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Au-Yeung WTM, Miller L, Wu CY, Beattie Z, Nunnerley M, Hanna R, Gothard S, Wild K, Kaye J. Examining the Relationships Between Indoor Environmental Quality Parameters Pertaining to Light, Noise, Temperature, and Humidity and the Behavioral and Psychological Symptoms of People Living With Dementia: Scoping Review. Interact J Med Res 2024; 13:e56452. [PMID: 39121471 PMCID: PMC11344188 DOI: 10.2196/56452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 05/27/2024] [Accepted: 06/28/2024] [Indexed: 08/11/2024] Open
Abstract
BACKGROUND A common challenge for individuals caring for people with Alzheimer disease and related dementias is managing the behavioral and psychological symptoms of dementia (BPSD). Effective management of BPSD will increase the quality of life of people living with dementia, lessen caregivers' burden, and lower health care cost. OBJECTIVE In this review, we seek to (1) examine how indoor environmental quality parameters pertaining to light, noise, temperature, and humidity are associated with BPSD and how controlling these parameters can help manage these symptoms and (2) identify the current state of knowledge in this area, current gaps in the research, and potential future directions. METHODS Searches were conducted in the CINAHL, Embase, MEDLINE, and PsycINFO databases for papers published from January 2007 to February 2024. We searched for studies examining the relationship between indoor environmental quality parameters pertaining to light, noise, temperature, and humidity and BPSD. RESULTS A total of 3123 papers were identified in the original search in October 2020. After an additional 2 searches and screening, 38 (0.69%) of the 5476 papers were included. Among the included papers, light was the most studied environmental factor (34/38, 89%), while there were fewer studies (from 5/38, 13% to 11/38, 29%) examining the relationships between other environmental factors and BPSD. Of the 38 studies, 8 (21%) examined multiple indoor environmental quality parameters. Subjective data were the only source of environmental assessments in 6 (16%) of the 38 studies. The findings regarding the relationship between agitation and light therapy are conflicted, while the studies that examined the relationship between BPSD and temperature or humidity are all observational. The results suggest that when the environmental factors are deemed overstimulating or understimulating for an individual with dementia, the behavioral symptoms tend to be exacerbated. CONCLUSIONS The findings of this scoping review may inform the design of long-term care units and older adult housing to support aging in place. More research is still needed to better understand the relationship between indoor environmental quality parameters and BPSD, and there is a need for more objective measurements of both the indoor environmental quality parameters and behavioral symptoms. One future direction is to incorporate objective sensing and advanced computational methods in real-time assessments to initiate just-in-time environmental interventions. Better management of BPSD will benefit patients, caregivers, and the health care system.
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Affiliation(s)
- Wan-Tai M Au-Yeung
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
| | - Lyndsey Miller
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
| | - Chao-Yi Wu
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Zachary Beattie
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
| | - Michael Nunnerley
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
- Department of Psychology, Portland State University, Portland, OR, United States
| | - Remonda Hanna
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
- Fariborz Maseeh Department of Mathematics and Statistics, Portland State University, Portland, OR, United States
| | - Sarah Gothard
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
| | - Katherine Wild
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
| | - Jeffrey Kaye
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
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Schütz N, Saner H, Botros A, Pais B, Santschi V, Buluschek P, Gatica-Perez D, Urwyler P, Müri RM, Nef T. Contactless Sleep Monitoring for Early Detection of Health Deteriorations in Community-Dwelling Older Adults: Exploratory Study. JMIR Mhealth Uhealth 2021; 9:e24666. [PMID: 34114966 PMCID: PMC8235297 DOI: 10.2196/24666] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 02/27/2021] [Accepted: 04/23/2021] [Indexed: 01/29/2023] Open
Abstract
Background Population aging is posing multiple social and economic challenges to society. One such challenge is the social and economic burden related to increased health care expenditure caused by early institutionalizations. The use of modern pervasive computing technology makes it possible to continuously monitor the health status of community-dwelling older adults at home. Early detection of health issues through these technologies may allow for reduced treatment costs and initiation of targeted preventive measures leading to better health outcomes. Sleep is a key factor when it comes to overall health and many health issues manifest themselves with associated sleep deteriorations. Sleep quality and sleep disorders such as sleep apnea syndrome have been extensively studied using various wearable devices at home or in the setting of sleep laboratories. However, little research has been conducted evaluating the potential of contactless and continuous sleep monitoring in detecting early signs of health problems in community-dwelling older adults. Objective In this work we aim to evaluate which contactlessly measurable sleep parameter is best suited to monitor perceived and actual health status changes in older adults. Methods We analyzed real-world longitudinal (up to 1 year) data from 37 community-dwelling older adults including more than 6000 nights of measured sleep. Sleep parameters were recorded by a pressure sensor placed beneath the mattress, and corresponding health status information was acquired through weekly questionnaires and reports by health care personnel. A total of 20 sleep parameters were analyzed, including common sleep metrics such as sleep efficiency, sleep onset delay, and sleep stages but also vital signs in the form of heart and breathing rate as well as movements in bed. Association with self-reported health, evaluated by EuroQol visual analog scale (EQ-VAS) ratings, were quantitatively evaluated using individual linear mixed-effects models. Translation to objective, real-world health incidents was investigated through manual retrospective case-by-case analysis. Results Using EQ-VAS rating based self-reported perceived health, we identified body movements in bed—measured by the number toss-and-turn events—as the most predictive sleep parameter (t score=–0.435, P value [adj]=<.001). Case-by-case analysis further substantiated this finding, showing that increases in number of body movements could often be explained by reported health incidents. Real world incidents included heart failure, hypertension, abdominal tumor, seasonal flu, gastrointestinal problems, and urinary tract infection. Conclusions Our results suggest that nightly body movements in bed could potentially be a highly relevant as well as easy to interpret and derive digital biomarker to monitor a wide range of health deteriorations in older adults. As such, it could help in detecting health deteriorations early on and provide timelier, more personalized, and precise treatment options.
