Progress in ambient assisted systems for independent living by the elderly

One of the challenges of the ageing population in many countries is the efficient delivery of health and care services, which is further complicated by the increase in neurological conditions among the elderly due to rising life expectancy. Personal care of the elderly is of concern to their relatives, in case they are alone in their homes and unforeseen circumstances occur, affecting their wellbeing. The alternative; i.e. care in nursing homes or hospitals is costly and increases further if specialized care is mobilized to patients’ place of residence. Enabling technologies for independent living by the elderly such as the ambient assisted living systems (AALS) are seen as essential to enhancing care in a cost-effective manner. In light of significant advances in telecommunication, computing and sensor miniaturization, as well as the ubiquity of mobile and connected devices embodying the concept of the Internet of Things (IoT), end-to-end solutions for ambient assisted living have become a reality. The premise of such applications is the continuous and most often real-time monitoring of the environment and occupant behavior using an event-driven intelligent system, thereby providing a facility for monitoring and assessment, and triggering assistance as and when needed. As a growing area of research, it is essential to investigate the approaches for developing AALS in literature to identify current practices and directions for future research. This paper is, therefore, aimed at a comprehensive and critical review of the frameworks and sensor systems used in various ambient assisted living systems, as well as their objectives and relationships with care and clinical systems. Findings from our work suggest that most frameworks focused on activity monitoring for assessing immediate risks while the opportunities for integrating environmental factors for analytics and decision-making, in particular for the long-term care were often overlooked. The potential for wearable devices and sensors, as well as distributed storage and access (e.g. cloud) are yet to be fully appreciated. There is a distinct lack of strong supporting clinical evidence from the implemented technologies. Socio-cultural aspects such as divergence among groups, acceptability and usability of AALS were also overlooked. Future systems need to look into the issues of privacy and cyber security

Technologies to support community-dwelling persons with dementia: a position paper on issues regarding development, usability, effectiveness and cost-effectiveness, deployment, and ethics

Background: With the expected increase in the numbers of persons with dementia, providing timely, adequate, and affordable care and support is challenging. Assistive and health technologies may be a valuable contribution in dementia care, but new challenges may emerge. Objective: The aim of our study was to review the state of the art of technologies for persons with dementia regarding issues on development, usability, effectiveness and cost-effectiveness, deployment, and ethics in 3 fields of application of technologies: (1) support with managing everyday life, (2) support with participating in pleasurable and meaningful activities, and (3) support with dementia health and social care provision. The study also aimed to identify gaps in the evidence and challenges for future research. Methods: Reviews of literature and expert opinions were used in our study. Literature searches were conducted on usability, effectiveness and cost-effectiveness, and ethics using PubMed, Embase, CINAHL, and PsycINFO databases with no time limit. Selection criteria in our selected technology fields were reviews in English for community-dwelling persons with dementia. Regarding deployment issues, searches were done in Health Technology Assessment databases Results: According to our results, persons with dementia want to be included in the development of technologies; there is little research on the usability of assistive technologies; various benefits are reported but are mainly based on low-quality studies; barriers to deployment of technologies in dementia care were identified, and ethical issues were raised by researchers but often not studied. Many challenges remain such as including the target group more often in development, performing more high-quality studies on usability and effectiveness and cost-effectiveness, creating and having access to high-quality datasets on existing technologies to enable adequate deployment of technologies in dementia care, and ensuring that ethical issues are considered an important topic for researchers to include in their evaluation of assistive technologies. Conclusions: Based on these findings, various actions are recommended for development, usability, effectiveness and cost-effectiveness, deployment, and ethics of assistive and health technologies across Europe. These include avoiding replication of technology development that is unhelpful or ineffective and focusing on how technologies succeed in addressing individual needs of persons with dementia. Furthermore, it is suggested to include these recommendations in national and international calls for funding and assistive technology research programs. Finally, practitioners, policy makers, care insurers, and care providers should work together with technology enterprises and researchers to prepare strategies for the implementation of assistive technologies in different care settings. This may help future generations of persons with dementia to utilize available and affordable technologies and, ultimately, to benefit from them

Innovative Technologies and Services for Smart Cities

A smart city is a modern technology-driven urban area which uses sensing devices, information, and communication technology connected to the internet of things (IoTs) for the optimum and efficient utilization of infrastructures and services with the goal of improving the living conditions of citizens. Increasing populations, lower budgets, limited resources, and compatibility of the upgraded technologies are some of the few problems affecting the implementation of smart cities. Hence, there is continuous advancement regarding technologies for the implementation of smart cities. The aim of this Special Issue is to report on the design and development of integrated/smart sensors, a universal interfacing platform, along with the IoT framework, extending it to next-generation communication networks for monitoring parameters of interest with the goal of achieving smart cities. The proposed universal interfacing platform with the IoT framework will solve many challenging issues and significantly boost the growth of IoT-related applications, not just in the environmental monitoring domain but in the other key areas, such as smart home, assistive technology for the elderly care, smart city with smart waste management, smart E-metering, smart water supply, intelligent traffic control, smart grid, remote healthcare applications, etc., signifying benefits for all countries

