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Solaiman B. Legal and Ethical Considerations of Artificial Intelligence for Residents in Post-Acute and Long-Term Care. J Am Med Dir Assoc 2024; 25:105105. [PMID: 38909630 DOI: 10.1016/j.jamda.2024.105105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 05/14/2024] [Accepted: 05/14/2024] [Indexed: 06/25/2024]
Abstract
This article proposes a framework for examining the ethical and legal concerns for using artificial intelligence (AI) in post-acute and long-term care (PA-LTC). It argues that established frameworks on health, AI, and the law should be adapted to specific care contexts. For residents in PA-LTC, their social, psychological, and mobility needs should act as a gauge for examining the benefits and risks of integrating AI into their care. Using those needs as a gauge, 4 areas of particular concern are identified. First, the threat that AI poses to the autonomy of residents can undermine their core needs. Second, how discrimination and bias in algorithmic decision-making can undermine Medicare coverage for PA-LTC, causing doctors' recommendations to be ignored and denying residents the care they are entitled to. Third, privacy rules concerning data use may undermine developers' ability to train accurate AI systems, limiting their usefulness in PA-LTC contexts. Fourth, the importance of obtaining consent before AI is used and discussions about how that care should continue if there are concerns about an ongoing decline in cognition. Together, these considerations elevate existing frameworks and adapt them to the context-specific case of PA-LTC. It is hoped that future research will examine the legal implications of these matters in each of these specific cases.
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Affiliation(s)
- Barry Solaiman
- HBKU, College of Law, Doha, Qatar; Weill Cornell Medicine, Doha, Qatar.
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2
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Largent EA, Karlawish J, Wexler A. From an idea to the marketplace: Identifying and addressing ethical and regulatory considerations across the digital health product-development lifecycle. BMC DIGITAL HEALTH 2024; 2:41. [PMID: 39130168 PMCID: PMC11308106 DOI: 10.1186/s44247-024-00098-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 05/09/2024] [Indexed: 08/13/2024]
Abstract
Widespread adoption of digital health tools has the potential to improve health and health care for individuals and their communities, but realizing this potential requires anticipating and addressing numerous ethical and regulatory challenges. Here, we help digital health tool developers identify ethical and regulatory considerations - and opportunities to advance desirable outcomes - by organizing them within a general product-development lifecycle that spans generation of ideas to commercialization of a product.
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Affiliation(s)
- Emily A Largent
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Jason Karlawish
- Department of Medicine, Department of Medical Ethics and Health Policy, Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Anna Wexler
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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MacNeil M, Hirslund E, Baiocco-Romano L, Kuspinar A, Stolee P. A scoping review of the use of intelligent assistive technologies in rehabilitation practice with older adults. Disabil Rehabil Assist Technol 2024; 19:1817-1848. [PMID: 37498115 DOI: 10.1080/17483107.2023.2239277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 05/30/2023] [Accepted: 07/17/2023] [Indexed: 07/28/2023]
Abstract
PURPOSE There is growing interest in intelligent assistive technologies (IATs) in the rehabilitation and support of older adults, however, the factors contributing to or preventing their use in practice are not well understood. This study aimed to develop an overview of current knowledge on barriers and facilitators to the use of smart technologies in rehabilitative practice with older adults. MATERIALS AND METHODS We undertook a scoping review following guidelines proposed by Arksey and O'Malley (2005) and Levac et al. (2010). A computerised literature search was conducted using the Scopus and Ovid databases, yielding 7995 citations. Of these, 94 studies met inclusion criteria. Analysis of extracted data identified themes which were explored in semi-structured interviews with a purposefully selected sample of seven clinical rehabilitation practitioners (three physical therapists, two occupational therapists, and two speech-language pathologists). RESULTS Barriers and facilitators to using these technologies were associated with accessibility, reported effectiveness, usability, patient-centred considerations, and staff considerations. CONCLUSIONS Collaborative efforts of policy-makers, researchers, manufacturers, rehabilitation professionals, and older persons are needed to improve the design of technologies, develop appropriate funding and reimbursement strategies, and minimise barriers to their appropriate use to support independence and quality of life. Any strategies to improve upon barriers to prescribing smart technologies for older people should leverage the expertise of rehabilitation professionals operating at the interface between older people; their health/mobility; their families; and technology-based solutions.
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Affiliation(s)
- Maggie MacNeil
- School of Nursing, McMaster University, Hamilton, Canada
| | - Emily Hirslund
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | | | - Ayse Kuspinar
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Paul Stolee
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
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Brijnath B, Rao R, Baruah U, Antoniades J, Loganathan S, Varghese M, Cooper C, Kent M, Dow B. Relational Solidarity and Conflicting Ethics in Dementia Care in Urban India. J Gerontol B Psychol Sci Soc Sci 2024; 79:gbae079. [PMID: 38708694 PMCID: PMC11157626 DOI: 10.1093/geronb/gbae079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Indexed: 05/07/2024] Open
Abstract
OBJECTIVES Using the concept of relational solidarity, we examine how autonomy, equality, dignity, and personhood are practiced in the care of people living with dementia at home in urban India. METHODS Video interviews with 19 family carers and 25 health providers conducted in English, Hindi, and Kannada in Bengaluru between March and July 2022. Data were translated into English and thematically analyzed. RESULTS Family carers and providers unanimously agreed that people with dementia should be respected and cared for. Concurrently, they perceived people with dementia as being "like a kid" and used the analogy of a parent-child relationship to understand their care responsibilities. This analogy informed how ethical principles such as personhood and equality were reframed in the relationships between family carers and people with dementia, as well as how carers and providers maintained the safety but undermined the autonomy of people with dementia through restricting their movements inside and outside the home. DISCUSSION There can be relational solidarity in dementia care at home in urban India but also contradictions in the interpretations and applications of the ethical principles of autonomy, equality, dignity, and personhood. As such, a more organic, grassroots model of ethical practice is needed to frame care and provide material support to families in India.
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Affiliation(s)
- Bianca Brijnath
- Social Gerontology Division, National Ageing Research Institute, Melbourne, Victoria, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Rachita Rao
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Upasana Baruah
- Social Gerontology Division, National Ageing Research Institute, Melbourne, Victoria, Australia
| | - Josefine Antoniades
- Social Gerontology Division, National Ageing Research Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Santosh Loganathan
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Mathew Varghese
- Department of Psychiatry, St John’s Medical College, Bengaluru, Karnataka, India
| | - Claudia Cooper
- Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Mike Kent
- School of Media, Creative Arts and Social Inquiry, Curtin University, Perth, Western Australia, Australia
| | - Briony Dow
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Director Division, National Ageing Research Institute, Melbourne, Victoria, Australia
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Howes J, Denier Y, Vandemeulebroucke T, Gastmans C. The Ethics of Electronic Tracking Devices in Dementia Care: An Interview Study with Developers. SCIENCE AND ENGINEERING ETHICS 2024; 30:17. [PMID: 38720094 PMCID: PMC11078786 DOI: 10.1007/s11948-024-00478-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 04/05/2024] [Indexed: 05/12/2024]
Abstract
Wandering is a symptom of dementia that can have devastating consequences on the lives of persons living with dementia and their families and caregivers. Increasingly, caregivers are turning towards electronic tracking devices to help manage wandering. Ethical questions have been raised regarding these location-based technologies and although qualitative research has been conducted to gain better insight into various stakeholders' views on the topic, developers of these technologies have been largely excluded. No qualitative research has focused on developers' perceptions of ethics related to electronic tracking devices. To address this, we performed a qualitative semi-structured interview study based on grounded theory. We interviewed 15 developers of electronic tracking devices to better understand how they perceive ethical issues surrounding the design, development, and use of these devices within dementia care. Our results reveal that developers are strongly motivated by moral considerations and believe that including stakeholders throughout the development process is critical for success. Developers felt a strong sense of moral obligation towards topics within their control and a weaker sense of moral obligation towards topics outside their control. This leads to a perceived moral boundary between development and use, where some moral responsibility is shifted to end-users.
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Affiliation(s)
- Jared Howes
- Centre for Biomedical Ethics and Law, KU Leuven, Leuven, Belgium.
| | - Yvonne Denier
- Centre for Biomedical Ethics and Law, KU Leuven, Leuven, Belgium
| | | | - Chris Gastmans
- Centre for Biomedical Ethics and Law, KU Leuven, Leuven, Belgium
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Dermody G, Fritz R, Glass C, Dunham M, Whitehead L. Family caregiver readiness to adopt smart home technology to monitor care-Dependent older adults: A qualitative exploratory study. J Adv Nurs 2024; 80:628-643. [PMID: 37614010 DOI: 10.1111/jan.15826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 06/20/2023] [Accepted: 07/31/2023] [Indexed: 08/25/2023]
Abstract
AIMS The aim of this study was to explore factors that influence family caregiver readiness to adopt health smart home technology for their care-dependent older adult family member. Health smart homes are designed to remotely monitor the health and wellness of community-dwelling older adults supporting independent living for as long as possible. Accordingly, if the health smart home is deployed into the home of a care-depended older adult, it can potentially support family caregivers by facilitating workforce participation and give piece of mind to the family caregiver who may not live close to the older adult. However, wider adoption of health smart home technologies into the homes of community-older adults is low, and little is known about the factors that influence the readiness of family caregivers to adopt smart home technologies for their care-dependent older adults. DESIGN A qualitative Descriptive study design was utilized. METHODS Qualitative data were collected between 2019 and 2020 via semi-structured interviews. Thematic analysis of interviews was completed, and data were organized into themes. RESULTS Study findings show that caregiver readiness (N = 10) to adopt smart home technology to monitor older adult family members were influenced by five primary themes including a 'big brother effect', 'framing for acceptance', 'data privacy', 'burden' and 'cost.' CONCLUSION Family caregivers were open to adopting smart home technology to support the independent living of their older adult family members. However, the readiness of family caregivers was inextricably linked to the older adults' readiness for smart home adoption. The family caregiver's primary concern was on how they could frame the idea of the smart home to overcome what they viewed as hesitancy to adopt in the older adult. The findings suggest that family caregivers endeavour to balance the hesitancy in their older adult family members with the potential benefits of smart home technology. IMPACT Family caregivers could benefit if their care-dependent older adults adopt smart home technology. Recognizing the role of caregivers and their perspectives on using smart home technologies with their care-dependents is critical to the meaningful design, use and adoption.
