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Designing Services and Systems for Safety of Elderly People at Home: An Ongoing Empirical Study

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This article reports on an ongoing study aiming at designing services and systems for safety of elderly people at home. There is an evident and urgent need to increase the knowledge of this area. Indeed, both academic as well as practical knowledge
    DESIGNING SERVICES AND SYSTEMS FOR SAFETY OF ELDERLY PEOPLE AT HOME: AN ONGOING EMPIRICAL STUDY Jukka Ojasalo, PhD, Professor Laurea University of Applied Sciences Espoo, Finland   Rob Moonen, Project Manager Laurea University of Applied Sciences Espoo, Finland   Niko Suomalainen, Researcher Laurea University of Applied Sciences Espoo, Finland   Heikki Seppälä, Researcher Laurea University of Applied Sciences Espoo, Finland   Abstract This article reports on an ongoing study aiming at designing services and systems for safety of elderly  people at home. There is an evident and urgent need to increase the knowledge of this area. Indeed, both academic as well as practical knowledge is needed. First, this article explains why the research and development in this area is needed. Then, it discusses technologies to enhance the safety of elderly in their homes. Next, it discusses Smart Homes and Ambient Intelligence. After that, it explains the ongoing empirical study. Then, it draws the final conclusions. 1 INTRODUCTION The proportion of elderly people of total population is increasing in several Western countries. For example, since 1997 the percentage of the European Union popula-tion between 65 and 79 years of age has grown from 11.6 to 12.6 in 2008. The population older than 79 years from 3.5 to 4.4. If this trend continues, 30% of the EU-27  population in 2030 will be 65 years or older [1]. In the US, the proportion of the population aged 65 and above is expected to increase from 12.4% in 2000 to 19.6% in 2030. The number of persons aged 65 and above is ex- pected to increase from approximately 35 million in 2000 to an estimated 71 million in 2030. The number of per-sons aged 80 and above is expected to increase from 9.3 million in 2000 to 19.5 million in 2030.[2] [3] Similarly, it was estimated that, for example in Australia, the pro- portion of elderly people will double by 2040 [4]. In 2000, the worldwide population of persons aged 65 and above was an estimated 420 million. The pattern of development is shown in Figure 1. This is a 9.5 million increase from 1999. During 2000-2030, the worldwide  population aged 65 and above is estimated to increase by approximately 550 million to 973 million, increasing from 6.9% to 12.0% worldwide. This includes the in-crease from 15.5% to 24.3% in Europe, from 12.6% to 20.3% in North America, from 6.0% to 12.0% in Asia, and from 5.5% to 11.6% in Latin America and the Carib- bean. Two main fac tors explain the increase of world‟s  population, namely declines in fertility and increases in life expectancy. Fertility rates have declined in develop-ing countries after 1970 and in developed countries throughout the 20th century. Moreover, in developed countries, the largest gain ever in life expectancy at birth occurred during the 20th century. Life expectancy at birth in developed countries now ranges from 76 to 80 years. Life expectancy also has increased in developing coun-tries since 1950, although the amount of increase va-ried.[5] [6] [7]  Figure 1 Population age distribution for developing and developed countries by age group and sex  –   worldwide 1950, 1990, and 2030 (adopted from MMWR Weekly 2003, p. 6 [8]) An increasing number of older people need long-term care and services, but do not meet the criteria of or 152  cannot afford to nursing homes, and consequently receive the caring at home [9] [10]. Long-term care needs to  become more effective in the prevention of medical healthcare utilization among those cared for at home. Older people who are granted long-term care at home may otherwise imply increased utilization of medical healthcare.[11] Age is the biggest risk factor for dependency on care. According to a prognosis of the EU-Project FELICIE (Future Elderly Living Conditions in Europe), under the “Healthy Life Gain Scenario” dependency on care until 2030 will increase by 20% for women and by 80% for men after the age of 75. Indeed, the share of older people in all fatal injuries in the EU has been steadily rising by approximately 1% every two years (from 40% in 1997 to 49% in 2006). Annually, 120 000 people in the EU aged 60 die annually due to consequences of injuries. The injury fatality rates rise sharply after the age of 70. Falls are the main causes of fatal injuries among older  people.[12] Figure 2 shows fatal injuries amongst older  people by causes of death.  Figure 2 Fatal injuries amongst older people (60+) by causes of death and sex (adopted from Bauer and Steiner, 2009, p. 12 [13]) When it concerns non-fatal injuries of older people, the home (about 60%) and streets (20%) are the most relevant places for occurrence. Gender differences exist in particular in home injuries, which primarily reflect the different exposure to work at home between men and women.