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ehcoBUTLER. A global ecosystem for the independent and healty living of elder people with mild cognitive impairments.

Periodic Reporting for period 5 - ehcoBUTLER (ehcoBUTLER. A global ecosystem for the independent and healty living of elder people with mild cognitive impairments.)

Reporting period: 2021-07-01 to 2022-03-31

Nowadays, it is a fact that Europe is ageing. A common characteristic of elders is the frequent occurrence of either physical or mild cognitive impairments. This situation brings new challenges in how to improve the independence and quality of life of elderly people and promote their good health in different ways. The ehcoBUTLER project addresses this challenge by developing an ICT technological platform with both leisure and care apps oriented to elder users with Mild Cognitive Impairment. The main objective of ehcoBUTLER is to demonstrate the socio-economic benefits from the deployment of seven innovative and user led ICT pilot projects based on different business models in order to be able to translate promising results into scalable practice across Europe.

The Key Results (that can be also understood as target objectives) of ehcoBUTLER were:
- To break the technological barrier that exists nowadays between the elderly and the ICTs, encouraging the e-Inclusion, and recovering the involvement of this group of people in our society.
- To facilitate psychological and cognitive techniques and support procedures, both for the elderly people and for the informal and formal caregivers.
- Taken into account existing ergonomics and usability studies, to develop an interoperable and open ICT platform particularly designed and adapted to elderly people which assures them to manage using the system successfully and in a completely autonomous way.
- To demonstrate the ROI from several business models based on the deployment of this ICT platform.
- To generate an ecosystem for apps provider that will allow end users to integrate all the leisure and healthcare related activities in just one platform.
- To develop several ad-hoc adapted to specific users' needs applications to be deployed over the ICT platform to facilitate its adoption by the elder with cognitive impairments.

With regards to the scientific results, the ehcoBUTLER study and the impact analysis highlight that ehcoBUTLER suite has been very well accepted by older people with mild or very mild cognitive impairment, and they have used most of its modules, bearing in mind that older people have significant digital illiteracy and in some cases they reject technology, so they need highly adapted technological solutions, as is the case with ehcoBUTLER platform. The main conclusions regarding the impact analysis of the use of the ehcoBUTLER suite, based on the non-economic KPIs are:
- Improvement of cognitive performance: achieved (better scores in the MMSE and CDT). 82,5% of the total sample improves the cognitive function.
- Improvement of mood: achieved (better scores in the GDS). 34,43% of the total sample improves the mood and the 32% maintain the same level.
- Improvement of quality of life: achieved (better scores in the MQLI). 74,17% of the total sample improves the quality of life.
- Improvement of social relationships: achieved (better scores in the LSNS). 81,12% of the total sample improves the quality of the relationships.
From the beginning of the ehcoBUTLER project the results obtained have been oriented into the definition of the foundations of the technological platform, its implementation and deployment, the definition of the rules of the pilot of the platform and its running, and the exploitation of the data gathered from pilots for analysing its impact and return of investment towards an exploitation plan.

The work done includes highlights such as:
- The definition of the features of the platform oriented to the needs of the MCI users.
- Development and deployment of the technological platform
- Pilot running.
- Revision of the economic/non-economic key performance indicators (KPIs) for the cost-benefit analysis.
- Generation of the cost-benefit analysis and the exploitation plan.
- Publications in journals and conferences for the scientific community concerning project results.

More specifically, with regards to the exploitation of results, based on the results we have obtained, the sustainability of ehcoBUTLER solution is proved, giving those benefits, both social and economic, are much greater than costs. Although we have had a lot of problems to implement the all pilots and users for the COVID-19 pandemia, we have tried to get as much as possible data to complete an adequate Business Plan. We have analysed the different services already in the market, apps and platforms for the elderly, for people with MCI and with dementia, that have similarities with the hole system of ehcoBUTLER. However, it is difficult to get a clear position for the different products in the market. None of them have the full comprehensive scope that is included in ehcoBUTLER.
Our primary target customers are social care providers B2Goverment/B2B, including nursing homes and health sector. Citizens-at-risk and family members can buy the product themselves out-of-pocket (and later reimbursed). Healthcare community endorsement is, however, seen as a must to succeed with population wide adoption.

Regarding dissemination, apart from multiple publications in social media (Facebook, linkedin, Twitter) 6 webinars have been organized, 12 scientific publications have been achieved (7 scientific papers and 5 book chapters in conferences). 10 press releases, 3 newsletters, 1 many-to-many activity and 1 outreach initiative have been reached by the project. About offline communication materials produced, 5 posters and 2 brochures have been created. Finally, about traditional communication channels, a total of 10 articles to non-specialized magazines and 13 articles to websites have been created by the Consortium.
Expected impacts of the deployment of ehcoBUTLER are:
- Increased patient independence, prolonging active participation in society, quality of life and integrated care processes for the elderly population.
- Reduction of costs for the healthcare systems and improvement of efficiency of care process.
- Increased degree of interoperability and standardisation in the developed ICT solutions, with secure, seamless communication of data related to health and wellbeing among all involved parties.
- Strengthened European industrial position in eHealth and independent living products and services by creating new business models in new areas like cognitive disease management.

As part of the analysis of the results obtained we have analyzed both the efficacy of the system and the cost-effectiveness of the use of ehcoBUTLER in the different business models.

The detailed results are escribed in the 3 deliverables of the WP6: D6.1: Impact Evaluation, D6.2. Cost-benefit analysis, and D6.3: Exploitation plan. The results indicate that the use of ehcoBUTLER platform for one month or more, benefits to the older people with mild cognitive impairment and very mild cognitive impairment, and the tool is effective and efficient.
In terms of cost-benefit analysis, for the business models analyzed, the generalized economic impact is translated into costs/savings in human resources of the entity due to the use of ehcoBUTLER, since it allows a monitoring of the state of the elderly person without the requirement of a professional on site. These savings are multiplied every 20 users of the platform.
In relation to the cost-benefit analysis, in the Technologies business model, the benefit-cost ratio is higher than the others BM, and 1 euro spent for the service implementation would generate benefits for 10 euros.
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