Usability of a Wearable Camera System for Dementia Family Caregivers

Acceptance and Privacy Perceptions Toward Video-based Active and Assisted Living technologies: Scoping Review (Preprint)

BACKGROUND

The aging society posits new socioeconomic challenges to which a potential solution is active and assisted living (AAL) technologies. Visual-based sensing systems are technologically among the most advantageous forms of AAL technologies in providing health and social care; however, they come at the risk of violating rights to privacy. With the immersion of video-based technologies, privacy-preserving smart solutions are being developed; however, the user acceptance research about these developments is not yet being systematized.

OBJECTIVE

With this scoping review, we aimed to gain an overview of existing studies examining the viewpoints of older adults and/or their caregivers on technology acceptance and privacy perceptions, specifically toward video-based AAL technology.

METHODS

A total of 22 studies were identified with a primary focus on user acceptance and privacy attitudes during a literature search of major databases. Methodological quality assessment and thematic analysis of the selected studies were executed and principal findings are summarized. The PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines were followed at every step of this scoping review.

RESULTS

Acceptance attitudes toward video-based AAL technologies are rather conditional, and are summarized into five main themes seen from the two end-user perspectives: caregiver and care receiver. With privacy being a major barrier to video-based AAL technologies, security and medical safety were identified as the major benefits across the studies.

CONCLUSIONS

This review reveals a very low methodological quality of the empirical studies assessing user acceptance of video-based AAL technologies. We propose that more specific and more end user- and real life-targeting research is needed to assess the acceptance of proposed solutions.

Wearable Activity Tracker Use and Physical Activity Among Informal Caregivers in the United States: Quantitative Study

BACKGROUND

With an increase in aging population and chronic medical conditions in the United States, the role of informal caregivers has become paramount as they engage in the care of their loved ones. Mounting evidence suggests that such responsibilities place substantial burden on informal caregivers and can negatively impact their health. New wearable health and activity trackers (wearables) are increasingly being used to facilitate and monitor healthy behaviors and to improve health outcomes. Although prior studies have examined the efficacy of wearables in improving health and well-being in the general population, little is known about their benefits among informal caregivers.

OBJECTIVE

This study aimed to examine the association between use of wearables and levels of physical activity (PA) among informal caregivers in the United States.

METHODS

We used data from the National Cancer Institute's Health Information National Trends Survey 5 (cycle 3, 2019 and cycle 4, 2020) for a nationally representative sample of 1273 community-dwelling informal caregivers-aged ≥18 years, 60% (757/1273) female, 75.7% (990/1273) had some college or more in education, and 67.3% (885/1273) had ≥1 chronic medical condition-in the United States. Using jackknife replicate weights, a multivariable logistic regression was fit to assess an independent association between the use of wearables and a binary outcome: meeting or not meeting the current World Health Organization's recommendation of PA for adults (≥150 minutes of at least moderate-intensity PA per week).

RESULTS

More than one-third (466/1273, 37.8%) of the informal caregivers met the recommendations for adult PA. However, those who reported using wearables (390/1273, 31.7%) had slightly higher odds of meeting PA recommendations (adjusted odds ratios 1.1, 95% CI 1.04-1.77; P=.04) compared with those who did not use wearables.

CONCLUSIONS

The results demonstrated a positive association between the use of wearables and levels of PA among informal caregivers in the United States. Therefore, efforts to incorporate wearable technology into the development of health-promoting programs or interventions for informal caregivers could potentially improve their health and well-being. However, any such effort should address the disparities in access to innovative digital technologies, including wearables, to promote health equity. Future longitudinal studies are required to further support the current findings of this study.

