Just a few decades ago a ripe old age meant 70. Now it means 100-plus, and people are paying for a longer life with more than wrinkles. Pharmacological and medical advances have lengthened lives without conquering the infirmity that comes with old age. No doubt ways will be found to prevent dementia and other scourges of advanced years. In the meantime significant human factors research is directed at helping elderly seniors cope with their infirmities and lead independent lives.
Research institutions, manufacturers and government agencies have noticed that more elders want to remain in their homes these days and have given the trend a name – aging in place. Increased computer power and all-but ubiquitous broadband and Wi-Fi make it possible to build what they need for coping into home systems.
Several products and prototypes were on display at the White House Conference on Aging in 2005. Intel Corp. displayed the prototype of a system aimed at helping elders cope with memory-wasting Alzheimer’s disease. As the system was described in an Associated Press news story about the conference, it is based on caller ID technology. A screen by the phone provides a photo of the caller and a prompt about who the caller is and the last time they called.
Sensors and Smart Beds
AP also described floor sensors developed by the Medical Automation Research Center at the University of Virginia, which can track movement. The sensors recognize changes in gait and detect falls, and the system is able to summon a caregiver for help.
A Business Week article about the conference saw merit in the "smart" bed developed at the same center. A patient need only lie down to check and transmit medical information. Expected to be called the NAPS bed, for non-invasive analysis of physiological signals, it has wireless sensors that measure pulse rate, breathing, and restlessness. As with most sensor systems, there must be a caregiver in the loop who can read and interpret the data.
In the General Electric project called Home Assurance, according to AP, networked wireless motion detectors send data to a central device resembling an answering machine that transmits data within seconds to a server at GE. Caregivers can log into the server over the Internet to check up, or set up the system so it alerts them automatically by phone or e-mail.
Business Week devoted several paragraphs to the E-Neighbor system made by Minnesota company Healthsense. Built on technology used in home security systems, it consists of wireless sensors programmed to detect unusual activity. If the shower runs for several hours, for example, or the refrigerator stays closed all day, the system calls the resident to ask if he or she needs help. If there is no response, the system can call or send an e-mail alert to someone who can help.
Research projects now under way are studying the benefits of sensors that can confirm a senior has awakened and used the restroom, for example, and kitchen appliances that remind dementia patients how to use the coffee pot. Researchers also are perfecting in-home devices that monitor the weight, blood pressure, and other vital signs of elders with chronic diseases and send a report to doctors or caregivers.
To detect conditions like cognitive decline, cardiac disease and cancer, Intel is developing ways to collect environmental, behavioral and biological data through a network of wireless sensors. And a watch and computer system developed by the company tracks movement. If an owner fails to go to the location of their pills the system can broadcast reminders and choose how to be reminded. A notice, "Agnes, it’s time for your pill," can appear on the television screen, for example, or the phone can ring and send a reminder either with a voice or text message.
In one scenario for this system, patients with early stage Alzheimer’s might receive prompts when they pause for an extended period while making tea. Reminders to eat, drink and take medicine could be sent through a radio or television.
Medication – A Dangerous Means of Prolonging Life
The article in Business Week invited readers to imagine rolling out of bed in the morning and heading for the bathroom sink. “You glance in the mirror, wince, open the medicine cabinet, and reach for a bottle of pills. But instead of grabbing your Lipitor, you take out the Tylenol with codeine. Suddenly a computerized voice tells you that you’re making a mistake. That should wake you up—and get you to reach for the right container.”
Medication is a dangerous means of prolonging life, and the scene painted by the magazine explains why. The AP article notes that the United States Congress is very concerned about medical errors in hospitals, but most occur at home.
At the White House conference, technology services company Accenture displayed its prototype of a medicine cabinet that can be programmed to keep track of what medicine it holds and when it should be taken. As described in the AP article, a built-on camera scans the face of the person at the cabinet and a voice issues a reminder that it’s time to take a pill. If the wrong bottle is chosen, the voice warns of the error.
The Oregon Center for Aging & Technology (ORCATECH) at the Oregon Health & Science University is exploring other ways of managing medication and reducing the risk of errors. One promising direction is a smart pillbox that shows up on a monitor when pills have been taken. Another is a wristwatch that issues a gentle reminder to take medication.
ORCATECH researcher Tamara Hayes is studying 50 people whose weekly pill tray has electronics attached to detect when it has been opened. "Often people use patterns of behavior to help them remember to take medications, such as right after breakfast," she explained in ORCATECH’s outline of the project. "So perhaps by understanding how these patterns of behavior are used, we can help by predicting when normal patterns are being disrupted and prompt them to take their medicine.”
At the Human Factors and Aging Laboratory at the Georgia Institute of Technology, researchers want to understand the strategies older adults use to help them to remember to take medications correctly, and the factors that influence their choice of strategy. The conclusions await the analysis of the results of a questionnaire sent to a random sample of older adults in the Atlanta Metropolitan area.
Remembering to Remember
The challenges of coping with memory loss underlie much of the ORCATECH research. Supported since its founding by the National Institute on Aging, with some programs conducted in collaboration with Intel, ORCATECH is investigating and development what it calls enabling technologies to assess elders for memory changes that may impair their ability to live independently. An outline of the project notes that changes in physical activity have been shown to precede changes in memory.
Funded by a 5-year US $7 million federal grant, ORATECH’S “living laboratory” project will test whether monitoring data from activity and computer sensors are effective in predicting when an elder is starting to decline. The study involves tracking the in-home activities of nearly 300 elderly people in Oregon’s Portland area, testing the new monitoring technologies to pick up mental and physical changes that could signal declining health.
