January 5, 2009

New Technologies for Aging in Place
By Athan Bezaitis, MA
For The Record
Vol. 21 No. 1 P. 24

Some are ready to use now; others will be in the future. Advanced technologies are paving the way for more older adults to age safely and independently in the comfort of their homes.

I can’t imagine how my 84-year-old grandmother, who lives alone, would feel about an intelligent toilet. I’m certain she would be less concerned with its capabilities for testing her urine sugar levels, blood pressure, and body fat than with her ability to clean it without making it explode.

While the toilet, available for around $3,500 from the Japanese company TOTO, may not be right for her, a wearable wireless sensor network that could alert my mother and aunt if she should fall would be highly desirable. And a mobile monitoring application that allows my family to keep track of my grandmother’s daily movements without intruding on her privacy would also be beneficial.

And perhaps it’s just my stomach talking, but a device that would help her remember which ingredients have already been added to a recipe could keep those delicious Greek dishes that only she can get right coming for years.

These innovations and more are in development through the collaborative efforts between corporations and university research centers around the country. At the Massachusetts Institute of Technology (MIT), architects are developing a home “chassis”—think Legos for interior home design—that will allow for the complete customization of one’s residence.

At the University of Southern California (USC), engineers are collaborating with eye doctors to develop “smart spectacles” that will help those with vision loss to navigate their homes. And researchers at the UCLA have created an inexpensive handheld video game to keep the brain sharp—one of the most important aspects of elders’ ability to maintain their independence.

On the Web, Microsoft offers a free program that allows individuals or their caregivers to collect, store, and share all their fragmented health information online.

Trendy gadgets are also on the way. Georgia Institute of Technology researchers have developed a communication device designed to create a personality for advanced household technology. Dubbed FaceBot, it features two cameras for eyes, microphones as ears, and a speaker as its mouth.

However, the reality remains that no matter how wired, sensored, or digitized the homes of the future become, new technologies will need to be accessible and user friendly in order for people like my grandmother to adopt them. What will the FaceBot say if she burns the chicken? If it’s smart, nothing.

Aging in Place
Elizabeth Mynatt, PhD, director of Georgia Tech’s Graphics, Visualization, and Usability (GVU) Center, conducts research on new technology and the needs of aging adults. “Moving from the home equates to loss of independence and identity,” she says. “Developing new technologies is really about maintaining independence. From an economic perspective, it’s also about putting off the cost of an institutional care setting and maybe avoiding it altogether.”

Keeping older adults in their homes, where many of them say they want to be, will help reduce the staggering healthcare costs projected for elders by billions of dollars. According to a study from the National Coalition on Health Care, U.S. healthcare spending is expected to reach $4 trillion in 2015, or 20% of the gross domestic product.

New developments in technology promise to help transition healthcare from expensive clinical settings into private residences, encourage behavioral modifications that emphasize prevention rather than the treatment of illnesses, and make it easier for family caregivers to monitor loved ones and take action in case of an emergency.

Currently, 70% of elders live in their own homes, and more than 80% indicate that they never want to leave. The desire for most is to age in place. One of the biggest obstacles, however, is often the house itself, says Jon Pynoos, PhD, a professor at the USC Davis School of Gerontology. Pynoos, who also directs the Archstone foundation-funded National Resource Center on Supportive Housing and Home Modifications, has made a career of advocating improved housing for older adults.

“The current living conditions for many elder Americans can best be described as ‘Peter Pan housing,’ by which I mean housing designed for persons who are never going to grow old,” he says. “The three biggest problems older people encounter are getting in and out of the house, up and down stairs, and safely using the bathroom.”

A variety of well-documented home modifications can help reduce accidents and enable older adults to engage in major life activities, but forward-looking research in home design is taking remodeling one giant step into the future.

Mass Home Customization
The House_n team is a research group from MIT’s architecture department that explores new technologies, materials, and strategies for improving living environments. Principal investigator Kent Larson borrowed from innovations in the automobile, electronics, aviation, and shipbuilding industries to create an interior home design from a chassis that can be speedily and accurately installed with minimal field labor. “It’s a mass customization project. The chassis is the bare bones that allows you to reconfigure a home to fit the individual’s needs,” Larson says.