Definition of Guideline-Based Metrics to Evaluate AAL Ecosystem’s Usability

The elderly population growth has posed several challenges which the current healthcare systems are incapable of handling. In the past few years, there has been a close collaboration between both the scientific and industry communities to provide feasible solutions capable of addressing the growing demands from people with special needs, namely, in terms of assistance and improvement of their overall life quality, which promoted to the development of the ambient assisted living (AAL). Despite the general consensus regarding its positive impact in the user’s daily life, several challenges compromise their overall adoption. As a consequence, the research undertaken so far focused over the mitigation of technical-related limitations, overshadowing user-related limitations, namely, the ecosystem’s usability. This article presents a parametrization of the literature guidelines, which provides the end-users a consistent and accurate way of using the heuristic methodology to assert the interface’s usability without relying in external entities with specialized know-how.

What evidence supports the use of Body Worn Cameras in mental health inpatient wards? A systematic review and narrative synthesis of the effects of Body Worn Cameras in public sector services

Body-Worn-Cameras (BWCs) are being introduced into Mental Health Inpatient Units. At present, minimal evidence surrounding their use in a mental health environment exists. This review examined research on the uses of BWCs in public sector services including healthcare, public transportation, and law enforcement. All eligible studies included a visible BWC, recording on a continuous loop as the main intervention. The evidence base presented high levels of bias, highly varied camera protocols, and heterogeneity of outcome measurements. This review found there is limited evidence for the efficacy of BWCs to control and manage violence within mental health inpatient wards. The technology has shown to be effective in reducing the number of public complaints in a law enforcement setting, but it is unclear how this is achieved. It appears there may be potential beneficial uses and unintended consequences of BWCs yet to be explored by mental health services.

Review of Technology-Supported Multimodal Solutions for People with Dementia

The number of people living with dementia in the world is rising at an unprecedented rate, and no country will be spared. Furthermore, neither decisive treatment nor effective medicines have yet become effective. One potential alternative to this emerging challenge is utilizing supportive technologies and services that not only assist people with dementia to do their daily activities safely and independently, but also reduce the overwhelming pressure on their caregivers. Thus, for this study, a systematic literature review is conducted in an attempt to gain an overview of the latest findings in this field of study and to address some commercially available supportive technologies and services that have potential application for people living with dementia. To this end, 30 potential supportive technologies and 15 active supportive services are identified from the literature and related websites. The technologies and services are classified into different classes and subclasses (according to their functionalities, capabilities, and features) aiming to facilitate their understanding and evaluation. The results of this work are aimed as a base for designing, integrating, developing, adapting, and customizing potential multimodal solutions for the specific needs of vulnerable people of our societies, such as those who suffer from different degrees of dementia.

Acceptance, adoption, and usability of information and communication technologies for people living with dementia and their care partners: a systematic review

PURPOSE

This review aims to examine the instruments, approaches, scales, or assessment tools used to evaluate technology acceptance, technology adoption, and usability of information and communication technologies (ICTs) for people living with dementia and their care partners.

METHODS

A systematic literature review was conducted. Studies that explored the use of instruments, approaches, scales, or assessment tools to evaluate the technology acceptance and usability of ICTs for people living with dementia and their care partners were identified through five databases: Medline, EMBASE, CINAHL, Web of Science, and Scopus.

RESULTS

We included 74 out of 2182 papers. The most common scales used included the System Usability Scale (SUS) (11%), the ISONORM 9241/10 Questionnaire (4%), and the Post-Study System Usability Questionnaire (PSSUQ) (4%). Most (59%) of the included approaches, however, were bespoke (i.e., created by the authors for a particular study) and were not named. The approaches or tools used to assess technology acceptance, technology adoption, and usability of ICTs that applied to people living with dementia had an average of 15 items and used an average of 5.23 scale points.

CONCLUSION

There is no clear, standardised approach for assessing the technology acceptance, technology adoption, and usability of ICTs for people living with dementia and their care partners. The findings of this review may be used by academics to design and implement improved and more consistent assessment tools to assess technology acceptance, technology adoption, and usability of ICTs for people living with dementia and their care partners.IMPLICATIONS FOR REHABILITATIONThe number of ICTs for people with dementia and their care partners that can be used for rehabilitation is increasingThe most commonly recognized assessment tools used in this study were the SUS, ISONORM 9241/10, and PSSUQ questionnaires.For the custom assessment tools, the average number of items included in this study was 15 with five-point bidirectional labelling.There is no clear, standardized approach for assessing the technology acceptance, technology adoption, or usability of ICTs for people with dementia and their care partners.