[14] Figure 3 shows places of occurrence of injuries amongst older people and activities leading to home injuries.  Figure 3 Places of occurrence of injuries amongst older  people (60+) and activities leading to home injuries (adopted from Bauer and Steiner, 2009, p. 13  [15]) As a conclusion, there is an evident and urgent need to increase the knowledge of services and systems that increase the home safety of elderly people. Indeed, both academic as well as practical knowledge is needed. The  purpose of this empirical study is to increase the knowledge of designing services and systems for safety of elderly people at home. The focus is on ICT-systems which can support elderly people living independently and safely at home. This report results from an on-going action research. Thus, any results and conclusions suggested here are tentative. 2 TECHNOLOGIES TO ENHANCE THE SAFETY OF ELDERLY IN THEIR HOMES Several technologies can be used to improve safety and lower risk of injury of elderly at home. According Daniel, Cason, and Ferrell [16], such technologies fall into five categories:    General adaptive technologies.  These are the most „„low tech‟‟ of all applications. They include such things as lever door handles, amplifiers on door bells and telephones, grab rails and handrails in appropriate locations, ramps, stair lifts, external lighting with passive infra-red, lowered light switches, raised electrical outlets, level thresholds, wider doors and corridors, and electric window and door openers [17]. These technologies help older  people to stay independent in their homes longer, delaying expensive moves to congregate living arrangements while maintaining quality of life [18].     Passive environmental sensors . These are devices that monitor the safety features of the 153  home as well as individuals in the home. They usually have low obtrusiveness as they are entirely passive. Examples of passive environmental sensors include devices to monitor gas leaks, carbon dioxide, and other  potential hazards. Motion sensors are another example of passive adaptive technologies. These technologies increase the safety of senior adults and help to maintain their independence.     Assistive technologies.  They help elderly in meeting their daily needs and may be useful for elderly who are physically disabled, but still cognitively intact. They include, for example, voice activation technologies of various devices, smart mail box notifies, and alert systems.    Wander management systems.  This system tracks patients with cognitive impairments (CI) such as Alzheimer‟s, Down‟s syndrome, and autism. It happens through a watchsized bracelet that emits a silent, low-level radio frequency. The system is activated only when a caregiver reports the CI person is missing. Participating loca l authorities can then „„tune in‟‟ the specific frequency for the device issued to that individual.     Appliance technology.  Using radio frequency identification, the technology  –   smart wave  –   has the capability of recognizing the type of food product selected, and based on the selection, an instructional video is displayed indicating the steps for preparation. The smart wave has the ability to program itself for the appropriate cooking time. When the food is cooked it notifies the person via audio and video announcement that the food is completed, and also cautions the user when handling the food. Drawing on Eriksson and Timpka‟s  [19] study, successful safety technologies for elderly should be unobtrusive, easy to use, and economically viable. They (ibid.) argue that the greatest challenge for the designers of such systems is not technical, but rather to integrate health functions in the correct products (i.e., household items) and to make the health functions attractive to consumers. Consumers may not behave in a way that is considered rational from a technical perspective. There are other factors in addition to functionality and cost, such as design, fashion, lifestyle, status, and general trends in society. 3 SMART HOMES AND AMBIENT INTELLIGENCE (AmI) Smart environments can assist with valuable functions such as remote health monitoring and intervention. The need for the development of such technologies increases due to the aging of the population, the cost of formal health care, and the importance that individuals place on remaining independent in their own homes.[20] The term “S mart H ome” is used for a residence equipped with technology that allows monitoring of its inhabitants and/or encourages independence and the maintenance of good health [21]. To function independently at home, individuals need to be able to complete Activities of Daily Living (ADLs) such as eating, dressing, cooking, drinking, and taking medicine [22]. Figure 4 shows an example of a smart home test bed used by researchers of smart environments.