Once integrated into the home, the assembly provides structure, power, signal, plumbing connections, mechanical attachments, and floor and ceiling finishes. At the point of sale, walls are added to fit size requirements, and the buyer engages in a process of defining the interior design, systems, and services. The chassis provides necessary connections for components to be installed, replaced, and upgraded without disruption.

“You could essentially customize a condominium at the point of sale. What’s new is that now the Internet and supply chain management tools and all of the enabling technologies are mature,” Larson says.

As for market availability, “it is a matter of industry mass producing the necessary products,” Larson says. However, homebuilders are notoriously slow to adapt to new innovations. On a small level, designers have built homes using the chassis that are already available for sale. While architects will continue to design unique houses for people with wealth, there is currently little choice for everyone else. Larson believes mass customization will allow the quality of home building to improve without raising costs. At the low end, he says mobile homes would be commonplace, with the greatest potential in the middle market. On the high end, the chassis would offer the efficiencies of mass production with the added benefits of customization.

My grandmother, who is surprisingly proficient on the Internet, may feel a bit overwhelmed by the idea of remodeling her own home. With this in mind, Larson’s group developed software for nonexpert designers, allowing someone like her to consider dimensions, decor, and demising walls (shared walls between tenants). With some help, she could digitally redesign her home to fit her needs and even find a place to plug in her favorite rotary telephone.

Technology Is All About Lifestyle
Octogenarians make up the nation’s fastest growing population group. Within the next decade, 76 million baby boomers will begin to retire. In the face of overwhelming healthcare costs, experts believe that home innovations will represent a critical means to encourage healthy living.

“The big problems that society has to address, like obesity, congestive heart failure, type 2 diabetes, and smoking, can’t be treated effectively in a doctor’s office; they can only be affected through lifestyle and behavior changes,” Larson says.

His team is exploring technology solutions that look at the behavioral side of maintaining independence. Using wireless sensors in drawers, medicine cabinets, pill bottles, and footwear, it has developed prototypes that interface with cell phones, TVs, remote controls, and computers to provide information at the point of decision. The technology acts as a coach to create awareness, provide feedback, and guide lifestyle choices.

At the House_n lab, a pilot study shed light on how new technologies can be used to fight the startling correlations between obesity and time spent watching television. “A PDA used as a TV remote control encouraged participants to watch less TV by helping people set personal goals. It monitored exercise levels, provided information on how much TV participants watched, and suggested other activities by offering a task list. When participants completed their quota for exercise, the system would congratulate them and encourage them to enjoy more television,” Larson says.

Similar research is underway at Georgia Tech. Wendy A. Rogers, PhD, director of the Human Factors and Aging Laboratory, studies how age-related cognitive changes interact with new technologies such as computers and home healthcare products. She has also developed a technology “coach” that supports older adults in learning to use a blood glucose meter that provides them with feedback if they make errors.

“The most critical products are going to be ones that support health—both preventive measures, such as nutrition guidance, and management of chronic conditions, such as medication reminders or guidance using medical devices,” Rogers says. “These are the types of issues that lead to older adults having to move out of their homes. So if we can support them in these activities, they will likely retain their independence longer.”

These devices will be unobtrusive. Wireless networks will link computers and consumer electronic devices throughout the home, creating an interface that is familiar and easy to use.

To adapt to new technologies, Rogers enlists older adults to actively participate in the design process. She begins with what she calls a needs analysis, which involves interviewing older adults to discover what kind of support they require to maintain their independence in the home environment.

Rogers encourages older adults to come into the laboratories, either the Human Factors and Aging Laboratory or the Aware Home Residential Laboratory at Georgia Tech, to be involved in user testing of the products and systems in development. She conducts technology acceptance surveys that analyze perceived usefulness, compatibility, and privacy.

“We also sometimes visit local senior centers and independent or assisted living facilities to either observe older adults in their home environment or to broaden the range of people from whom we gather input,” Rogers says. “One of the key things we have learned is that if an older adult does not perceive something to be beneficial to them personally, they will not use it. Thus it is absolutely critical to involve them in all stages of the development process.”

What’s New?
At USC, Norberto Mauricio Grzywacz, PhD, a biomedical engineer, leads research to design visual aids for millions of older adults who suffer from significant vision loss caused by neural pathologies such as macular degeneration and other diseases affecting the retina. According to the National Eye Institute, approximately 1.7 million Americans have some form of age-related macular degeneration.

“Our dream is to build devices like intelligent spectacles or intelligent television displays that can allow people to ambulate around their homes,” Grzywacz says.