Smart Environments and Social Robots for Age-Friendly Integrated Care Services

The world is facing major societal challenges because of an aging population that is putting increasing pressure on the sustainability of care. While demand for care and social services is steadily increasing, the supply is constrained by the decreasing workforce. The development of smart, physical, social and age-friendly environments is identified by World Health Organization (WHO) as a key intervention point for enabling older adults, enabling them to remain as much possible in their residences, delay institutionalization, and ultimately, improve quality of life. In this study, we survey smart environments, machine learning and robot assistive technologies that can offer support for the independent living of older adults and provide age-friendly care services. We describe two examples of integrated care services that are using assistive technologies in innovative ways to assess and deliver of timely interventions for polypharmacy management and for social and cognitive activity support in older adults. We describe the architectural views of these services, focusing on details about technology usage, end-user interaction flows and data models that are developed or enhanced to achieve the envisioned objective of healthier, safer, more independent and socially connected older people.

Innovative Assisted Living Tools, Remote Monitoring Technologies, Artificial Intelligence-Driven Solutions, and Robotic Systems for Aging Societies: Systematic Review

BACKGROUND

The increase in life expectancy and recent advancements in technology and medical science have changed the way we deliver health services to the aging societies. Evidence suggests that home telemonitoring can significantly decrease the number of readmissions, and continuous monitoring of older adults' daily activities and health-related issues might prevent medical emergencies.

OBJECTIVE

The primary objective of this review was to identify advances in assistive technology devices for seniors and aging-in-place technology and to determine the level of evidence for research on remote patient monitoring, smart homes, telecare, and artificially intelligent monitoring systems.

METHODS

A literature review was conducted using Cumulative Index to Nursing and Allied Health Literature Plus, MEDLINE, EMBASE, Institute of Electrical and Electronics Engineers Xplore, ProQuest Central, Scopus, and Science Direct. Publications related to older people's care, independent living, and novel assistive technologies were included in the study.

RESULTS

A total of 91 publications met the inclusion criteria. In total, four themes emerged from the data: technology acceptance and readiness, novel patient monitoring and smart home technologies, intelligent algorithm and software engineering, and robotics technologies. The results revealed that most studies had poor reference standards without an explicit critical appraisal.

CONCLUSIONS

The use of ubiquitous in-home monitoring and smart technologies for aged people's care will increase their independence and the health care services available to them as well as improve frail elderly people's health care outcomes. This review identified four different themes that require different conceptual approaches to solution development. Although the engineering teams were focused on prototype and algorithm development, the medical science teams were concentrated on outcome research. We also identified the need to develop custom technology solutions for different aging societies. The convergence of medicine and informatics could lead to the development of new interdisciplinary research models and new assistive products for the care of older adults.

Factors Influencing the Adoption of Smart Health Technologies for People With Dementia and Their Informal Caregivers: Scoping Review and Design Framework

Background

Smart Health technologies (s-Health technologies) are being developed to support people with dementia (PwD) and their informal caregivers at home, to improve care and reduce the levels of burden and stress they experience. However, although s-Health technologies have the potential to facilitate this, the factors influencing a successful implementation in this population are still unknown.

Objective

The aim of this study was to review existing literature to explore the factors influencing PwD and their informal caregivers’ adoption of s-Health technologies for home care.

Methods

Following the Arksey and O’Malley methodology, this study is a scoping review providing a narrative description of the scientific literature on factors influencing s-Health technology adoption for PwD and their informal caregivers. A search was conducted using PubMed, the Cochrane library, the IEEE library, and Scopus. Publications screening was conducted by 2 researchers based on inclusion criteria, and full-text analysis was then conducted by 1 researcher. The included articles were thematically analyzed by 2 researchers to gain an insight into factors influencing adoption that PwD and their informal caregivers have to encounter when using s-Health technologies. Relevant information was identified and coded. Codes were later discussed between the researchers for developing and modifying them and for achieving a consensus, and the researchers organized the codes into broader themes.