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Affiliation(s)
- Gordana Dermody
- University of the Sunshine Coast, Sippy Downs, Queensland, Australia
- Edith Cowan University, School of Nursing and Midwifery, Joondalup, Western Australia, Australia
| | - Roschelle Fritz
- Washington State University, College of Nursing, Vancouver, Western Australia, Australia
| | - Courtney Glass
- Edith Cowan University, School of Nursing and Midwifery, Joondalup, Western Australia, Australia
| | - Melissa Dunham
- Edith Cowan University, School of Nursing and Midwifery, Joondalup, Western Australia, Australia
| | - Lisa Whitehead
- Edith Cowan University, School of Nursing and Midwifery, Joondalup, Western Australia, Australia
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Grey E, Baber F, Corbett E, Ellis D, Gillison F, Barnett J. The use of technology to address loneliness and social isolation among older adults: the role of social care providers. BMC Public Health 2024; 24:108. [PMID: 38184519 PMCID: PMC10770975 DOI: 10.1186/s12889-023-17386-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 11/30/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND Addressing loneliness and social isolation among older adults remains a public health priority. The restrictions enforced during the COVID-19 pandemic simultaneously heightened the need for services to overcome social isolation and reduce loneliness among older adults, while also limiting social care providers' ability to deliver these. The aim of this study was to explore the experiences of social care providers in using technology to address loneliness and social isolation among older adults during the pandemic. METHODS This was a mixed methods study involving an online survey and interviews with providers of older adult social care in Wales, UK. Invitations to participate were sent to commissioners and providers of adult social care services, including those working in the voluntary and community sectors, across all local authorities in Wales. Data was collected between September 2021 and January 2022. RESULTS Sixty-one service providers completed the survey, 19 of whom also took part in an interview. Addressing loneliness and isolation among older adults was reported as a key concern by nearly all survey respondents. While telephone calls were the most common means of facilitating social interaction, many service providers also tried to support older adults to make more use of devices that they already had (e.g., smartphones to hold video calls). Where funding was available, organisations purchased devices, such as tablets and smart speakers, for older adults. Analysis of interviews resulted in three themes: (1) The potential and limitations of technology; (2) Individuals' capabilities, confidence, motivations and values; and (3) The wider system. CONCLUSIONS Technology was employed in a variety of ways during the pandemic to address loneliness and social isolation among older adults; many service providers continue to use technology in a hybrid system of care now that pandemic-related social restrictions have been lifted. Our findings emphasise a need for technology-assisted interventions to be designed and deployed in alignment with service users' values, motivations and capabilities. Further, there is a need to better support service providers to assess loneliness and social isolation among older adults, and to acknowledge the important role providers play in helping older adults to adopt technology-assisted interventions.
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Affiliation(s)
- Elisabeth Grey
- NIHR Applied Research Collaboration West & Bristol Medical School, University of Bristol, Bristol, UK
- Department for Health, University of Bath, Bath, UK
| | - Fran Baber
- Department of Psychology, University of Bath, Bath, UK
| | | | - David Ellis
- School of Management, University of Bath, Bath, UK
| | | | - Julie Barnett
- Department of Psychology, University of Bath, Bath, UK.
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Dietrich M, Krüger M, Weisswange TH. What should a robot disclose about me? A study about privacy-appropriate behaviors for social robots. Front Robot AI 2023; 10:1236733. [PMID: 38162995 PMCID: PMC10757370 DOI: 10.3389/frobt.2023.1236733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 11/17/2023] [Indexed: 01/03/2024] Open
Abstract
For robots to become integrated into our daily environment, they must be designed to gain sufficient trust of both users and bystanders. This is in particular important for social robots including those that assume the role of a mediator, working towards positively shaping relationships and interactions between individuals. One crucial factor influencing trust is the appropriate handling of personal information. Previous research on privacy has focused on data collection, secure storage, and abstract third-party disclosure risks. However, robot mediators may face situations where the disclosure of private information about one person to another specific person appears necessary. It is not clear if, how, and to what extent robots should share private information between people. This study presents an online investigation into appropriate robotic disclosure strategies. Using a vignette design, participants were presented with written descriptions of situations where a social robot reveals personal information about its owner to support pro-social human-human interaction. Participants were asked to choose the most appropriate robot behaviors, which differed in the level of information disclosure. We aimed to explore the effects of disclosure context, such as the relationship to the other person and the information content. The findings indicate that both the information content and relationship configurations significantly influence the perception of appropriate behavior but are not the sole determinants of disclosure-adequacy perception. The results also suggest that expected benefits of disclosure and individual general privacy attitudes serve as additional influential factors. These insights can inform the design of future mediating robots, enabling them to make more privacy-appropriate decisions which could foster trust and acceptance.
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Affiliation(s)
| | - Matti Krüger
- Honda Research Institute Europe GmbH, Offenbach, Germany
- Honda Research Institute Japan Co Ltd., Saitama, Japan
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Turner NR, Berridge C. How I want technology used in my care: Learning from documented choices of people living with dementia using a dyadic decision making tool. Inform Health Soc Care 2023; 48:387-401. [PMID: 37675938 PMCID: PMC10792656 DOI: 10.1080/17538157.2023.2252066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
While technologies for aging in place are promoted to support care partners and people living with dementia, perspectives of people living with dementia are underrepresented in both use decisions among families and discussions within academia and industry. This mixed-methods study examined the use preferences of twenty-nine people living with mild Alzheimer's disease (AD) for four categories of technologies: location tracking, in-home sensors, web-cameras, and virtual companion robots. Participants completed a novel dyadic intervention, Let's Talk Tech, where they documented their preferences of the four technology categories for care planning purposes. Post-test interviews were thematically analyzed and provide insight into selection processes. Technology preferences varied considerably by and within participant living with mild AD. Excepting location tracking, non-technology and low-technology options were more desirable than the featured technologies. Control over technology use was of great importance to people living with AD. Considerations given to technology preference selection imperfectly fit within the new Health Technology Acceptance Model (H-TAM) developed for older adults. These findings underscore the importance of including people living with dementia in decision making about technologies to support care at home and the need for further personalization and tailorable technological devices to accommodate and align with their preferences.
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Affiliation(s)
| | - Clara Berridge
- School of Social Work, University of Washington, Seattle, WA, USA
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10
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Tian YJ(A, Jotterand F, Wangmo T. Remote Technologies and Filial Obligations at a Distance: New Opportunities and Ethical Challenges. Asian Bioeth Rev 2023; 15:479-504. [PMID: 37808448 PMCID: PMC10555987 DOI: 10.1007/s41649-023-00256-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/02/2023] [Accepted: 08/07/2023] [Indexed: 10/10/2023] Open
Abstract
The coupled growth of population aging and international migration warrants attention on the methods and solutions available to adult children living overseas to provide distance caregiving for their aging parents. Despite living apart from their parents, the transnational informal care literature has indicated that first-generation immigrants remain committed to carry out their filial caregiving obligations in extensive and creative ways. With functions to remotely access health information enabled by emergency, wearable, motion, and video sensors, remote monitoring technologies (RMTs) may thus also allow these international migrants to be alerted in sudden changes and remain informed of their parent's state of health. As technological solutions for caregiving, RMTs could allow independent living for older persons while any unusual deviations from normal health patterns are detected and appropriately supported. With a vignette of a distance care arrangement, we engage with concepts such as filial piety, in-absentia caregiving distress, and the social exchange theory, as well as the upholding of shifting cultural ideals to illustrate the complex dynamic of the satisfaction and quality of the informal caregiving relationship. This paper extends the traditional ethical issues in technology-aided caregiving, such as autonomy, privacy, and justice, to be considered within the context of distance care. We also posit newer ethical considerations such as consent in power imbalances, harm to caregivers, and stigma. These known and new ethical issues aim to encourage further ethically conscious design and use of RMTs to support distance care for older persons.
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Affiliation(s)
| | - Fabrice Jotterand
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
- Center for Bioethics and Medical Humanities, Medical College of Wisconsin, Milwaukee, USA
| | - Tenzin Wangmo
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
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Qi C, Wang Y, Qi X, Jiao Y, Que C, Chen Y. Barriers to providing internet-based home care services for urban older adults in China: a qualitative study of the service providers. BMC Geriatr 2023; 23:320. [PMID: 37221471 DOI: 10.1186/s12877-023-04028-4] [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: 06/07/2022] [Accepted: 05/08/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Due to the increasingly aging population in China and the changes in social and family structure, older adults' care problems are becoming more and more prominent. To meet the home care needs of urban older adults, the Chinese government has launched Internet-Based Home Care Services (IBHCS). Although this model innovation can significantly relieve care problems, more and more evidence shows that there are many barriers in the process of IBHCS supply. The current literature is mostly from the perspective of the service users, and there are very few studies on the experience of service providers. METHODS In this study, we took a qualitative phenomenological approach and used semi-structured interviews to investigate service providers' daily experiences and the barriers they encounter. A total of 34 staff from 14 Home Care Service Centers (HCSCs) were included. Interviews were transcribed and analyzed using thematic analysis. RESULTS We identified the barriers that service providers encounter in IBHCS supply: (1) bureaucratic repression: unreasonable policy plans, harsh assessment, excessive paperwork, different preferences of government leaders, and obstacles caused by COVID-19 control lead to a shift of focus in their work; (2) profitability crisis in the market: high service costs, dampened effective demand, government intervention in setting prices, and parent companies' excessively high sales targets hinder the service supply process; (3) client-related challenges: the crisis of confidence, the dilemma of popularizing new technology, and communication barriers lead to rejection by older adults; (4) job dissatisfaction: low and unstable salary, heavy tasks, poor social acceptance of occupations, and lack of professional value reduce work enthusiasm. CONCLUSION We have investigated the barriers faced by service providers when providing IBHCS for urban older adults in China, providing empirical evidence in the Chinese context for the relevant literature. In order to provide IBHCS better, it is necessary to improve the institutional environment and market environment, strengthen publicity and communication, target customer needs, and adjust the working conditions of front-line workers.