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Affiliation(s)
- Narayan Schütz
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Hugo Saner
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland.,Department of Cardiology, University Hospital Bern, University of Bern, Bern, Switzerland.,I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Angela Botros
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Bruno Pais
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts of Western Switzerland, Lausanne, Switzerland
| | - Valérie Santschi
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts of Western Switzerland, Lausanne, Switzerland
| | | | - Daniel Gatica-Perez
- Idiap Research Institute, Martigny, Switzerland.,École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Prabitha Urwyler
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland.,Department of Neurology, University Hospital Bern, University of Bern, Bern, Switzerland
| | - René M Müri
- Department of Neurology, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Tobias Nef
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland.,Department of Neurology, University Hospital Bern, University of Bern, Bern, Switzerland
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Beattie Z, Miller LM, Almirola C, Au-Yeung WTM, Bernard H, Cosgrove KE, Dodge HH, Gamboa CJ, Golonka O, Gothard S, Harbison S, Irish S, Kornfeld J, Lee J, Marcoe J, Mattek NC, Quinn C, Reynolds C, Riley T, Rodrigues N, Sharma N, Siqueland MA, Thomas NW, Truty T, Wall R, Wild K, Wu CY, Karlawish J, Silverberg NB, Barnes LL, Czaja S, Silbert LC, Kaye J. The Collaborative Aging Research Using Technology Initiative: An Open, Sharable, Technology-Agnostic Platform for the Research Community. Digit Biomark 2020; 4:100-118. [PMID: 33442584 DOI: 10.1159/000512208] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/09/2020] [Indexed: 12/11/2022] Open
Abstract
Introduction Future digital health research hinges on methodologies to conduct remote clinical assessments and in-home monitoring. The Collaborative Aging Research Using Technology (CART) initiative was introduced to establish a digital technology research platform that could widely assess activity in the homes of diverse cohorts of older adults and detect meaningful change longitudinally. This paper reports on the built end-to-end design of the CART platform, its functionality, and the resulting research capabilities. Methods CART platform development followed a principled design process aiming for scalability, use case flexibility, longevity, and data privacy protection while allowing sharability. The platform, comprising ambient technology, wearables, and other sensors, was deployed in participants' homes to provide continuous, long-term (months to years), and ecologically valid data. Data gathered from CART homes were sent securely to a research server for analysis and future data sharing. Results The CART system was created, iteratively tested, and deployed to 232 homes representing four diverse cohorts (African American, Latinx, low-income, and predominantly rural-residing veterans) of older adults (n = 301) across the USA. Multiple measurements of wellness such as cognition (e.g., mean daily computer use time = 160-169 min), physical mobility (e.g., mean daily transitions between rooms = 96-155), sleep (e.g., mean nightly sleep duration = 6.3-7.4 h), and level of social engagement (e.g., reports of overnight visitors = 15-45%) were collected across cohorts. Conclusion The CART initiative resulted in a minimally obtrusive digital health-enabled system that met the design principles while allowing for data capture over extended periods and can be widely used by the research community. The ability to monitor and manage health digitally within the homes of older adults is an important alternative to in-person assessments in many research contexts. Further advances will come with wider, shared use of the CART system in additional settings, within different disease contexts, and by diverse research teams.
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Affiliation(s)
- Zachary Beattie
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Lyndsey M Miller
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,School of Nursing, Oregon Health & Science University, Portland, Oregon, USA
| | - Carlos Almirola
- Center for Cognitive Neuroscience and Aging, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Wan-Tai M Au-Yeung
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Hannah Bernard
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Kevin E Cosgrove
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Hiroko H Dodge
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Charlene J Gamboa
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Ona Golonka
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Sarah Gothard
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Sam Harbison
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Stephanie Irish
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Judith Kornfeld
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Jonathan Lee
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Jennifer Marcoe
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Nora C Mattek
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Charlie Quinn
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Christina Reynolds
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Thomas Riley
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Nathaniel Rodrigues
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Nicole Sharma
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Mary Alice Siqueland
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Neil W Thomas
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Timothy Truty
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Rachel Wall
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Portland Veterans Affairs Medical Center, Portland, Oregon, USA
| | - Katherine Wild
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Chao-Yi Wu
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Jason Karlawish
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nina B Silverberg
- Division of Neuroscience, National Institute on Aging, National Institute of Health, Bethesda, Maryland, USA
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Sara Czaja
- Center for Cognitive Neuroscience and Aging, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA.,Center on Aging and Behavioral Research, Division of Geriatrics and Palliative Medicine, Weil Cornell Medicine, New York, New York, USA
| | - Lisa C Silbert
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Portland Veterans Affairs Medical Center, Portland, Oregon, USA
| | - Jeffrey Kaye
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA.,National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
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