Results

Emerging themes were built in a way that said something specific and meaningful about the research question, creating a list of factors influencing the adoption of s-Health technologies for PwD and their informal caregivers, including attitudinal aspects, ethical issues, technology-related challenges, condition-related challenges, and identified gaps. A design framework was created as a guide for future research and innovation in the area of s-Health technologies for PwD and their informal caregivers: DemDesCon for s-Health Technologies. DemDesCon for s-Health Technologies addresses 4 domains to consider for the design and development of s-Health technologies for this population: cognitive decline domain, physical decline domain, social domain, and development domain.

Conclusions

Although s-Health technologies have been used in health care scenarios, more work is needed for them to fully achieve their potential for use in dementia care. Researchers, businesses, and public governments need to collaborate to design and implement effective technology solutions for PwD and their informal caregivers, but the lack of clear design guidelines seems to be slowing the process. We believe that the DemDesCon framework will provide them with the guidance and assistance needed for creating meaningful devices for PwD home care and informal caregivers, filling a much-needed space in the present knowledge gap.

Acceptability of a lifelogging wearable camera in older adults with mild cognitive impairment: a mixed-method study

BACKGROUND

The main objective of this research was to evaluate the acceptance of technology based on a wearable lifelogging camera in a sample of older adults diagnosed with mild cognitive impairment (MCI).

METHODS

A mixed-method design was used, consisting of a self-report questionnaire, numerous images taken by users, and a series of focus group discussions. The patients were involved in an individualized training programme.

RESULTS

Nine MCI patients and their caregiver relatives were included. They showed good acceptance of the camera and downloaded an appropriate number of images on a daily basis. Perceived severity and ease of use were the main factors associated with the intention to use the device.

CONCLUSIONS

Older adults with MCI can become competent users of lifelogging wearable cameras with a good level of acceptance. Privacy concerns are outweighed by the potential benefits for memory. Limitations, strengths and implications for future research are discussed.

Six-Month Effectiveness of Remote Activity Monitoring for Persons Living With Dementia and Their Family Caregivers: An Experimental Mixed Methods Study

Background and Objectives

This study aimed to evaluate if and how remote activity monitoring (RAM) improves caregiver outcomes for family members providing care for persons living with Alzheimer's disease or a related dementia (ADRD).

Research Design and Methods

We conducted an embedded experimental mixed methods study of 132 persons living with ADRD and their family caregivers (n = 64 randomly assigned to RAM treatment condition). In addition to baseline and 6-month quantitative survey data on context of care, primary objective stressors, resources, self-efficacy/competence, and distress collected from caregivers, 6-month RAM review checklists contained open-ended, qualitative information on perceived acceptability of the technology.

Results

The RAM system did not exert statistically significant effects on caregiving outcomes over a 6-month period. However, qualitative analyses identified several potential moderators of RAM technology effectiveness that were subsequently tested in post-hoc repeated measures analyses of variance. Caregivers who utilized RAM technology and cared for relatives with: (a) less severe cognitive impairment; and (b) difficulty navigating around the home were more likely to indicate statistically significant increases in competence and self-efficacy, respectively.

Discussion and Implications

We found that the early months spent calibrating and modifying RAM are potentially challenging for families, which may prevent this technology from improving caregiving outcomes during initial months of use. Remote activity monitoring may work optimally for caregivers of persons living with ADRD in specific situations (e.g., earlier stages of dementia; wandering risk), which suggests the need for appropriate needs assessments that can better target such innovations.