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Affiliation(s)
- Caiyun Qi
- Department of social work, Shandong University, Jinan, China
| | - Yuan Wang
- Department of labor and social security, Jilin University, Qianjin Street 2699, Changchun, China.
| | - Xiaonan Qi
- Department of management, School of applied technology and health industries, Anshan Normal University, Anshan, China
| | - Yunhe Jiao
- Department of labor and social security, Jilin University, Qianjin Street 2699, Changchun, China
| | - Chuanqi Que
- department of social work, The Chinese University of Hong Kong, Hong Kong, China
| | - Yufei Chen
- Department of labor and social security, Jilin University, Qianjin Street 2699, Changchun, China
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Kwon HJ, Oh J. Comparing Older Parents' and Adult Children's Fear of Falling and Perceptions of Age-Friendly Home Modification: An Integration of the Theories of Planned Behavior and Protection Motivation. Behav Sci (Basel) 2023; 13:bs13050403. [PMID: 37232640 DOI: 10.3390/bs13050403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 05/08/2023] [Indexed: 05/27/2023] Open
Abstract
This study investigated how a fear of falling affects perceptions and behavioral intentions toward age-friendly home modification (AFHM) in older parents and adult children by integrating the theory of planned behavior (TPB) to explain AFHM decision-making processes and the protection motivation theory to explain the impact of a fear of falling on AFHM intention. The target population comprised older parents (≥75 years old) and adult children (45-64 years old) in Busan, South Korea (N = 600). The participants completed a self-administered questionnaire in March 2022. Independent t-test and path model analyses were conducted to compare primary constructs between older parents and adult children and analyze the relationships among a fear of falling, TPB components, and AFHM intention. Results showed that both groups had positive attitudes toward AFHM. However, adult children showed significantly higher rates of having a fear of falling, lower perceived behavioral control, and higher AFHM intention than older parents. The proposed research models were partially supported in the older-parent group and fully supported in the adult-children group. Adult children play a critical role in AFHM, along with older adults who are directly involved in an aging society. AFHM-supporting programs, including monetary and human-force assistance, education, related public advertisements, and an active AFHM market, should be expanded.
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Affiliation(s)
- Hyun Joo Kwon
- Department of Interior & Environmental Design, Pusan National University, Busan 46241, Republic of Korea
| | - Jiyoung Oh
- Research Institute of Ecology, Pusan National University, Busan 46241, Republic of Korea
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Sonnauer F, Frewer A. Trojan technology in the living room? Ethik Med 2023. [DOI: 10.1007/s00481-023-00756-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2023]
Abstract
Abstract
Definition of the problem
Assistive technologies, including “smart” instruments and artificial intelligence (AI), are increasingly arriving in older adults’ living spaces. Various research has explored risks (“surveillance technology”) and potentials (“independent living”) to people’s self-determination from technology itself and from the increasing complexity of sociotechnical interactions. However, the point at which self-determination of the individual is overridden by external influences has not yet been sufficiently studied. This article aims to shed light on this point of transition and its implications.
Arguments
The identification of this “tipping point” could contribute to analysis of familiar issues of conflict between the ethical principles of beneficence and respect for autonomy. When using technology in the living spaces of older adults, relationships, among other factors, may play a crucial role in older adult’s self-determination. We find the tipping point to occur subjectively and variably. To this end, the article combines theoretical ethical considerations with two examples from a qualitative study illustrating the perspective of older adults aged 65–85 years.
Conclusion
The study of the tipping point underscores the importance of perceiving an older person’s perspective. Particularly at the tipping point, this might be the only way to effectively identify whether the individual concerned perceives their self-determination as externally overridden. In conceptualizing the tipping point itself as well as its variability, we might create the basis for a normative call to shift the tipping point to promote self-determination and prevent overriding the will of older adults. We highlight individual, relational, and societal implications of our findings.
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Berridge C, Turner NR, Liu L, Fredriksen-Goldsen KI, Lyons KS, Demiris G, Kaye J, Lober WB. Preliminary Efficacy of Let's Talk Tech: Technology Use Planning for Dementia Care Dyads. Innov Aging 2023; 7:igad018. [PMID: 37123031 PMCID: PMC10132307 DOI: 10.1093/geroni/igad018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Indexed: 03/06/2023] Open
Abstract
Background and Objective Care partners of people living with dementia require support to knowledgeably navigate decision making about how and when to use monitoring technologies for care purposes. We conducted a pilot study of a novel self-administered intervention, "Let's Talk Tech," for people living with mild dementia and their care partners. This paper presents preliminary efficacy findings of this intervention designed to educate and facilitate dyadic communication about a range of technologies used in dementia care and to document the preferences of the person living with dementia. It is the first-of-its-kind decision-making and planning tool with a specific focus on technology use. Research Design and Methods We used a 1-group pretest-post-test design and paired t tests to assess change over 2 time periods in measures of technology comprehension, care partner knowledge of the participant living with mild Alzheimer's disease's (AD) preferences, care partner preparedness to make decisions about technology use, and mutual understanding. Thematic analysis was conducted on postintervention interview transcripts to elucidate mechanisms and experiences with Let's Talk Tech. Results Twenty-nine mild AD dementia care dyads who live together completed the study. There was statistically significant improvement with medium and large effect sizes on outcome measures of care partners' understanding of each technology, care partners' perceptions of the person living with dementia's understanding of each technology, knowledge of the person living with dementia's preferences, decision-making preparedness, and care partners' feelings of mutual understanding. Participants reported that it helped them have important and meaningful conversations about using technology. Discussion and Implications Let's Talk Tech demonstrated promising preliminary efficacy on targeted measures that can lead to informed, shared decision making about technologies used in dementia care. Future studies should assess efficacy with larger samples and more diverse sample populations in terms of race, ethnicity, and dementia type.
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Affiliation(s)
- Clara Berridge
- School of Social Work, University of Washington, Seattle, Washington, USA
| | - Natalie R Turner
- School of Social Work, University of Washington, Seattle, Washington, USA
| | - Liu Liu
- College of Education, University of Washington, Seattle, Washington, USA
| | | | - Karen S Lyons
- William F. Connell School of Nursing, Boston College, Boston, Massachusetts, USA
| | - George Demiris
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jeffrey Kaye
- Layton Aging and Alzheimer’s Disease Center and Oregon Center for Aging and Technology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - William B Lober
- Clinical Informatics Research Group, School of Nursing, University of Washington, Seattle, Washington, USA
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15
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Emilsson M, Karlsson C, Svensson A. Experiences of using surveillance cameras as a monitoring solution at nursing homes: The eldercare personnel's perspectives. BMC Health Serv Res 2023; 23:144. [PMID: 36765321 PMCID: PMC9912642 DOI: 10.1186/s12913-023-09130-2] [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: 08/02/2022] [Accepted: 01/31/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND As the number of older people increases, so does the need for care. However, the workforce in eldercare cannot increase at the rate required to match the needs. Welfare technologies, such as surveillance cameras, can replace physical visits and be used at night to monitor older people in order to keep them safe, while not disturbing their sleep. The aim of the paper is to analyze obstacles and opportunities associated with implementation and use of surveillance cameras at nursing homes from the perspectives of the practitioners who use the technology, their working environment and the conditions of the older people with cognitive impairment who live in nursing homes. METHODS Individual semi-structured interviews were conducted with the eldercare personnel at nursing homes to understand their experiences of implementation and use of surveillance cameras. The transcribed interviews were analyzed using qualitative content analysis. The consolidated criteria for reporting qualitative research (COREQ) was used as a guidance tool. RESULTS The results show that the eldercare personnel experienced lack of adequate information, education and support related to using surveillance cameras. Several benefits are highlighted, such as better working environment and that the residents were not unnecessarily disturbed at night. However, the results also show that it is important to clarify that surveillance cameras cannot replace the human presence. CONCLUSIONS The conclusions from this study are the importance of prerequisites for implementation, and that using surveillance cameras contributed to improvements in the working environment at night and created possibilities to maintain security and integrity for older people living in nursing homes.
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Affiliation(s)
- Maria Emilsson
- grid.412716.70000 0000 8970 3706Department of Health sciences, Section of Nursing Graduate Level, University West, SE-461 86 Trollhättan, Sweden
| | - Christina Karlsson
- grid.412716.70000 0000 8970 3706Department of Health sciences, Section of Nursing Undergraduate Level, University West, SE-461 86 Trollhättan, Sweden
| | - Ann Svensson
- School of Business, Economics and IT, Division of Informatics, University West, SE-461 86, Trollhättan, Sweden.
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16
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Frennert S. Moral distress and ethical decision-making of eldercare professionals involved in digital service transformation. Disabil Rehabil Assist Technol 2023; 18:156-165. [PMID: 33151763 DOI: 10.1080/17483107.2020.1839579] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
AIM Technology affects almost all aspects of modern eldercare. Ensuring ethical decision-making is essential as eldercare becomes more digital; each decision affects a patient's life, self-esteem, health and wellness. METHODS We conducted a survey and interviews with eldercare professionals to better understand the behavioural ethics and decision making involved in the digital transition of eldercare. CONCLUSION Our qualitative analysis showed three recurrent roles among eldercare professionals in regard to digital service transformation; makers, implementers and maintainers. All three encountered challenging and stressful ethical dilemmas due to uncertainty and a lack of control. The matter of power relations, the attempts to standardize digital solutions and the conflict between cost efficiency and if digital care solutions add value for patients, all caused moral dilemmas for eldercare professionals. The findings suggest a need for organizational infrastructure that promotes ethical conduct and behaviour, ethics training and access to related resources.Implications for rehabilitationThe transition to digital care service is not neutral, but value-laden. Digital transformation affects ethical behaviour and decision-making.The decision as to which digital services should be developed and deployed must include eldercare professionals and not lay solely in the hands of managers, technologists and economists.We must move away from attempting to fit standardized solutions to a heterogenous group of older patients; accommodating the pluralism of patients' needs and wants protects their dignity, autonomy and independence.As digital care practices evolve, so too must organizational structures that promote ethical conduct.