[23]  Figure 4 The smart apartment testbed. Sensors in the apartment monitor motion (M), temperature (T), water (W), burner (B), telephone (P), and item (I) use.(Adopted  from Crandall and Cook, 2009, p. 2, [24]) Based on Chan, Campo, Estève and Fourniols, several user groups can benefit from Smart Home technologies [25]:    People living alone who are unable to seek help in emergencies (unconsciousness, falls, strokes, myocardial infarction, etc.).    Elderly or disabled people who suffer from cognitive (Alzheimer disease, dementia, etc.) and/or physical (visual, hearing, mobility, speech, etc.) impairment.    People who need help in daily life to perform  personal care activities (eating, toileting, getting dressed, bathing, etc.) and instrumental activities (cooking healthy meals, dealing with medication, and doing laundry)[26]    Informal (family, friends, neighbor people) or formal (care provider) caregivers for the elderly or the handicapped.    People living in rural and remote communities or in urban communities with inadequate health service provision [27]    People who suffer from chronic disease, and who need continuous monitoring (diabetes, cancer, cardiovascular disease, asthma, COPD, etc.)[28]    People involved in telehealth care undertaking health care at a distance or telemedicine, with  physicians practising „vi r  tual visits‟  [29] 154  “Ambient Intelligence” (AmI) is a term closely related to Smart Homes. Smart Homes are, in fact, an application of AmI. The term Ambient Intelligence was used by the European Union to refer to a potential future in which we will be surrounded by intelligent objects and in which the environment will recognize the presence of persons and will respond to it in an undetectable manner [30]. Ambient Intelligence is an emerging discipline that  brings intelligence to our everyday environments and makes those environments sensitive to us. AmI research  builds upon advances in sensors and sensor networks,  pervasive computing, and artificial intelligence. Ambient intelligence systems are sensitive, responsive, and adaptive. This highlights the dependence on context-aware computing.[31] It refers to the presence of a digital environment that is sensitive, adaptive, and responsive to the presence of people [32]. In an AmI environment,  people are surrounded with networks of embedded intelligent devices that can sense their state, anticipate, and perhaps adapt to their needs [33]. Such a digital environment proactively, but sensibly, assists people in their daily lives [34]. AmI is a vision of a future daily life and contains the assumption that intelligent technology should disappear into our environment to bring humans an easy and entertaining life [35]. According to Cook, Augusto and Jakkula, sensing, reasoning, and acting are basic functions of AmI [36].    Sensing  . Effective use of sensors is vital for AmI. Sensors are the key that link available computational power with physical applications. Sensors are used to position measurement, for detection of chemicals and humidity sensing, and to determine readings for light, radiation, temperature, sound, strain, pressure, position, velocity, and direction, and physiological sensing to support health monitoring [37]. Sensors are typically small, they may be wireless, and often use power from batteries. Environmental monitoring, situational awareness, and structural safety monitoring are examples of sensor application areas.     Reasoning  . Sensing and acting provide links  between intelligent algorithms and the real world where they operate. In order to make these algorithms responsive, adaptive, and  beneficial to users, a number of types of reasoning must take place. Reasoning includes user modelling, activity prediction and recognition, decision making, and spatial-temporal reasoning.     Acting  . AmI systems tie reasoning to the real world through sensing and acting. Intelligent and assistive devices provide a mechanism by which AmI systems can executive actions and affect the system user, for example an elderly  person. Another mechanism for acting is through robots. Robots are able to provide an increasing range of assistive tasks to support AmI. They can monitor the vital signs of their masters, provide conversational stimulation, exhibit more human-like emotions and expressions than in the past and even influence human decision [38]. According to Chan, Campo, Estève and Fourniols [39], as difference people have varying needs, the provision of assistance must be tailored to each individual [40]. Smart Homes contribute to caring the elderly, people with chronic illness, and disabled people living alone at home. This new approach to health assessment can improve the quality and variety of information transmitted to the clinician. Measures of physiological signs and behavioral  patterns can be translated into accurate predictors of health risk. This can happen already at an early stage, and can be combined with alarm-triggering systems as a technical platform to initiate appropriate action. Telecare and smart homes can provide the infrastructure for coordinating multidisciplinary care outside the hospital. This can include, for example, scheduling visits with health staff and community health workers, automating collection of clinical findings and test results.