Mapping Movement: Applying Motion Measurement Technologies to the Psychiatric Care of Older Adults

PURPOSE OF REVIEW

Recent advances in technology have changed the landscape of treatment for adults with mental illness. This review highlights technological innovations that may improve care for older adults with mental illness and neurocognitive disorders through the measurement and assessment of physical motion. These technologies include wearable sensors (such as smart watches and Fitbits), passive motion sensors, and smart home models that incorporate both active and passive motion technologies.

RECENT FINDINGS

Clinicians have evaluated motion measurement technologies in older adults with depression, dementia, anxiety, and schizophrenia. Results from studies in dementia populations suggest that motion measurement technologies can assist clinicians in diagnosing dementia earlier through the evaluation of gait, balance, and postural kinematics. Motion detection technologies can also be used to identify mood episodes at an earlier stage by detecting subtle behavioral changes. Clinicians may use the objective data provided by technologies such as accelerometers to identify illnesses earlier, which may inform treatment decisions. The data may be used as a suitable surrogate marker for detecting depression in older adults, predicting the likelihood of falls, or quantifying physical activity in older adults with chronic mental illnesses or anxiety. Motion-based technologies also have the potential to detect physical activity for older adults residing in nursing homes. Wearable technologies are generally well tolerated in older adults, although the use of new technology and electronic health data could involve privacy and security concerns among this vulnerable population.

"It's Like a Cyber-Security Blanket": The Utility of Remote Activity Monitoring in Family Dementia Care

Technologies have emerged that aim to help older persons with Alzheimer's disease and related dementias (ADRDs) remain at home while also supporting their caregiving family members. However, the usefulness of these innovations, particularly in home-based care contexts, remains underexplored. The current study evaluated the acceptability and utility of an in-home remote activity monitoring (RAM) system for 30 family caregivers of persons with ADRD via quantitative survey data collected over a 6-month period and qualitative survey and interview data collected for up to 18 months. A parallel convergent mixed methods design was employed. The integrated qualitative and quantitative data suggested that RAM technology offered ongoing monitoring and provided caregivers with a sense of security. Considerable customization was needed so that RAM was most appropriate for persons with ADRD. The findings have important clinical implications when considering how RAM can supplement, or potentially substitute for, ADRD family care.

Views of individuals with spinal cord injury on the use of wearable cameras to monitor upper limb function in the home and community

OBJECTIVE

Hand function impairment after cervical spinal cord injury (SCI) can significantly reduce independence. Unlike current hand function assessments, wearable camera systems could potentially measure functional hand usage at home, and thus benefit the development of neurorehabilitation strategies. The objective of this study was to understand the views of individuals with SCI on the use of wearable cameras to track neurorehabilitation progress and outcomes in the community.

DESIGN

Questionnaires.

SETTING

Home simulation laboratory.

PARTICIPANTS

Fifteen individuals with cervical SCI.

OUTCOME MEASURES

After using wearable cameras in the simulated home environment, participants completed custom questionnaires, comprising open-ended and structured questions.

RESULTS

Participants showed relatively low concerns related to data confidentiality when first-person videos are used by clinicians (1.93 ± 1.28 on a 5-point Likert scale) or researchers (2.00 ± 1.31). Storing only automatically extracted metrics reduced privacy concerns. Though participants reported moderate privacy concerns (2.53 ± 1.51) about wearing a camera in daily life due to certain sensitive situations (e.g. washrooms), they felt that information about their hand usage at home is useful for researchers (4.73 ± 0.59), clinicians (4.47 ± 0.83), and themselves (4.40 ± 0.83). Participants found the system moderately comfortable (3.27 ± 1.44), but expressed low desire to use it frequently (2.87 ± 1.36).

CONCLUSION

Despite some privacy and comfort concerns, participants believed that the information obtained would be useful. With appropriate strategies to minimize the data stored and recording duration, wearable cameras can be a well-accepted tool to track function in the home and community after SCI.