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Affiliation(s)
- Susanne Frennert
- Department of Computer Science and Media Technology, Internet of Things and People Research Center, Malmö University, Malmo, Sweden
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17
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Ellison KL, Martin W, Pedersen I, Marshall BL. Visualizing the datasphere: Representations of old bodies and their data in promotional images of smart sensor technologies for aging at home. FRONTIERS IN SOCIOLOGY 2022; 7:1008510. [PMID: 36606119 PMCID: PMC9807810 DOI: 10.3389/fsoc.2022.1008510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 11/21/2022] [Indexed: 06/17/2023]
Abstract
Technologies for people aging at home are increasingly prevalent and include ambient monitoring devices that work together with wearables to remotely track and monitor older adults' biometric data and activities of daily living. There is, however, little research into the promotional and speculative images of technology-in-use. Our paper examines the ways in which the datafication of aging is offered up visually by technology companies to promote their products. Specifically, we ask: how are data visualized in promotional images of smart sensor technologies for aging at home? And in these visualizations, what happens to the aging body and relations of care? We include in our definition of smart sensor technologies both wearable and ambient monitoring devices, so long as they are used for the in-home passive monitoring of the inhabitant by a caregiver, excluding those devices targeted for institutional settings or those used for self-monitoring purposes. Our sample consists of 221 images collected between January and July of 2021 from the websites of 14 English-language companies that offer smart sensor technology for aging at home. Following a visual semiotic analysis, we present 3 themes on the visual representation of old bodies and their data: (1) Captured Data, (2) Spatialized Data, and (3) Networked Data. Each, we argue, contribute to a broader visualization of the "datasphere". We conclude by highlighting the underlying assumptions of old bodies in the co-constitution of aging and technologies in which the fleshy and lived corporeality of bodies is more often lost, reduced to data points and automated care scenarios, and further disentangled from other bodies, contexts and things.
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Affiliation(s)
| | - Wendy Martin
- Department of Health Sciences, Brunel University London, Uxbridge, Middlesex, United Kingdom
| | - Isabel Pedersen
- Faculty of Social Sciences and Humanities, Ontario Tech University, Oshawa, ON, Canada
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18
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Wrede C, Braakman-Jansen A, van Gemert-Pijnen L. How to create value with unobtrusive monitoring technology in home-based dementia care: a multimethod study among key stakeholders. BMC Geriatr 2022; 22:921. [PMID: 36451119 PMCID: PMC9713088 DOI: 10.1186/s12877-022-03550-1] [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: 07/12/2022] [Accepted: 10/11/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND There is a growing interest to support extended independent living of people with dementia (PwD) via unobtrusive monitoring (UM) technologies which allow caregivers to remotely monitor lifestyle, health, and safety of PwD. However, these solutions will only be viable if developers obtain a clear picture of how to create value for all relevant stakeholders involved and achieve successful implementation. The aim of this study was therefore to explore the value proposition of UM technology in home-based dementia care and preconditions for successful implementation from a multi-stakeholder perspective. METHODS We conducted an expert-informed survey among potential stakeholders (n = 25) to identify key stakeholders for UM technology in home-based dementia care. Subsequently, focus groups and semi-structured interviews were conducted among 5 key stakeholder groups (n = 24) including informal caregivers (n = 5), home care professionals (n = 5), PwD (n = 4), directors and managers within home care (n = 4), and policy advisors within the aged care and health insurance sector (n = 6). The sessions addressed the value proposition- and business model canvas and were analyzed using thematic analysis. RESULTS Stakeholders agreed that UM technology should provide gains such as objective surveillance, timely interventions, and prevention of unnecessary control visits, whereas pains mainly included information overload, unplannable care due to real-time monitoring, and less human interaction. The overall design-oriented need referred to clear situation classifications including urgent care (fall- and wandering detection), non-urgent care (deviations in eating, drinking, sleeping), and future care (risk predictions). Most important preconditions for successful implementation of UM technology included inter-organizational collaboration, a shared vision on re-shaping existing care processes, integrated care ICT infrastructures, clear eligibility criteria for end-users, and flexible care reimbursement systems. CONCLUSIONS Our findings can guide the value-driven development and implementation of UM technology for home-based dementia care. Stakeholder values were mostly aligned, although stakeholders all had their own perspective on what UM technology should accomplish. Besides, our study highlights the complexity of implementing novel UM technology in home-based dementia care. To achieve successful implementation, organizational and financial preconditions, as well as digital data exchange between home care organizations, will be important.
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Affiliation(s)
- Christian Wrede
- grid.6214.10000 0004 0399 8953Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Drienerlolaan 5, Enschede, 7522 NB The Netherlands
| | - Annemarie Braakman-Jansen
- grid.6214.10000 0004 0399 8953Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Drienerlolaan 5, Enschede, 7522 NB The Netherlands
| | - Lisette van Gemert-Pijnen
- grid.6214.10000 0004 0399 8953Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Drienerlolaan 5, Enschede, 7522 NB The Netherlands
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19
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Zhu J, Shi K, Yang C, Niu Y, Zeng Y, Zhang N, Liu T, Chu CH. Ethical issues of smart home-based elderly care: A scoping review. J Nurs Manag 2022; 30:3686-3699. [PMID: 34806243 DOI: 10.1111/jonm.13521] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 11/10/2021] [Accepted: 11/16/2021] [Indexed: 12/30/2022]
Abstract
AIM To explore current research on the ethics of smart home technologies including artificial intelligence and information technologies for elderly care by conducting a scoping review. BACKGROUND The development of smart home technologies for care of the older adults provides potential solutions to reduce the caregiver burden within families where they are urgently needed. Building an ethical system to support the application of these technical products should be explored. METHODS The literature search was performed in seven electronic databases. Relevant studies from January 2015 to February 2021 were selected; screening and analysis were completed independently by two researchers. RESULTS There were a total of 15 included studies on the ethics of smart home technologies for elderly care, which focused on the following issues: privacy (information privacy and physical privacy), autonomy (independence, informed consent and user-centred control), safety guarantee, fairness and concerns about reduced human contact. CONCLUSIONS There exist a number of ethical conflicts in the application of smart home technologies for elderly care. Therefore, it is necessary to further investigate the ethical issues with regards to the decision-making process of weighing the advantages and disadvantages of these technologies. IMPLICATIONS FOR NURSING MANAGEMENT Efforts should be made to establish a corresponding ethical framework to ensure the sustainable development of smart, home-based elderly care. Nurses may play an important role in the design and implementation of these technologies to promote ethical awareness and practice.
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Affiliation(s)
- Junhong Zhu
- Nursing Studies, School of Medicine, Zhejiang University, Hangzhou, China
| | - Kaiyuan Shi
- Nursing Studies, School of Medicine, Zhejiang University and Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China
| | - Chengyue Yang
- Department of Sociology, Zhejiang University, Hangzhou, China
| | - Yanping Niu
- Department of Nursing, Changzhi Medical College, Changzhi, China
| | - Yingchun Zeng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Ning Zhang
- School of Public Health and the Second Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, China
| | - Tao Liu
- State Key Laboratory of Fluid Power and Mechatronic Systems, School of Mechanical Engineering, Zhejiang University, Yuquan Campus, Hangzhou, China
| | - Charlene H Chu
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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20
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Graham ME. Ambient ageism: Exploring ageism in acoustic representations of older adults in AgeTech advertisements. FRONTIERS IN SOCIOLOGY 2022; 7:1007836. [PMID: 36299412 PMCID: PMC9588956 DOI: 10.3389/fsoc.2022.1007836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
Ageing-in-place environments are increasingly marked by ambient digital technologies designed to keep older adults safe while they live independently at home. These AgeTech companies market their products by constructing imagined visual and aural worlds of the smart home, usually deploying ageist representations of ageing and older adults. The advertisements are multimodal, and while what is seen on screen is often considered most important in a visuo-centric western culture, scholars have argued that it is what audiences hear that has the greatest impact. The acoustic domain of AgeTech advertisements and its relationship to ageism in marketing has not yet been explored. Accordingly, this paper will address this gap by following Van Leeuwen's framework for critical analysis of musical discourse to explore what AgeTech companies say about ageing, older adults, and ageing-in-place technologies using sound in an illustrative set of smart home advertisements for ageing-in-place. The paper will discuss how music, voice, and sound are semiotic resources that are used to construct stereotypical (both negative and positive) portrayals of older adults, reinforce the narrative of "technology as saviour," and trouble the private/public boundaries of the ageing-in-place smart home.
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Affiliation(s)
- Megan E. Graham
- Department of Sociology and Anthropology, Faculty of Arts and Social Sciences, Carleton University, Ottawa, ON, Canada
- Department of Sociology, Trent University, Peterborough, ON, Canada
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21
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Leung T, Turner NR, Liu L, Karras SW, Chen A, Fredriksen-Goldsen K, Demiris G. Advance Planning for Technology Use in Dementia Care: Development, Design, and Feasibility of a Novel Self-administered Decision-Making Tool. JMIR Aging 2022; 5:e39335. [PMID: 35896014 PMCID: PMC9377442 DOI: 10.2196/39335] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/17/2022] [Accepted: 06/28/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Monitoring technologies are used to collect a range of information, such as one's location out of the home or movement within the home, and transmit that information to caregivers to support aging in place. Their surveilling nature, however, poses ethical dilemmas and can be experienced as intrusive to people living with Alzheimer disease (AD) and AD-related dementias. These challenges are compounded when older adults are not engaged in decision-making about how they are monitored. Dissemination of these technologies is outpacing our understanding of how to communicate their functions, risks, and benefits to families and older adults. To date, there are no tools to help families understand the functions of monitoring technologies or guide them in balancing their perceived need for ongoing surveillance and the older adult's dignity and wishes. OBJECTIVE We designed, developed, and piloted a communication and education tool in the form of a web application called Let's Talk Tech to support family decision-making about diverse technologies used in dementia home care. The knowledge base about how to design online interventions for people living with mild dementia is still in development, and dyadic interventions used in dementia care remain rare. We describe the intervention's motivation and development process, and the feasibility of using this self-administered web application intervention in a pilot sample of people living with mild AD and their family care partners. METHODS We surveyed 29 mild AD dementia care dyads living together before and after they completed the web application intervention and interviewed each dyad about their experiences with it. We report postintervention measures of feasibility (recruitment, enrollment, and retention) and acceptability (satisfaction, quality, and usability). Descriptive statistics were calculated for survey items, and thematic analysis was used with interview transcripts to illuminate participants' experiences and recommendations to improve the intervention. RESULTS The study enrolled 33 people living with AD and their care partners, and 29 (88%) dyads completed the study (all but one were spousal dyads). Participants were asked to complete 4 technology modules, and all completed them. The majority of participants rated the tool as having the right length (>90%), having the right amount of information (>84%), being very clearly worded (>74%), and presenting information in a balanced way (>90%). Most felt the tool was easy to use and helpful, and would likely recommend it to others. CONCLUSIONS This study demonstrated that our intervention to educate and facilitate conversation and documentation of preferences is preliminarily feasible and acceptable to mild AD care dyads. Effectively involving older adults in these decisions and informing care partners of their preferences could enable families to avoid conflicts or risks associated with uninformed or disempowered use and to personalize use so both members of the dyad can experience benefits.
