A Review and Classification of Assisted Living Systems

Smartwatch-Based Interventions for People With Dementia: User-Centered Design Approach

BACKGROUND

Assistive technologies can help people living with dementia maintain their everyday activities. Nevertheless, there is a gap between the potential and use of these materials. Involving future users may help close this gap, but the impact on people with dementia is unclear.

OBJECTIVE

We aimed to determine if user-centered development of smartwatch-based interventions together with people with dementia is feasible. In addition, we evaluated the extent to which user feedback is plausible and therefore helpful for technological improvements.

METHODS

We examined the interactions between smartwatches and people with dementia or people with mild cognitive impairment. All participants were prompted to complete 2 tasks (drinking water and a specific cognitive task). Prompts were triggered using a smartphone as a remote control and were repeated up to 3 times if participants failed to complete a task. Overall, 50% (20/40) of the participants received regular prompts, and 50% (20/40) received intensive audiovisual prompts to perform everyday tasks. Participants' reactions were observed remotely via cameras. User feedback was captured via questionnaires, which included topics like usability, design, usefulness, and concerns. The internal consistency of the subscales was calculated. Plausibility was also checked using qualitative approaches.

RESULTS

Participants noted their preferences for particular functions and improvements. Patients struggled with rating using the Likert scale; therefore, we assisted them with completing the questionnaire. Usability (mean 78 out of 100, SD 15.22) and usefulness (mean 9 out of 12) were rated high. The smartwatch design was appealing to most participants (31/40, 76%). Only a few participants (6/40, 15%) were concerned about using the watch. Better usability was associated with better cognition. The observed success and self-rated task comprehension were in agreement for most participants (32/40, 80%). In different qualitative analyses, participants' responses were, in most cases, plausible. Only 8% (3/40) of the participants were completely unaware of their irregular task performance.

CONCLUSIONS

People with dementia can have positive experiences with smartwatches. Most people with dementia provided valuable information. Developing assistive technologies together with people with dementia can help to prioritize the future development of functional and nonfunctional features.

Mapping emerging technologies in aged care: results from an in-depth online research

BACKGROUND

Emerging Technologies (ETs) have recently acquired great relevance in elderly care. The exceptional experience with SARS-CoV-2 pandemic has emphasized the usefulness of ETs in the assistance and remote monitoring of older adults. Technological devices have also contributed to the preservation of social interactions, thus reducing isolation and loneliness. The general purpose of this work is to provide a comprehensive and updated overview of the technologies currently employed in elderly care. This objective was achieved firstly, by mapping and classifying the ETs currently available on the market and, secondly, by assessing the impact of such ETs on elderly care, exploring the ethical values promoted, as well as potential ethical threats.

METHODS

An in-depth search was carried out on Google search engine, by using specific keywords (e.g. technology, monitoring techniques, ambient intelligence; elderly, older adults; care and assistance). Three hundred and twenty-eight technologies were originally identified. Then, based on a predetermined set of inclusion-exclusion criteria, two hundreds and twenty-two technologies were selected.

RESULTS

A comprehensive database was elaborated, where the two hundred and twenty-two ETs selected were classified as follows: category; developmental stage; companies and/or partners; functions; location of development; time of development; impact on elderly care; target; website. From an in-depth qualitative analysis, some ethically-related contents and themes emerged, namely: questions related to safety, independence and active aging, connectedness, empowerment and dignity, cost and efficiency. Although not reported by developers, a close analysis of website contents highlights that positive values are often associated with potential risks, notably privacy threats, deception, dehumanization of care.

CONCLUSIONS

Research findings may ultimately lead to a better understanding of the impact of ETs on elderly people.

Using IoT Assistive Technologies for Older People Non-Invasive Monitoring and Living Support in Their Homes

Many western societies are confronted with issues in planning and adapting their health policies due to an ageing population living alone. The “NOt Alone at Home—NOAH” project aimed to involve older people in the Agile co-creation of services for a collaborative monitoring and awareness notification for remote caregivers. Our research aim was to create a scalable and modern information system that permitted a non-invasive monitorization of the users for keeping their caregivers up to date. This was done via a cloud IoT (Internet of Things), which collects and processes data from its domotic sensors. The notifications generated by the system, via the three applications we developed (NOAH/NOAH Care/Admin Centre), offer caregivers an easy way of detecting changes in the day-to-day behaviour and activities of their patients, giving them time to intervene in case of abnormal activity. Such an approach would lead to a longer and more independent life for the older people. We evaluated our system by conducting a year-long pilot-study, offering caregivers constant information from the end-users while still living independently. For creating our pilot groups, we used the ABAS (Adaptive Behaviour Assessment System) II, which we then matched with the pre-profiled Behavioral Analysis Models of older people familiar with modern communication devices. Our results showed a low association between daily skills and the sensors we used, in contrast with the results from previous studies done in this field. Another result was efficiently capturing the behaviour changes that took place due to the COVID-19 Lockdown measures.