Other products for the visually impaired include FETCH, a mobile system that utilizes Bluetooth technology for locating misplaced objects, developed at Georgia Tech’s Aware Labs.

At the GVU Center, Mynatt’s team created the Digital Family Portrait, which also uses motion sensors to help family members keep an eye on aging relatives. A monitor hangs in the caregiver’s home and displays a static photo of the older relative. The photo is surrounded by a digital image frame with an icon, such as a butterfly, that changes daily to reflect activity level.

“It was really about the day-to-day concern that family members had. We designed a product that, instead of being used in an emergency, would be used 99% of the rest of the time,” Mynatt says.

She says motion sensors offer an ideal privacy-preserving technology. As the elder care recipient moves within the home, he or she sets off the motion detectors. Each butterfly icon on the digital picture frame would vary by size, based on how much the person being monitored had moved within the house. On a day in which the participant slept, sat, and read the paper, there would be a small butterfly.

In one family trial, Mynatt recalled a concerned son who noticed his mother’s butterfly icon was quite large and out of the ordinary. (In cases of dementia, this would be a common concern.) The son called his mother only to discover she had been preparing the house for painting.

“He was able to take advantage of the fact that he had this information but didn’t push it in his mother’s face,” Mynatt says. “After the study, the mother said that because the sensors were hidden, she didn’t actually see anything and also said that it made her feel less lonely knowing that she had ‘this extra connection.’ This is when we knew we were on to something.”

When these new technologies become available on the market, Mynatt says they will have to work within the social fabric of the family.

The Future Is Now
Products similar to the Digital Family Portrait are already on the market. For example, QuietCare utilizes wireless activity sensors placed throughout the home. Each sensor transmits information to a book-sized communicator which updates information to the QuietCare server every two hours, day and night, or as needed in case of an emergency. Customer representatives notify family members via phone calls, text messages, e-mail, or periodic updates on a personal Web page.

GrandCare Systems also uses wireless sensors to monitor wellness. In addition, a “Como” unit communicates through the elder’s Internet or television. Family and friends can send messages, pictures, reminders, calendar appointments, and more to a dedicated, customized television channel.

“These products provide a Web portal for monitoring the elder, as well as a system to detect when there is a significant deviation from the routine,” says Brian D. Jones, a research engineer at Georgia Tech’s Interactive Media Technology Center. “The Digital Family Portrait provides a more ambient display or visualization of the activity in the home, where the family member might assess that something is wrong rather than relying on an automated system.”

Family caregivers make up the largest source of long-term care services in the United States. It is estimated that by 2050, their numbers will swell to 37 million, up 85% from 2000. Elders often visit multiple healthcare providers and have numerous appointments.

To help manage data, Microsoft HealthVault, a free service developed for caregivers or family health managers, searches for up-to-date treatments, catalogs existing health records, receives test results, and monitors current physical readings.

“Generally, a nurse can collect some simple information and immediately know whether a person is doing fine or headed for trouble. The problem is that it’s way too expensive for everyone to be monitored in this manner; our healthcare system can’t afford it, and we’ve already got a nursing shortage,” explains James Mault, MD, FACS, director of new products and business development for Microsoft’s Health Solutions Group. “That’s where sensors in the home and all of that kind of stuff are a key starting point. But now you’ve got a vehicle through which the data provided by the new technology can connect to the places the information needs to go.”

Mault likened HealthVault’s ease of use to sharing pictures from a digital camera online with friends. The same way a user downloads information from a camera’s memory card onto a free Web site and then invites friends to view, HealthVault provides similar plug-and-play-like connectivity of an individual’s health data with automated alerts to the physician, clinic, hospital, or pharmacy. Family members can also receive health updates.

“At the end of the day, the smartest place for the important health data to reside is actually in the possession and control of the individual or their caregiver,” Mault says.

HealthVault users have the ability to grant permission for third parties to view health records and can filter what comes into their files and what data is shared.

Personalized electronic health information organizers, digital reminders, wireless sensors, and other new technologies are products of forward-looking research with the goal of making aging in place a reality for older adults. Hopefully, fine-tuning the technology and increasing affordability will make these advances accessible to more individuals who wish to remain safe, independent, and comfortable in their own homes as they age.

— Athan Bezaitis, MA, is a freelance writer based in southern California.