The effect of bright light on sleep in nursing home patients with dementia

Background: Up to 70% of nursing home patients with dementia suffer from disrupted sleep, often characterized by multiple awakenings at night and excessive daytime sleep. Sleep disruption may have negative effects on the cognition, mood, behaviour, and well-being of nursing home patients, while also representing a challenge for nursing home staff. However, few sleep scales are developed and validated specifically for the nursing home setting. Sleep problems among nursing home patients are frequently treated by medications, which are associated with severe side effects, including daytime sleepiness, and an increased risk of falls. Thus, there is a need for non-pharmacological interventions to improve sleep in this population. Bright light treatment (BLT) may represent such an intervention, providing increased light exposure aiming to impact sleep, circadian rhythmicity, mood, and/or behaviour. Light is the most important zeitgeber to the circadian system, and consequently has a significant impact on sleep-wake behaviour. Unfortunately, studies have reported low indoor light levels in nursing homes, which in combination with dementia-related neuropathology and age-related reductions in light sensitivity, are likely to contribute to sleep problems in this population. The aim of this thesis was to investigate whether increasing daytime light exposure, by means of BLT, can improve sleep in nursing home patients with dementia, and also to address methodological challenges in this field of research. Methods: Paper 1 is a systematic review of the literature, focusing on the methodological features of the included studies, in addition to their findings. Paper 2 and 3 are based on data from the DEM.LIGHT trial; a cluster-randomized placebo-controlled trial conducted in Norwegian nursing homes, including 69 patients. The intervention comprised a diurnal cycle of ambient light with a maximum of 1,000 lux and 6,000 Kelvin (K) from 10:00-15:00, administered using light emitting diode (LED) light. Before and after this interval, the light levels gradually increased/decreased in lux and K. In the placebo condition, standard light levels were maintained at 150-300 lux and approximately 3,000 K throughout the day. The intervention and placebo lights were installed in the common rooms of the included nursing home units. Outcomes were measured at baseline and at follow-up at week 8, 16, and 24. Paper 2 was a validation study of a proxy-rated sleep scale, using the baseline data from the DEM. LIGHT trial. Actigraphy was used as the reference standard. Paper 3 reported on the sleep outcomes of the trial, which were the primary outcomes. Results: Paper 1 found that there are promising, though inconsistent, results regarding the effect of BLT on sleep and circadian rhythmicity in dementia. Large heterogeneity in terms of interventions, study designs, population characteristics, and outcome measurement tools may explain some of the inconsistencies of results across studies. Paper 2 showed that the proxy-rated Sleep Disorder Inventory (SDI) had satisfactory internal consistency and convergent validity. Using actigraphy as the reference standard, the SDI was termed clinically useful, and we suggested a cut-off score of five or more as defining disrupted sleep in nursing home patients with dementia. These results should be interpreted keeping in mind that actigraphy have some important weaknesses, such as underestimating wake time. Paper 3 evaluated the effects of the BLT on sleep and found an improvement in sleep according to the SDI scores in the intervention group, as compared to the control group, from baseline to week 16 and baseline to week 24. There was no effect in terms of sleep measured by actigraphy. Conclusion: In summary, this thesis found that the evidence for an effect of BLT on sleep in nursing home patients with dementia is promising, but equivocal. Importantly, the research field faces some important methodological challenges, such as accurately measuring sleep. The SDI may represent a valid tool to measure sleep in the nursing home setting, which may be used both by researchers and by practitioners. Although the results of this thesis are not conclusive regarding the effect of BLT on sleep in nursing home patients with dementia, it may represent a step forward in understanding the potential value of BLT in this population, and may lay the ground for further investigation. The lack of an improvement on the SDI at week 8 indicates that the effect of BLT may take a long time to manifest in this population.Doktorgradsavhandlin

Accessibility of Health Data Representations for Older Adults: Challenges and Opportunities for Design

Health data of consumer off-the-shelf wearable devices is often conveyed to users through visual data representations and analyses. However, this is not always accessible to people with disabilities or older people due to low vision, cognitive impairments or literacy issues. Due to trade-offs between aesthetics predominance or information overload, real-time user feedback may not be conveyed easily from sensor devices through visual cues like graphs and texts. These difficulties may hinder critical data understanding. Additional auditory and tactile feedback can also provide immediate and accessible cues from these wearable devices, but it is necessary to understand existing data representation limitations initially. To avoid higher cognitive and visual overload, auditory and haptic cues can be designed to complement, replace or reinforce visual cues. In this paper, we outline the challenges in existing data representation and the necessary evidence to enhance the accessibility of health information from personal sensing devices used to monitor health parameters such as blood pressure, sleep, activity, heart rate and more. By creating innovative and inclusive user feedback, users will likely want to engage and interact with new devices and their own data