Similarities and Differences between EU Platforms in the AHA and AAL Domains from a Software Viewpoint

The EU PlatformUptake project’s main goal is to investigate the usage of EU open and partly-open platforms in active and healthy aging (AHA) and ambient-assisted living (AAL) domains, from a software viewpoint. The aim of the project was to provide tools for a deeper interpretation and examination of the platforms, gather user feedback, and use it to improve the state-of-the-art approach in the AHA and AAL domains, and define instructions to enhance the platforms within the recommended order. The emphasis is on the software viewpoint for decision makers. In this paper, we present (i) the PlatformUptake methodology for AHA open platform assessments and its main objectives; (ii) clustering of the analyzed platforms; and (iii) the taxonomies generated from the text descriptions of the chosen platforms. With the use of the clustering tools, we present which platforms could be grouped together due to their similarities. Different numbers of clusters were obtained with two clustering approaches, resulting in the most informative two and four cluster groups. The platforms could be rather neatly presented in this way and, thus, potentially guide future platform structuring. Moreover, taxonomies, i.e., decision trees of platforms, were generated to easily determine each specific platform or to find platforms with the desired properties. Altogether, the computer comprehension of the platforms may be important additions to the human way of dealing with the AHA platforms, influencing future design, publications, related work, and research.

Aging 4.0? Rethinking the ethical framing of technology-assisted eldercare

Technological approaches are increasingly discussed as a solution for the provision of support in activities of daily living as well as in medical and nursing care for older people. The development and implementation of such assistive technologies for eldercare raise manifold ethical, legal, and social questions. The discussion of these questions is influenced by theoretical perspectives and approaches from medical and nursing ethics, especially the principlist framework of autonomy, non-maleficence, beneficence, and justice. Tying in with previous criticism, the present contribution is taking these principles as a starting point and as a frame of reference to be critically re-examined. It thus aims to outline how existing ethical frameworks need to be extended or reconsidered to capture the ethical issues posed by technological developments regarding care for older people. In a first step, we provide a brief overview of assistive technologies in eldercare according to their purposes and functions. In the next step, we discuss how the questions and problems raised by new technologies in eldercare call for an expansion, re-interpretation, and revision of the principlist framework. We underline that the inclusion of ethical perspectives from engineering and computer science as well as a closer consideration of socio-political dimensions and fundamental anthropological and praxeological questions are needed.

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.

Reference Architectures, Platforms, and Pilots for European Smart and Healthy Living—Analysis and Comparison

Motivated by the aging trend, much effort is being invested into implementing ICT (Information and Communications Technology)-enabled systems to provide a better quality of life and support the independent living of older people. As a result, many systems, often labeled as eHealth or AAL (Ambient/Active Assisted Living), were developed over the years. In creating such systems, which very often serve various needs, different architectures have emerged. This work focuses on analyzing and comparing the work and architectures from seven (six of which are in progress) EU-funded healthcare projects, with a total budget of 126MEUR in which we participate. After establishing the theoretical foundation by defining core concepts, we give a brief background on architectures in eHealth and AAL. We elaborate on the chosen analysis method based on three established healthcare and AAL taxonomies we identified by performing a literature survey and the selected Reference Architecture Model (RAM). Since there is no standard way of describing architectures in the eHealth and AAL domain, we conducted the online survey during August and September 2020 and identified CREATE-IoT 3D RAM as the most appropriate option. We present a classification of selected projects based on established taxonomies and map projects’ architectures to CREATE-IoT 3D RAM, which we also propose as standard RAM for future digital healthcare and AAL projects. During our analysis, we identify the most common types of assistance: communication support, reminders, monitoring, and guidance to address health and communication issues. We conclude that proper ecosystems are critical for lowering entry barriers and facilitating sustainable solutions for smart and healthy living.

A Solution for the Remote Care of Frail Elderly Individuals via Exergames

Internet of Things (IoT) solutions are a concrete answer to many needs in the healthcare framework since they enable remote support for patients and foster continuity of care. Currently, frail elderly people are among end users who most need and would benefit from IoT solutions from both a social and a healthcare point of view. Indeed, IoT technologies can provide a set of services to monitor the healthcare of the elderly or support them in order to reduce the risk of injuries, and preserve their motor and cognitive abilities. The main feature of IoT solutions for the elderly population is ease of use. Indeed, to fully exploit the potential of an IoT solution, patients should be able to autonomously deal with it. The remote-monitoring validation engineering system (ReMoVES) described here is an IoT solution that caters to the specific needs of frail elderly individuals. Its architecture was designed for use at rehabilitation centers and at patients' homes. The system is user-friendly and comfortably usable by persons who are not familiar with technology. In addition, exergames enhance patient engagement in order to curb therapy abandonment. Along with the technical presentation of the solution, a real-life scenario application is described referring to sit-to-stand activity.