Digital technology to enable aging in place

Aging, both of individuals and populations, presents challenges and opportunities. The multitude of morbidities and disabilities that are a too common component of aging represent significant challenges to individuals, their families and to healthcare systems. Aging in place is the ability to safely and comfortably maintain an independent and high quality of life in one's own home and community and is a highly desirable goal of most individuals with the additional benefit of significantly impacting the impending enormous healthcare burden. In order to make this possible, new care models that take advantage of novel technologies for tracking important physiologic and safety parameters need to be developed and implemented. By thoughtfully doing so, it can be possible to seamlessly provide preventative interventions when and as needed, detect the earliest signs of aggravation of chronic conditions, or identify and respond to any emergency situations, such as falls or cardiac arrest. In contrast to current approaches, caring for elderly individuals in their homes based on a digital technology infrastructure could be effective and cost-saving. In this review, we provide an overview of the characteristics of potential digital solutions applicable to creative aging along with the existing evidence supporting their ability to improve care, increase quality of life, and substantially decrease the emotional and financial costs associated with aging.

[Caregiver intervention studies : Recommendations on endpoints and outcome measures for cognitively impaired care recipients]

BACKGROUND

Even though the intervention effects on cognitively impaired care recipients are of interest, the evaluation in dementia caregiver studies on caregiver outcomes is often limited. Furthermore, the comparison of studies and interventions is difficult because of the large variance of endpoints and assessments used in this field.

OBJECTIVE

The aim of this study was to give an overview on the most prevalent outcomes for cognitively impaired care recipients and expert based recommendations for assessment.

MATERIAL AND METHODS

A written Delphi survey was carried out on 16 assessments from 5 dimensions with 14 experts working in different disciplines in German healthcare and research institutes.

RESULTS

The most important outcomes and best rated assessments were 1) for problem behavior: revised memory and behavior problem checklist and neuropsychiatric inventory Q, 2) for depressive symptoms: geriatric depression scale, 3) for quality of life: quality of life in Alzheimer's disease, 4) for cognition: mini mental state examination and 5) for ADL/IADL: Katz activities of daily living and Lawton instrumental activities of daily living.

CONCLUSION

Due to the varying experiences of the experts with particular assessments, the ratings were in some cases relatively heterogeneous. Overall previous international recommendations could be confirmed. There is particular need of German validation studies on internationally used instruments within the dimensions of problem behavior and quality of life.

Mobile health solutions for the aging population: A systematic narrative analysis

Introduction The ubiquitous nature of mobile technology coupled with the acceptance of mobile health (mHealth) among the elderly offers an opportunity to augment the existing medical workforce in long-term care. The objective of this review and narrative analysis is to identify and analyse facilitators and barriers to adoption of mHealth for the elderly. Methods Studies over the last year were identified in multiple database indices, and three reviewers examined abstracts ( k = 0.82) and analysed articles for themes which were tallied in affinity diagrams to identify frequency of occurrence in the literature (n = 36). Results The three facilitators mentioned most often were independence (18%), understanding (13%), and visibility (13%). The three barriers mentioned most often were complexity (21%), limited by users (12%) and ineffective (12%). Discussion and conclusions The reviewers concluded that the work done so far illustrates that mHealth enables a perception of independence. Future research should focus on the barriers of complexity of technology and improving existing medical literacy in order to facilitate further adoption.

Wearable Technology to Garner the Perspective of Dementia Family Caregivers

Family caregivers of individuals with dementia typically have limited opportunity during brief clinical encounters to describe the dementia-related behaviors and interactions they find difficult to handle. Lack of objective data depicting the nature, intensity, and impact of these manifestations of the underlying disease further constrains the extent to which strategies recommended by nurses or other health care providers can be tailored to the situation. The current article describes a prototype wearable camera system used to gather image and voice data from the caregiver's perspective in a pilot feasibility intervention study conducted with 18 caregiving dyads. Several scenarios are presented that include salient events (i.e., behaviors or interactions deemed difficult by the caregiver or identified as concerning by the research team during screening) captured in the resulting video. The current authors anticipate future wearable camera systems and software will automate screening for salient events, providing new tools for assessment and intervention by nurses.