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Affiliation(s)
| | - Natalie R Turner
- School of Social Work, University of Washington, Seattle, WA, United States
| | - Liu Liu
- College of Education, University of Washington, Seattle, WA, United States
| | - Sierramatice W Karras
- Clinical Informatics Research Group, Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, United States
| | - Amy Chen
- Clinical Informatics Research Group, Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, United States
| | | | - George Demiris
- School of Nursing and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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22
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Park EH, Werder K, Cao L, Ramesh B. Why do Family Members Reject AI in Health Care? Competing Effects of Emotions. J MANAGE INFORM SYST 2022. [DOI: 10.1080/07421222.2022.2096550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Affiliation(s)
- Eun Hee Park
- Information Technology & Decision Sciences, Strome College of Business, Old Dominion University, Norfolk, VA 23529, USA
| | - Karl Werder
- Cologne Institute for Information Systems, Faculty of Management, Economics and Social Sciences, University of Cologne, Pohligstr. 1, 50969 Cologne, Germany
| | - Lan Cao
- Information Technology & Decision Sciences, Strome College of Business, Old Dominion University, Norfolk, VA 23529, USA
| | - Balasubramaniam Ramesh
- Computer Information Systems, J. Mack Robinson College of Business, Georgia State University, Atlanta, GA 30303, USA
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23
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Bin Noon G, Hanjahanja-Phiri T, Dave H, Fadrique LX, Morita PP, Teague J. Exploring the Role of Active Assisted Living in the Continuum of Care for Older Adults: Thematic Analysis (Preprint). JMIR Aging 2022; 6:e40606. [DOI: 10.2196/40606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 01/30/2023] [Accepted: 03/05/2023] [Indexed: 03/07/2023] Open
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24
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The Use of Robotic Pets by Community-Dwelling Older Adults: A Scoping Review. Int J Soc Robot 2022. [DOI: 10.1007/s12369-022-00892-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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25
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Berridge C, Zhou Y, Lazar A, Porwal A, Mattek N, Gothard S, Kaye J. Control Matters in Elder Care Technology:: Evidence and Direction for Designing It In. DIS. DESIGNING INTERACTIVE SYSTEMS (CONFERENCE) 2022; 2022:1831-1848. [PMID: 35969716 PMCID: PMC9367632 DOI: 10.1145/3532106.3533471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Studies find that older adults want control over how technologies are used in their care, but how it can be operationalized through design remains to be clarified. We present findings from a large survey (n=825) of a well-characterized U.S. online cohort that provides actionable evidence of the importance of designing for control over monitoring technologies. This uniquely large, age-diverse sample allows us to compare needs across age and other characteristics with insights about future users and current older adults (n=496 >64), including those concerned about their own memory loss (n=201). All five control options, which are not currently enabled, were very or extremely important to most people across age. Findings indicate that comfort with a range of care technologies is contingent on having privacy- and other control-enabling options. We discuss opportunities for design to meet these user needs that demand course correction through attentive, creative work.
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Segkouli S, Fico G, Vera-Muñoz C, Lecumberri M, Voulgaridis A, Triantafyllidis A, Sala P, Nunziata S, Campanini N, Montanari E, Morton S, Duclos A, Cocchi F, Nava MD, de Lorenzo T, Chalkia E, Loukea M, Colomer JBM, Dafoulas GE, Guillén S, Arredondo Waldmeyer MT, Votis K. Ethical Decision Making in Iot Data Driven Research: A Case Study of a Large-Scale Pilot. Healthcare (Basel) 2022; 10:healthcare10050957. [PMID: 35628094 PMCID: PMC9141539 DOI: 10.3390/healthcare10050957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 11/25/2022] Open
Abstract
IoT technologies generate intelligence and connectivity and develop knowledge to be used in the decision-making process. However, research that uses big data through global interconnected infrastructures, such as the ‘Internet of Things’ (IoT) for Active and Healthy Ageing (AHA), is fraught with several ethical concerns. A large-scale application of IoT operating in diverse piloting contexts and case studies needs to be orchestrated by a robust framework to guide ethical and sustainable decision making in respect to data management of AHA and IoT based solutions. The main objective of the current article is to present the successful completion of a collaborative multiscale research work, which addressed the complicated exercise of ethical decision making in IoT smart ecosystems for older adults. Our results reveal that among the strong enablers of the proposed ethical decision support model were the participatory and deliberative procedures complemented by a set of regulatory and non-regulatory tools to operationalize core ethical values such as transparency, trust, and fairness in real care settings for older adults and their caregivers.
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Affiliation(s)
- Sofia Segkouli
- Centre for Research and Technology Hellas, Information Technologies Institute, 57001 Thessaloniki, Greece; (A.V.); (A.T.); (K.V.)
- Correspondence: ; Tel.: +30-2311257714
| | - Giuseppe Fico
- Life Supporting Technologies, E.T.S.I. Telecomunicación, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (G.F.); (C.V.-M.); (J.B.M.C.); (M.T.A.W.)
| | - Cecilia Vera-Muñoz
- Life Supporting Technologies, E.T.S.I. Telecomunicación, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (G.F.); (C.V.-M.); (J.B.M.C.); (M.T.A.W.)
| | | | - Antonis Voulgaridis
- Centre for Research and Technology Hellas, Information Technologies Institute, 57001 Thessaloniki, Greece; (A.V.); (A.T.); (K.V.)
| | - Andreas Triantafyllidis
- Centre for Research and Technology Hellas, Information Technologies Institute, 57001 Thessaloniki, Greece; (A.V.); (A.T.); (K.V.)
| | - Pilar Sala
- Mysphera SL, 46980 Paterna, Spain or (P.S.); (S.G.)
- ITACA Institute, Universitat Politècnica València, 46022 Valencia, Spain
| | | | - Nadia Campanini
- Azienda Unita’ Sanitaria Locale Di Parma, 43125 Parma, Italy; (N.C.); (E.M.); (F.C.)
| | - Enrico Montanari
- Azienda Unita’ Sanitaria Locale Di Parma, 43125 Parma, Italy; (N.C.); (E.M.); (F.C.)
| | | | - Alexandre Duclos
- Centre Expert en Technologies et Services pour le Maintien en Autonomie a Domicile des Personnes Agees, 75015 Paris, France;
| | - Francesca Cocchi
- Azienda Unita’ Sanitaria Locale Di Parma, 43125 Parma, Italy; (N.C.); (E.M.); (F.C.)
| | | | | | - Eleni Chalkia
- Centre for Research and Technology Hellas, Hellenic Institute of Transport, 57001 Thessaloniki, Greece; (E.C.); (M.L.)
| | - Matina Loukea
- Centre for Research and Technology Hellas, Hellenic Institute of Transport, 57001 Thessaloniki, Greece; (E.C.); (M.L.)
| | - Juan Bautista Montalvá Colomer
- Life Supporting Technologies, E.T.S.I. Telecomunicación, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (G.F.); (C.V.-M.); (J.B.M.C.); (M.T.A.W.)
| | | | | | - María Teresa Arredondo Waldmeyer
- Life Supporting Technologies, E.T.S.I. Telecomunicación, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (G.F.); (C.V.-M.); (J.B.M.C.); (M.T.A.W.)
| | - Konstantinos Votis
- Centre for Research and Technology Hellas, Information Technologies Institute, 57001 Thessaloniki, Greece; (A.V.); (A.T.); (K.V.)
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Digitization of Aging-in-Place: An International Comparison of the Value-Framing of New Technologies. SOCIETIES 2022. [DOI: 10.3390/soc12020035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Planning for aging populations has been a growing concern for policy makers across the globe. Integral to strategies for promoting healthy aging are initiatives for ‘aging in place’, linked to services and care that allow older people to remain in their homes and communities. Technological innovations—and especially the development of digital technologies—are increasingly presented as potentially important in helping to support these initiatives. In this study, we employed qualitative document analysis to examine and compare the discursive framing of technology in aging-in-place policy documents collected in three countries: The Netherlands, Spain, and Canada. We focus on the framing of technological interventions in relation to values such as quality of life, autonomy/independence, risk management, social inclusion, ‘active aging’, sustainability/efficiency of health care delivery, support for caregivers, and older peoples’ rights. The findings suggest that although all three countries reflected common understandings of the challenges of aging populations, the desirability of supporting aging in place, and the appropriateness of digital technologies in supporting the latter, different value-framings were apparent. We argue that attention to making these values explicit is important to understanding the role of social policies in imagining aging futures and the presumed role of technological innovation in their enactment.
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Remote activity monitoring for family caregivers of persons living with dementia: a mixed methods, randomized controlled evaluation. BMC Geriatr 2021; 21:715. [PMID: 34922475 PMCID: PMC8684277 DOI: 10.1186/s12877-021-02634-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 11/09/2021] [Indexed: 11/10/2022] Open
Abstract
Background The goal of the present study was to determine whether a remote activity monitoring (RAM) system benefited caregivers who aided relatives with Alzheimer’s disease or related dementias (ADRD) living at home. We hypothesized that over 18 months, families randomly assigned to receive RAM technology in the home of the person with ADRD would experience statistically significant (p < .05): 1) improvements in caregiver self-efficacy and sense of competence when managing their relative’s dementia; and 2) reductions in caregiver distress (e.g., burden, role captivity, and depression). Methods An embedded mixed methods design was utilized, where 179 dementia caregivers were randomly assigned to receive RAM or not. Caregivers were surveyed bi-annually over an 18-month period to collect quantitative and qualitative data on RAM’s effects. Semi-structured interviews with 30 caregivers were completed following the 18-month data collection period to explore more in-depth how and why RAM was perceived as helpful or not. Results Growth curve models showed no direct or moderation effect of RAM on dementia caregiver outcomes. The qualitative data revealed a complex utilization process of RAM influenced by the care environment/context as well as the temporal progression of ADRD and the caregiving trajectory. Conclusions The findings suggest the need for developing more effective mechanisms to match appropriate technologies with the heterogeneous needs and care contexts of people living with ADRD and their caregivers. A triadic approach that incorporates professional care management alongside passive monitoring systems such as RAM may also enhance potential benefits. Trial registration ClinicalTrials.govNCT03665909, retrospectively registered on 11 Sept 2018. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02634-8.
