio. The clinical evaluations were done in an association of older people so as to spare participants from having to come to the hospital.

Do you have any technical background that helps you with the manipulation of the devices?
Rafaela: I don’t have any specific background, but I own a smartphone and a tablet and can get my way through it. And it’s important to say that the FrailSafe ICT partners, Gruppo Sigla and Smartex, had briefed us about the smart vest, the dynamometer and the eCRF and they are always there in case we have a problem.
Anne: I don’t have any specific technical background. It is true that the technicians and engineers of Gruppo Sigla and Smartex are available in case of technical problems. And we have regular video chats to solve technical issues.

What do you think of FrailSafe?
Rafaela: I am really enthusiastic about it. I think it’s a useful, helpful and innovative programme. It has a lot to give to the participants. The volunteers are always in contact with a doctor or a nurse. Through the eCRF, doctors or nurses can see if something is wrong. I think that those who will benefit from the final FrailSafe solutions will be able to better monitor their health and act accordingly when needed. Also, thanks to the study, volunteers try new technologies such as the wearable vest and the games and they benefit from using it. Through their participation, they perceive research projects in a different way, and thanks to their positive opinion, they helped us recruit new volunteers.
Anne: I think it is a novel concept! There’s nothing else on the market that offers such a pack composed of several high tech devices that detect frailty as early as possible. The proposed devices are various: the blood pressure monitors e.g. can easily be used by someone aged over 70. On the other hand, the tablets and smartphones are trickier, as most of our volunteers have never used them before. Regarding the motion sensors inside their homes, once they are placed, the participants don’t have to bother about them, so it’s also very easy to use. I have been visiting them in their houses on several occasions, so we have developed a good relationship. Visits for installing the devices are always very friendly for all of us. We have often involved there a friend of a participant.

How could FrailSafe solutions prevent frailty among older people?
Rafaela: The FrailSafe study can teach older people to pay more attention to their health and to consult their GP if something isn’t right. For example, a participant measured his blood pressure as requested for the FrailSafe study and we observed the recorded values were out of the normal range. We then advised him to check with his GP. Or when they play the games on the tablet and see they have scored low in memory, they would say “I’m still too young to have memory problems, I should train more”. It is a preventive approach that helps them to remain healthy and active for longer. Regarding the devices, I think the smart vest is a great solution. It still needs a lot of improvements, but I think it is very promising.
Anne: The FrailSafe package helps prevent frailty at different levels thanks to the FrailSafe tools. For example, the Red Wings Game helps detect muscular frailty by using the dynamometer and the pedometer and GPS tells us more about the frailty caused by a sedentary lifestyle. It already happened that we observed abnormal blood pressure measurements and had them sent over to the participant’s GP to take the appropriate actions. All these applications, games and devices help us see when a measurement is not normal, and therefore helps us react accordingly to prevent frailty among older people.

What problems have you faced so far?
Rafaela: As I said, I visit the participants and give them the devices for the study. At this point, I had some trouble with the smart vest, as it was very difficult to put it on or off, and it happened that participants contacted me to help them remove it because they couldn’t do it on their own. Some of them broke the recording device of the vest, so the Patras team went short of 2 smart vests. Also sometimes, the volunteers play the game without using the dynamometer, so no data of their grip strength is actually collected. All these experiences are shared with the technical partners to help improve the next versions of the FrailSafe devices.
Anne: The most frequent issue is when the participant accidentally stopped his/her smartphone. If the participant is aware of this, I visit him to switch it on again. For us, the smart vest is also an issue. Participants can’t plug the recording device to the vest and switch it on on their own. For the moment I go and see them in the morning to put it on and come back again in the evening to put it off. They keep the vest only for one day. We regularly inform Smartex about the pros and cons and share with them what the volunteers tell us. Therefore I’m sure that the updated smart vest will enable the participants to put it on and off alone for a whole session later on.

Do you think older people would use an online system to monitor their health?
Rafaela: If someone trains them to use the Virtual Patient Model (VPM) and explain to them how to access their medical data and how it can be used, they will use it. They are a little inexperienced with the use of technology at the beginning, but if you are patient enough to show them how it works, they like it. Some of them have decided to buy a tablet after using it for the FrailSafe study. But it’s important to point out that the system has to be easy, otherwise it won’t work.
Anne: I think it can happen indeed but it has to be user-friendly. Many participants take computer classes and I can see that they are making progress after each session. They have been using the FrailSafe system for their 4th session now and they can now use e.g. the tablet much more easily.

In your own words, why should other medical centers consider FrailSafe?
Rafaela: Frailsafe is a pioneering programme, I really believe that the VPM will turn out to be a really great asset for hospitals for example. Most hospitals don’t have a shared platform. Usually, when a patient goes to another hospital, the medical team needs to look for his/her medical data. Instead, with the VPM, they could have everything in one place. Also, I really think it will help delay the progression of frailty among older people, as they would have their own medical data at their disposal. For instance they have the possibility to check whether or not their blood pressure is too high/low and take measures to consult their GP as a reaction. It would favour a preventive approach towards healthy ageing.
Anne: This system is designed in such a way that it prevents different types of frailty (muscular, physical or cognitivefrailty). Frailty will then be addressed as a whole and no longer in a specific aspect, allowing for frailty prevention at a very early stage. In the end, this could increase the quality of life of people aged over 70.

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