Each home will be outfitted with a basic set of devices for continuous, remote assessment of activity and computer use, in which fluctuations can point to possible problems with cognition and mobility. These devices include motion and door sensors to track walking speed and overall in-home activity, and computers outfitted with software that can detect patterns that indicate memory changes.
The second phase of the study will follow up to 250 elders of 80 and older over three years.
The usefulness of sensor data relies on the creation of computer-based algorithms to help researchers interpret the significance of what they’re seeing. At ORCATECH, the task falls to Misha Pavel, professor in biomedical engineering at OHSU School of Science & Engineering. He is also director of ORCATECH’s Point of Care Lab, where many devices are developed and tested. "It’s very easy to put sensors in a house and produce a lot of data," he explained in the project outline. "The key is to build a model of what’s normal that’s tailored to that individual so that we can make better inferences about what’s going on. You don’t want to generate false alarms."
The professor has also been wrestling with another of the technical issues of the study. The sensors monitor movement, and researchers had to work out how to track a subject when they live with another person or when visitors come over. "Even a large dog can be a problem," he said. The solution they’ve come up with is asking subjects to wear a watch with an active RFID tag to distinguish the subject’s movements from those of their spouse or guest (or dog).
Recognizing that people of all ages like to play games, the ORCATECH researchers developed video games that track the dexterity and speed of the person playing them over time. Changes that can indicate neurological diseases are recorded and can help doctors recognize patterns they wouldn’t be able to notice in an occasional office visit.
A Future of Aware Homes
The Aware Home Research Initiative (AHRI) set up by the Georgia Institute of Technology is exploring similar issues. Its centerpiece is the Georgia Tech Broadband Institute Residential Laboratory, a three-story, 5040-square-foot home that functions as a living laboratory. The AHRI description of its work outlines several projects aimed at helping seniors cope with limited cognition.
Cook’s Collage is one of several designed to help users resume interrupted activities. The system provides a visual summary of recent cooking activity along a kitchen countertop, and the design emphasizes the temporal order of cooking events. Visual snapshots are arranged as a series of panels similar to a comic strip, ending with the most recent action highlighted in yellow.
Memory Mirror addresses the need to remember doing simple single tasks, such as taking a pill and feeding the cat. This feat becomes more difficult when the task is repeated often but not in a strict routine. A RFID tag is attached to individual household items, and their appropriate storage areas have a RFID reader on the top. Item are photographed and entered into the system’s inventory. With this setup, the memory mirror system tracks the removal and return of each differently tagged object to and from the storage area. The mirror reflects a period of time, such as 24 hours. As an item is used, it is visually posted to the mirror and recorded in a history log. When an item has been used, an episode mirror reflects details of the previous usages. The mirror also warns of possibly lost items that have yet to be returned.
The AHRI outline points out that remote controls with tiny buttons, complex interfaces and an uncanny ability to get lost in the couch are part of everyday life – and bad news for people whose cognition is impaired. Several AHRI projects tackle the problem.
The Context-Aware Universal Remote helps users control multiple devices throughout the house via one remote device, while the Gesture Pendant controls multiple devices with the wave of a hand. The pendant, containing a wireless camera, is worn around the neck. Replacing complicated remote controls with buttons and scroll wheels, it offers particular benefits for people with impaired dexterity or vision. As a bonus, the system can also analyze the user’s movement as he/she makes gestures. This means that the system can look for loss of motor skill or tremors in the hand that might indicate the onset of illness or problems with medication. It can also observe daily activities to determine, for example, if a person has been eating regularly and moving around.
A variety of technologies throughout the home space, ranging from simple low-resolution strategies, such as RFID, to sophisticated and high resolution vision solutions, help pinpoint where people are located in the Aware House. With systems engineered to detect specific events, such as a fall, the researchers are developing recognition methods to monitor the general activities of the occupants. This awareness includes low-level tasks such as reading a newspaper or watching TV, and higher-level tasks such as preparing a meal or using a blood glucose monitor.
Automating Independent Living
The automation of complex tasks has proven effective in reducing human errors in many domains, including aviation, medicine and process control. Advances in hardware, software and machine learning have made it possible for computers to open up or take over many manual tasks, making automation commonplace in everyday living.
Several projects under way at Georgia Tech’s Human Factors and Aging Laboratory explore circumstances that influence the trust of elderly people in automated information. In one the focus is on decision aid, where an action is suggested and the user is given the choice of following it or not. The researchers surmise that the decision to agree with the automated suggestion might be influenced by what is at risk if the suggestion is wrong and a mistake is made, and by the cost of seeking confirming or disconfirming information. Essentially, the person must weigh the benefits and costs of following the suggestion versus not following it.
Preliminary results suggest that people tend to have more trust in their own abilities, rather than in the abilities of a decision aid, when there is a relatively high cost of making a mistake. The researchers note that findings could guide the design of automation in high-risk situations.
Any system or device that involves monitoring of people confronts privacy issues. Since dementia and other problems associated with aging can increase feelings of paranoia, technologies designed to help elderly seniors lead independent lives will have to take that into account. Each of the research facilities focusing on aging in place issues has at least one human factors project to explore the privacy concerns of older seniors, and the input is expected to shape the technology to mitigate their concerns.
Sources: Associated Press; Business Week, Intel Corp., Human Factors and Aging Laboratory, Georgia Institute of Technology; Aware Home Research Initiative; Oregon Center for Aging & Technology
This article originally appeared in The Ergonomics Report™ on 2007-06-29.