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Mejía ST, Su TT, Lan Q, Zou A, Griffin A, Sosnoff JJ. The Context of Caring and Concern for Falling Differentiate Which Mobile Fall Technology Features Chinese Family Caregivers Find Most Important. J Appl Gerontol 2021; 41:1175-1185. [PMID: 34852205 DOI: 10.1177/07334648211053857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Falls are not only a leading cause of death and disability, but also a strain on the capacity for caregivers to provide care. This study examined how the context of caregiving relates to the importance of caregiver-defined mobile fall prevention feature sets. A sample of 266 family caregivers, recruited from a Chinese social media platform, reported care for an older adult and interest in mobile fall prevention technology features. Factor analysis identified three caregiver-defined feature sets: automatic fall response, digitized fall prevention tools, and social features. Multiple regression showed caregivers' concern about falling was the most robust predictor of a feature set's importance. Poisson regression revealed that caregiver concern and assistance with instrumental activities of daily living were associated with rating more features as important. Our findings suggest that caregivers are interested in mobile fall prevention technologies that support older adults' independence while also alleviating concerns about falling.
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Affiliation(s)
- Shannon T Mejía
- Department of Kinesiology and Community Health, 14589University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Tai-Te Su
- Department of Kinesiology and Community Health, 14589University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Qingyi Lan
- Department of Kinesiology and Community Health, 14589University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Ajiang Zou
- Sports Humanities Department, 66444Shenyang Sport University Shenyang, China
| | - Aileen Griffin
- Department of Kinesiology and Community Health, 14589University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Jacob J Sosnoff
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA
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Old-age diversity is underrepresented in digital health research: findings from the evaluation of a mobile phone system for post-operative progress monitoring in Sweden. AGEING & SOCIETY 2021. [DOI: 10.1017/s0144686x21001641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Much research is conducted to evaluate digital-based solutions for health-care services, but little is known about how such evaluations acknowledge diversity in later life. This study helps fill this gap and analyses participation in the evaluation of a web-based mobile phone system for monitoring the post-operative progress of patients after day surgery. Participation is conceptualised as resulting from three processes: pre-screening, recruitment and self-selection. Based on field information and survey data, this study models (a) the (non-)participation in a sample of 498 individuals aged 60 and older that includes non-screened, non-recruited, decliners and participants in the evaluation, and (b) the individual decision to participate in a sample of 210 individuals aged 60 and older who were invited to take part in the evaluation. Increasing age enhances the likelihood of not being screened, not being recruited or declining the invitation. Those not recruited were most often ineligible because of technology-related barriers. Decliners and participants differed by age, gender, job, health status, digital skills, but not by social participation. Results suggest that highly specific groups of older people are more likely to be involved than others. Old-age diversity is not properly represented in digital health research, with implications for the inclusivity of new digital health technologies. This has implications for increased risks of old-age exclusion and exacerbation of social and digital inequalities in ageing societies.
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Largent EA, Abera M, Harkins K, Feldman SJ, Uhlmann WR, Roberts JS, Karlawish J. Family members' perspectives on learning cognitively unimpaired older adults' amyloid-β PET scan results. J Am Geriatr Soc 2021; 69:3203-3211. [PMID: 34252201 PMCID: PMC8595546 DOI: 10.1111/jgs.17362] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/11/2021] [Accepted: 06/11/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND/OBJECTIVES Disclosure of Alzheimer's disease (AD) risk information to cognitively unimpaired older adults may become more common if preclinical AD is shown to be identifiable and amenable to treatment. Little, however, is known about how families will react to this information. DESIGN AND SETTING Semi-structured telephonic interviews. PARTICIPANTS Seventy study partners (mean age = 68 [±11]; 50% female; 70% spouses/significant others; 18% children, siblings; 12% friends) of cognitively unimpaired adults who learned a personalized AD dementia risk estimate and an amyloid-β PET scan result through their participation in preclinical AD research. MEASUREMENT Interviewees were asked about their desire for information regarding their family member's AD dementia risk, baseline expectations of risk, understanding of amyloid-β PET scan results, and the impact of AD dementia risk information on emotions, health behaviors, and future plans, as well as on perceptions of their family member's or friend's memory. RESULTS Interviewees generally understood the AD dementia risk information (83%) and considered it valuable (75%). Risk information perceived as favorable elicited feelings of happiness and relief; unfavorable information elicited disappointment, as well as increased awareness of the participants' memory and monitoring for incipient changes in cognition. While noting that AD dementia risk information was not medically actionable at this time due to the lack of disease-modifying therapies, some interviewees described changes to their family members' and their own health behaviors and future plans. CONCLUSION Guidelines for the disclosure of AD dementia risk estimates and biomarker results to cognitively unimpaired adults should account for the needs and interests of individuals and their family members, who may step into a pre-caregiver role.
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Affiliation(s)
- Emily A Largent
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Maramawit Abera
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Kristin Harkins
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Sara J Feldman
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Wendy R Uhlmann
- Department of Internal Medicine, Division of Genetic Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
- Department of Human Genetics, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - J Scott Roberts
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Jason Karlawish
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Cao Y, Erdt M, Robert C, Naharudin NB, Lee SQ, Theng YL. Decision-Making Factors towards Adoption of Smart Home Sensors by Older Adults: An Intervention Study in Singapore (Preprint). JMIR Aging 2021; 5:e34239. [PMID: 35749213 PMCID: PMC9270706 DOI: 10.2196/34239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 04/30/2022] [Accepted: 05/12/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Yuanyuan Cao
- Centre for Healthy and Sustainable Cities, Wee Kim Wee School of Communication and Information, Nanyang Technological University, Singapore, Singapore
| | - Mojisola Erdt
- Institute for Infocomm Research, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Caroline Robert
- Centre for Healthy and Sustainable Cities, Wee Kim Wee School of Communication and Information, Nanyang Technological University, Singapore, Singapore
| | - Nurhazimah Binte Naharudin
- Centre for Healthy and Sustainable Cities, Wee Kim Wee School of Communication and Information, Nanyang Technological University, Singapore, Singapore
| | - Shan Qi Lee
- Centre for Healthy and Sustainable Cities, Wee Kim Wee School of Communication and Information, Nanyang Technological University, Singapore, Singapore
| | - Yin-Leng Theng
- Centre for Healthy and Sustainable Cities, Wee Kim Wee School of Communication and Information, Nanyang Technological University, Singapore, Singapore
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Camp N, Johnston J, Lewis MGC, Zecca M, Di Nuovo A, Hunter K, Magistro D. Perceptions of ADLs and In-Home ADL monitoring technology among Community-Dwelling Older Adults: a qualitative study (Preprint). JMIR Aging 2021; 5:e33714. [PMID: 35511248 PMCID: PMC9121226 DOI: 10.2196/33714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 02/21/2022] [Accepted: 03/25/2022] [Indexed: 11/16/2022] Open
Abstract
Background Many older adults prefer to remain in their own homes for as long as possible. However, there are still questions surrounding how best to ensure that an individual can cope with autonomous living. Technological monitoring systems are an attractive solution; however, there is disagreement regarding activities of daily living (ADL) and the optimal technologies that should be used to monitor them. Objective This study aimed to understand older adults’ perceptions of important ADL and the types of technologies they would be willing to use within their own homes. Methods Semistructured interviews were conducted on the web with 32 UK adults, divided equally into a younger group (aged 55-69 years) and an older group (≥70 years). Results Both groups agreed that ADL related to personal hygiene and feeding were the most important and highlighted the value of socializing. The older group considered several activities to be more important than their younger counterparts, including stair use and foot care. The older group had less existing knowledge of monitoring technology but was more willing to accept wearable sensors than the younger group. The younger group preferred sensors placed within the home but highlighted that they would not have them until they felt that daily life was becoming a struggle. Conclusions Overall, technological monitoring systems were perceived as an acceptable method for monitoring ADL. However, developers and carers must be aware that individuals may express differences in their willingness to engage with certain types of technology depending on their age and circumstances.
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Affiliation(s)
- Nicola Camp
- School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | - Julie Johnston
- School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | | | - Massimiliano Zecca
- Wolfson School of Mechanical, Electrical and Manufacturing Engineering, Loughborough University, Loughborough, United Kingdom
| | - Alessandro Di Nuovo
- Institute of Electrical and Electronics Engineers, Sheffield Hallam University, Sheffield, United Kingdom
| | - Kirsty Hunter
- School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | - Daniele Magistro
- School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
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Sumner J, Chong L, Bundele A, Wei Lim Y. Co-Designing Technology for Aging in Place: A Systematic Review. THE GERONTOLOGIST 2021; 61:e395-e409. [PMID: 32506136 PMCID: PMC8437501 DOI: 10.1093/geront/gnaa064] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND AND OBJECTIVES There is a growing interest to involve older adults in the co-design of technology to maintain their well-being and independence. What remains unknown is whether the beneficial effects of co-designed solutions are greater than those reported for non co-designed solutions. The aim of this study was to evaluate the effects and experiences of co-designed technology that support older adults to age in place. RESEARCH DESIGN AND METHODS We conducted a systematic review to (a) investigate the health and well-being outcomes of co-designed technology for older adults (≥60 years), (b) identify co-design approaches and contexts where they are applied, and (c) identify barriers and facilitators of the co-design process with older adults. Searches were conducted in MEDLINE, EMBASE, CINAHL, Science Citation Index (Web of Science), Scopus, OpenGrey, and Business Source Premiere. RESULTS We identified 14,649 articles and included 34 projects. Four projects reported health and well-being outcomes; the effects were inconsistent. Co-design processes varied greatly and in their intensity of older adult involvement. Common facilitators of and barriers to co-design included the building of relationships between stakeholders, stakeholder knowledge of problems and solutions, and expertise in the co-design methodology. DISCUSSION AND IMPLICATIONS The effect of co-designed technology on health and well-being was rarely studied and it was difficult to ascertain its impact. Future co-design efforts need to address barriers unique to older adults. Evaluation of the impact of co-designed technologies is needed and standardization of the definition of co-design would be helpful to researchers and designers.