[41] Chan, Campo, Estève and Fourniols introduced a model of key organization in Smart Home (Figure 4).  Figure 4 Key organization in Smart Home (adopted from Chan, Campo, Estève and Fourniols., p. 95  [42]) 155    4 AN ONGOING EMPIRICAL STUDY  Next, the present ongoing empirical study is described. The study aims at designing services and systems for safety of elderly people at home is briefly described. This relates to the research project which is a part of ITEA2 (Information Technology for European Advancement) strategic clus ter project “GUARANTEE –   A Guardian Angel for the Extend ed Home Environment”. Technologies that can support elderly people to live independently at home rather than being institutionalized  by delivering customised support in a non-intrusive and respectful way are envisaged as one of the main solutions for a significant reduction of health-care costs. Home safety is one of the important aspects for the elderly. With increase in life expectancy come many other issues like health problems, difficulty in moving around or  possibility of getting injured. Accidents   are one of the major causes of hospital admission, morbidity and mortality among the elderly. It is therefore important to increase the elders' awareness of safety in everyday life and to introduce technological means to improve it. Several applications of all generations of telecare (from simple user activated alarms to advanced remote home management and remote therapy services) have been developed, piloted, and tested on an experimental basis in the context of various European projects‟ R&D  programmes, but few of them are currently being delivered on a commercial basis. This is due to several reasons, the most important of which are (a) the lack of commonly agreed standards and technology platforms to support these new services, which gives rise to problems concerning the interconnectivity, interoperability and further extension of these systems; and (b)lack of  business model and the delay in the initiation of a social dialogue on the costs and benefits of technological solutions, given that this dialogue did not accompany the development of these technologies in a timely manner. The research focuses on    Social impacts, issues and concerns of elderly and disabled about safety in their home environment.    Ethical issues including privacy, informed consent and others arising from the deployment and use of home safety products and services    Designing a conceptual model for safety solution services for elderly at home Indeed, in this study, we aim to contribute to the social and ethical analysis of home safety products and services for elderly and disabled. An end-user study will be done that answers the research questions and gives powerful insights that will propel the design process. The end- user research‟s main goal is to examine and identify issues and concerns of elderly and disabled people about safety in their home environment. The end-user research will be done in cooperation with  partners that are providing the end-users and test environment. Different meetings and sessions will be  planned to identify, gather and analyze the required information. It is important to get an overview of the context in which the design needs to be implemented and the users for whom it is meant. This understanding is mandatory for Laurea to be able to act as an effective facilitator taking the needs and perspectives of the different players into consideration. Laurea aims to facilitate the interaction  between technology providers, service providers and users (Figure 5). “Laurea” refers to our research group at Laurea University of Applied Sciences in Figure 5.  Figure 5 Focus of the research Understanding how a safety service concept can give  people a peace of mind and contribute in increasing the quality of lives while simultaneous preventing accidents, is a crucial part of the research. A good safety concept including ways of support could boost elderly and disable  people‟s confidence, makes them feel more secure and would enable them to handle day-to-day activities with more ease. Ethical issues including privacy, informed consent and others arising from the deployment and use of home safety products and services will be researched while social impacts will be identified. Also, the objective is to design a conceptual service model which delivers a set of safety solutions to the end-user internally or through external collaboration (Figure 6). The eventual design will include a safety solution which involves end-users, technology providers and service providers. The roles of the different actors will be visualized. 156
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