Ambient assisted living and European funds: a bibliometric approach

Purpose

The authors analyse the impact of European funding research programmes on the topic of Ambient Assisted Living by considering its status, future context, and the implications for prospective knowledge management.

Design/methodology/approach

The authors apply our variation of classical Systematic Literature Review – Systematic Literature Network Analysis, which also includes bibliographic networks – to identify the readership cliques of the associated technological publication outputs.

Findings

The authors’ main conclusion suggests that there was an increase in scientific production on AAL fields just after the start of the two EU funding programmes (2008 and 2014). Three main research directions were identified: activity and vital sign recognition, human-computer interaction and technology acceptance.

Originality/value

To date, previous reviews on Ambient Assisted Livig focus on specific aspects, such as the study of technology. The present review provides a complete overview of Ambient Assisted living technology and it grasps how the European funds have impacted on the development of this technology.

My-AHA: Software Platform to Promote Active and Healthy Ageing

The population is getting old, and the use of technology has improved the quality of life of the senior population. This is confirmed by the increasing number of solutions targeting healthy and active ageing. Such solutions keep track of the daily routine of the elderly and combine it with other relevant information (e.g., biosignals, physical activity, social activity, nutrition) to help identify early signs of decline. Caregivers and elders use this information to improve their routine, focusing on improving the current condition. With that in mind, we have developed a software platform to support My-AHA, which is composed of a multi-platform middleware, a decision support system (DSS), and a dashboard. The middleware seamlessly merges data coming from multiple platforms targeting health and active ageing, the DSS performs an intelligent computation on top of the collected data, and the dashboard provides a user’s interaction with the whole system. To show the potential of the proposed My-AHA software platform, we introduce the My Personal Dashboard web-based application over a frailty use case to illustrate how senior well-being can benefit from the use of technology.

A Review of Internet of Things Technologies for Ambient Assisted Living Environments

The internet of things (IoT) aims to extend the internet to real-world objects, connecting smart and sensing devices into a global network infrastructure by connecting physical and virtual objects. The IoT has the potential to increase the quality of life of inhabitants and users of intelligent ambient assisted living (AAL) environments. The paper overviews and discusses the IoT technologies and their foreseen impacts and challenges for the AAL domain. The results of this review are summarized as the IoT based gerontechnology acceptance model for the assisted living domain. The model focuses on the acceptance of new technologies by older people and underscores the need for the adoption of the IoT for the AAL domain.

Individual Behavior Modeling with Sensors Using Process Mining

Understanding human behavior can assist in the adoption of satisfactory health interventions and improved care. One of the main problems relies on the definition of human behaviors, as human activities depend on multiple variables and are of dynamic nature. Although smart homes have advanced in the latest years and contributed to unobtrusive human behavior tracking, artificial intelligence has not coped yet with the problem of variability and dynamism of these behaviors. Process mining is an emerging discipline capable of adapting to the nature of high-variate data and extract knowledge to define behavior patterns. In this study, we analyze data from 25 in-house residents acquired with indoor location sensors by means of process mining clustering techniques, which allows obtaining workflows of the human behavior inside the house. Data are clustered by adjusting two variables: the similarity index and the Euclidean distance between workflows. Thereafter, two main models are created: (1) a workflow view to analyze the characteristics of the discovered clusters and the information they reveal about human behavior and (2) a calendar view, in which common behaviors are rendered in the way of a calendar allowing to detect relevant patterns depending on the day of the week and the season of the year. Three representative patients who performed three different behaviors: stable, unstable, and complex behaviors according to the proposed approach are investigated. This approach provides human behavior details in the manner of a workflow model, discovering user paths, frequent transitions between rooms, and the time the user was in each room, in addition to showing the results into the calendar view increases readability and visual attraction of human behaviors, allowing to us detect patterns happening on special days.

Evaluation of a Rehabilitation System for the Elderly in a Day Care Center

This paper presents a rehabilitation system based on a customizable exergame protocol to prevent falls in the elderly population. The system is based on depth sensors and exergames. The experiments carried out with several seniors, in a day care center, make it possible to evaluate the usability and the efficiency of the system. The outcomes highlight the user-friendliness, the very good usability of the developed system and the significant enhancement of the elderly in maintaining a physical activity. The performance of the postural response is improved by an average of 80%.