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Affiliation(s)
- Jennifer Sumner
- Yong Loo Lin School of Medicine, Department of Medicine, National University of Singapore, Singapore
- Medical Affairs— Research Innovation & Enterprise, Alexandra Hospital, National University Health System, Singapore
| | - Lin Siew Chong
- Yong Loo Lin School of Medicine, Department of Medicine, National University of Singapore, Singapore
- Medical Affairs— Research Innovation & Enterprise, Alexandra Hospital, National University Health System, Singapore
| | - Anjali Bundele
- Medical Affairs— Research Innovation & Enterprise, Alexandra Hospital, National University Health System, Singapore
| | - Yee Wei Lim
- Yong Loo Lin School of Medicine, Department of Medicine, National University of Singapore, Singapore
- Medical Affairs— Research Innovation & Enterprise, Alexandra Hospital, National University Health System, Singapore
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Freiesleben SD, Megges H, Herrmann C, Wessel L, Peters O. Overcoming barriers to the adoption of locating technologies in dementia care: a multi-stakeholder focus group study. BMC Geriatr 2021; 21:378. [PMID: 34154542 PMCID: PMC8218472 DOI: 10.1186/s12877-021-02323-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 05/13/2021] [Indexed: 11/19/2022] Open
Abstract
Background Locating technologies are a subtype of assistive technology that aim to support persons with dementia by helping manage spatial orientation impairments and provide aid to care partners by intervening when necessary. Although a variety of locating devices are commercially available, their adoption has remained low in the past years. Several studies have explored barriers to the adoption of assistive technologies from the perspective of professional stakeholders, but in-depth explorations for locating technologies are sparse. Additionally, the inputs of business professionals are lacking. The aim of this study was to expand knowledge on barriers to the adoption of locating technologies from a multi-stakeholder professional perspective, and to explore strategies to optimize adoption. Methods In total, 22 professionals working in business (n = 7), healthcare (n = 6) and research (n = 9) fields related to gerontology and gerontechnology participated in our focus group study. Perceptions on the value of using locating technologies for dementia care, barriers to their adoption, as well as salient services and information dissemination strategies were explored. After verbatim transcription, transcripts were analysed following an inductive data-driven content analysis approach in MAXQDA. Results Six key adoption barriers centering on: (1) awareness-, (2) technological-, (3) product characteristic- and (4) capital investment-based limitations, (5) unclear benefits, as well as (6) ethical concerns emerged. The interplay between barriers was high. Five core themes on services and information dissemination strategies centering on: (1) digital autonomy support, (2) emergency support, (3) information dissemination actors, (4) product acquisition, and (5) product advertising were extracted. Conclusions Our study with interdisciplinary stakeholders expands knowledge on barriers to the adoption of locating technologies for dementia care, and reinforces recommendations that an interdisciplinary strategy is needed to optimize adoption. Also, our findings show that focusing on services to increase digital autonomy and on information dissemination strategies has been largely overlooked and may be particularly effective. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02323-6.
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Affiliation(s)
- Silka Dawn Freiesleben
- Department of Psychiatry, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Lindenberger Weg 80, 13125, Berlin, Germany. .,German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany. .,Memory Clinic and Dementia Prevention Center, Experimental and Clinical Research Center (ECRC), Lindenberger Weg 80, 13125, Berlin, Germany.
| | - Herlind Megges
- Department of Psychiatry, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Lindenberger Weg 80, 13125, Berlin, Germany.,German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany.,Memory Clinic and Dementia Prevention Center, Experimental and Clinical Research Center (ECRC), Lindenberger Weg 80, 13125, Berlin, Germany.,Present address: Federal Ministry for Family Affairs, Senior Citizens, Women and Youth (BMFSFJ), Berlin, Germany
| | - Christina Herrmann
- Department of Psychiatry, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Lindenberger Weg 80, 13125, Berlin, Germany.,Memory Clinic and Dementia Prevention Center, Experimental and Clinical Research Center (ECRC), Lindenberger Weg 80, 13125, Berlin, Germany
| | - Lauri Wessel
- European New School of Digital Studies, European University Viadrina, Große Scharrnstraße 59, 15230, Frankfurt (Oder), Germany
| | - Oliver Peters
- Department of Psychiatry, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Lindenberger Weg 80, 13125, Berlin, Germany.,German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany.,Memory Clinic and Dementia Prevention Center, Experimental and Clinical Research Center (ECRC), Lindenberger Weg 80, 13125, Berlin, Germany
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Frennert S. Gender blindness: On health and welfare technology, AI and gender equality in community care. Nurs Inq 2021; 28:e12419. [PMID: 33979011 DOI: 10.1111/nin.12419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/12/2021] [Accepted: 04/14/2021] [Indexed: 11/28/2022]
Abstract
Digital health and welfare technologies and artificial intelligence are proposed to revolutionise healthcare systems around the world by enabling new models of care. Digital health and welfare technologies enable remote monitoring and treatments, and artificial intelligence is proposed as a means of prediction instead of reaction to individuals' health and as an enabler of proactive care and rehabilitation. The digital transformation not only affects hospital and primary care but also how the community meets older people's needs. Community care is often provided by informal and formal care-givers, most of whom are women. Gender equality is at the heart of many national strategies, but do all genders have equal rights, responsibilities and opportunities when it comes to community care and its digital transformation? The digital transformation of community care is entangled with how care is provided to older people and the working conditions of community-care professionals. Current and, even more so, future community-care systems are and will be partly constituted by networks of technological artefacts. These health and welfare technological artefacts and the discourse surrounding them mediate and constitute social relations and community care. This article looks into how health and welfare technology and artificial intelligence-based devices and systems mediate and constitute gender relations in community care and presents an argument for reflexivity, embodiment, pluralism, participation and ecology as an alternative strategy to treating community care as one-size-fit-all and being blind to gender-related issues.
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Affiliation(s)
- Susanne Frennert
- Department of Computer Science and Media Technology, Internet of Things and People Research Center, Malmö University, Malmö, Sweden
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Wrede C, Braakman-Jansen A, van Gemert-Pijnen L. Requirements for Unobtrusive Monitoring to Support Home-Based Dementia Care: Qualitative Study Among Formal and Informal Caregivers. JMIR Aging 2021; 4:e26875. [PMID: 33843596 PMCID: PMC8076981 DOI: 10.2196/26875] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/23/2021] [Accepted: 02/28/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Due to a growing shortage in residential care, people with dementia will increasingly be encouraged to live at home for longer. Although people with dementia prefer extended independent living, this also puts more pressure on both their informal and formal care networks. To support (in)formal caregivers of people with dementia, there is growing interest in unobtrusive contactless in-home monitoring technologies that allow caregivers to remotely monitor the lifestyle, health, and safety of their care recipients. Despite their potential, these solutions will only be viable if they meet the expectations and needs of formal and informal caregivers of people with dementia. OBJECTIVE The objective of this study was to explore the expected benefits, barriers, needs, and requirements toward unobtrusive in-home monitoring from the perspective of formal and informal caregivers of community-dwelling people with dementia. METHODS A combination of semistructured interviews and focus groups was used to collect data among informal (n=19) and formal (n=16) caregivers of people with dementia. Both sets of participants were presented with examples of unobtrusive in-home monitoring followed by questions addressing expected benefits, barriers, and needs. Relevant in-home monitoring goals were identified using a previously developed topic list. Interviews and focus groups were transcribed and inductively analyzed. Requirements for unobtrusive in-home monitoring were elicited based on the procedure of van Velsen and Bergvall-Kåreborn. RESULTS Formal and informal caregivers saw unobtrusive in-home monitoring as a support tool that should particularly be used to monitor (the risk of) falls, day and night rhythm, personal hygiene, nocturnal restlessness, and eating and drinking behavior. Generally, (in)formal caregivers reported cross-checking self-care information, extended independent living, objective communication, prevention and proactive measures, emotional reassurance, and personalized and optimized care as the key benefits of unobtrusive in-home monitoring. Main concerns centered around privacy, information overload, and ethical concerns related to dehumanizing care. Furthermore, 16 requirements for unobtrusive in-home monitoring were generated that specified desired functions, how the technology should communicate with the user, which services surrounding the technology were seen as needed, and how the technology should be integrated into the existing work context. CONCLUSIONS Despite the presence of barriers, formal and informal caregivers of people with dementia generally saw value in unobtrusive in-home monitoring, and felt that these systems could contribute to a shift from reactive to more proactive and less obtrusive care. However, the full potential of unobtrusive in-home monitoring can only unfold if relevant concerns are considered. Our requirements can inform the development of more acceptable and goal-directed in-home monitoring technologies to support home-based dementia care.
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Affiliation(s)
- Christian Wrede
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health & Technology, University of Twente, Enschede, Netherlands
| | - Annemarie Braakman-Jansen
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health & Technology, University of Twente, Enschede, Netherlands
| | - Lisette van Gemert-Pijnen
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health & Technology, University of Twente, Enschede, Netherlands
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Grigorovich A, Kontos P. Towards Responsible Implementation of Monitoring Technologies in Institutional Care. THE GERONTOLOGIST 2021; 60:1194-1201. [PMID: 31958118 PMCID: PMC7491435 DOI: 10.1093/geront/gnz190] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Indexed: 11/17/2022] Open
Abstract
Increasing awareness of errors and harms in institutional care settings, combined with rapid advancements in artificial intelligence, have resulted in a widespread push for implementing monitoring technologies in institutional settings. There has been limited critical reflection in gerontology regarding the ethical, social, and policy implications of using these technologies. We critically review current scholarship regarding use of monitoring technology in institutional care, and identify key gaps in knowledge and important avenues for future research and development.
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Affiliation(s)
- Alisa Grigorovich
- Toronto Rehabilitation Institute-University Health Network, Ontario, Canada
| | - Pia Kontos
- Toronto Rehabilitation Institute-University Health Network, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
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McDonald AP, Rizzotti R, Rivera JM, D'Arcy RCN, Park G, Song X. Toward improved homecare of frail older adults: A focus group study synthesizing patient and caregiver perspectives. Aging Med (Milton) 2021; 4:4-11. [PMID: 33738374 PMCID: PMC7954833 DOI: 10.1002/agm2.12144] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/09/2020] [Accepted: 12/09/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Adopting a better understanding of how both older adults and health care providers view the community management of frailty is necessary for improving home health, especially facing the coronavirus disease 2019 (COVID-19) pandemic. We conducted a qualitative focus group study to assess how both older adults and health care providers view frailty and virtual health care in home health. METHODS Two focus groups enrolled home-living older adults and health care professionals, respectively (n = 15). Questions targeting the use of virtual / telehealth technologies in-home care for frail older adults were administered at audio-recorded group interviews. Transcribed discussions were coded and analyzed using NVivo software. RESULTS The older adult group emphasized the autonomy related to increasing frailty and social isolation and the need for transparent dissemination of health care planning. They were optimistic about remote technology-based supports and suggested that telehealth / health-monitoring/tracking were in high demand. Health care professionals emphasized the importance of a holistic biopsychosocial approach to frailty management. They highlighted the need for standardized early assessment and management of frailty. CONCLUSIONS The integrated perspectives provided an updated understanding of what older adults and practitioners value in home-living supports. This knowledge is helpful to advancing virtual home care, providing better care for frail individuals with complex health care needs.
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Affiliation(s)
- Andrew P. McDonald
- Health Sciences and InnovationSurrey Memorial HospitalFraser HealthSurreyBritish ColumbiaCanada
- Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | | | - Joanna M. Rivera
- Health Sciences and InnovationSurrey Memorial HospitalFraser HealthSurreyBritish ColumbiaCanada
- Faculty of Health SciencesSimon Fraser UniversityBurnabyBritish ColumbiaCanada
| | - Ryan C. N. D'Arcy
- Health Sciences and InnovationSurrey Memorial HospitalFraser HealthSurreyBritish ColumbiaCanada
- Faculty of Applied SciencesSimon Fraser UniversityBurnabyBritish ColumbiaCanada
| | - Grace Park
- Community Actions and Resources Empowering Seniors (CARES)Fraser HealthSurreyBritish ColumbiaCanada
- Home and Community Care MedicineFraser HealthSurreyBritish ColumbiaCanada
| | - Xiaowei Song
- Health Sciences and InnovationSurrey Memorial HospitalFraser HealthSurreyBritish ColumbiaCanada
- Faculty of ScienceSimon Fraser UniversityBurnabyBritish ColumbiaCanada
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Berridge C, Demiris G, Kaye J. Domain Experts on Dementia-Care Technologies: Mitigating Risk in Design and Implementation. SCIENCE AND ENGINEERING ETHICS 2021; 27:14. [PMID: 33599847 PMCID: PMC7892732 DOI: 10.1007/s11948-021-00286-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 12/21/2020] [Indexed: 06/12/2023]
Abstract
There is an urgent need to learn how to appropriately integrate technologies into dementia care. The aims of this Delphi study were to project which technologies will be most prevalent in dementia care in five years, articulate potential benefits and risks, and identify specific options to mitigate risks. Participants were also asked to identify technologies that are most likely to cause value tensions and thus most warrant a conversation with an older person with mild dementia when families are deciding about their use. Twenty-one interdisciplinary domain experts from academia and industry in aging and technology in the U.S. and Canada participated in a two-round online survey using the Delphi approach with an 84% response rate and no attrition between rounds. Rankings were analyzed using frequency counts and written-in responses were thematically analyzed. Twelve technology categories were identified along with a detailed list of risks and benefits for each. Suggestions to mitigate the most commonly raised risks are categorized as follows: intervene during design, make specific technical choices, build in choice and control, require data transparency, place restrictions on data use and ensure security, enable informed consent, and proactively educate users. This study provides information that is needed to navigate person-centered technology use in dementia care. The specific recommendations participants offered are relevant to designers, clinicians, researchers, ethicists, and policy makers and require proactive engagement from design through implementation.
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Affiliation(s)
- Clara Berridge
- School of Social Work, University of Washington, Seattle, WA USA
| | - George Demiris
- School of Nursing and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Jeffrey Kaye
- School of Medicine, Oregon Health and Science University, Portland, OR USA
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Zmora R, Mitchell LL, Bustamante G, Finlay J, Nkimbeng M, Gaugler JE. Dementia Caregivers' Experiences and Reactions to Remote Activity Monitoring System Alerts. J Gerontol Nurs 2021; 47:13-20. [PMID: 33377980 PMCID: PMC7891871 DOI: 10.3928/00989134-20201208-03] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Technology-based tools, including remote activity monitoring (RAM) systems, have been proposed as valuable aids for family caregivers of people with dementia. Previous analyses have shown limited effects of these systems and highlighted a number of barriers, including false alarms. We used data from an ongoing embedded mixed method randomized controlled intervention to describe patterns of alerts and their association with receipt of the RAM system and caregiver outcomes. Quantitative analyses showed a modest positive association between the number of alerts during the first month and system review score. In addition, qualitative results illustrated the importance of alert context, including utility, accuracy, and type of alert delivery. These findings highlight the relevance of early alerts to engagement with and perceived benefit from the RAM system. [Journal of Gerontological Nursing, 47(1), 13-20.].
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Alinia P, Samadani A, Milosevic M, Ghasemzadeh H, Parvaneh S. Pervasive Lying Posture Tracking. SENSORS (BASEL, SWITZERLAND) 2020; 20:E5953. [PMID: 33096769 PMCID: PMC7589361 DOI: 10.3390/s20205953] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/14/2020] [Accepted: 10/18/2020] [Indexed: 11/16/2022]
Abstract
Automated lying-posture tracking is important in preventing bed-related disorders, such as pressure injuries, sleep apnea, and lower-back pain. Prior research studied in-bed lying posture tracking using sensors of different modalities (e.g., accelerometer and pressure sensors). However, there remain significant gaps in research regarding how to design efficient in-bed lying posture tracking systems. These gaps can be articulated through several research questions, as follows. First, can we design a single-sensor, pervasive, and inexpensive system that can accurately detect lying postures? Second, what computational models are most effective in the accurate detection of lying postures? Finally, what physical configuration of the sensor system is most effective for lying posture tracking? To answer these important research questions, in this article we propose a comprehensive approach for designing a sensor system that uses a single accelerometer along with machine learning algorithms for in-bed lying posture classification. We design two categories of machine learning algorithms based on deep learning and traditional classification with handcrafted features to detect lying postures. We also investigate what wearing sites are the most effective in the accurate detection of lying postures. We extensively evaluate the performance of the proposed algorithms on nine different body locations and four human lying postures using two datasets. Our results show that a system with a single accelerometer can be used with either deep learning or traditional classifiers to accurately detect lying postures. The best models in our approach achieve an F1 score that ranges from 95.2% to 97.8% with a coefficient of variation from 0.03 to 0.05. The results also identify the thighs and chest as the most salient body sites for lying posture tracking. Our findings in this article suggest that, because accelerometers are ubiquitous and inexpensive sensors, they can be a viable source of information for pervasive monitoring of in-bed postures.
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Affiliation(s)
- Parastoo Alinia
- Philips Research North America, Cambridge, MA 02141, USA; (P.A.); (A.S.); (M.M.)
- School of Electrical Engineering and Computer Science, Washington State University, Pullman, WA 99164, USA;
| | - Ali Samadani
- Philips Research North America, Cambridge, MA 02141, USA; (P.A.); (A.S.); (M.M.)
| | - Mladen Milosevic
- Philips Research North America, Cambridge, MA 02141, USA; (P.A.); (A.S.); (M.M.)
| | - Hassan Ghasemzadeh
- School of Electrical Engineering and Computer Science, Washington State University, Pullman, WA 99164, USA;
| | - Saman Parvaneh
- School of Electrical Engineering and Computer Science, Washington State University, Pullman, WA 99164, USA;
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Ho A. Are we ready for artificial intelligence health monitoring in elder care? BMC Geriatr 2020; 20:358. [PMID: 32957946 PMCID: PMC7504871 DOI: 10.1186/s12877-020-01764-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 09/10/2020] [Indexed: 12/17/2022] Open
Abstract
Background The world is experiencing a dramatic increase in the aging population, challenging the sustainability of traditional care models that have relied on in-person monitoring. This debate article discusses whether artificial intelligence health monitoring may be suitable enhancement or replacement for elder care. Main text Internationally, as life expectancy continues to rise, many countries are facing a severe shortage of direct care workers. The health workforce is aging, and replacement remains a challenge. Artificial intelligence health monitoring technologies may play a novel and significant role in filling the human resource gaps in caring for older adults by complementing current care provision, reducing the burden on family caregivers, and improving the quality of care. Nonetheless, opportunities brought on by these emerging technologies raise ethical questions that must be addressed to ensure that these automated systems can truly enhance care and health outcomes for older adults. This debate article explores some ethical dimensions of using automated health monitoring technologies. It argues that, in order for these health monitoring technologies to fulfill the wishes of older adults to age in place and also to empower them and improve their quality of life, we need deep knowledge of how stakeholders may balance their considerations of relational care, safety, and privacy. Conclusion It is only when we design artificial intelligence health monitoring technologies with intersecting clinical and ethical factors in mind that the resulting systems will enhance productive relational care, facilitate independent living, promote older adults’ health outcomes, and minimize waste.
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Affiliation(s)
- Anita Ho
- Centre for Applied Ethics, University of British Columbia, 227 - 6356 Agricultural Road, Vancouver, BC, V6T 1Z2, Canada. .,Bioethics Program, University of California San Francisco, Vancouver, Canada. .,Centre for Health Evaluation & Outcome Sciences, Vancouver, Canada.
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