Smart Home Technologies and Services for Geriatric Rehabilitation

Smart Home Technologies and Services for Geriatric Rehabilitation provides a toolbox for healthcare stakeholders involved in decision-making for the design, development and implementation of smart home solutions. The book provides an in-depth look at the field of smart homes with readers from both research and practice in mind. It addresses the roles and contributions of smart home technologies and services in supporting geriatric rehabilitation and discusses the challenges of current practice and future innovation, especially with wireless technology and 5G advancements.

This reference offers advice on how to implement solutions in the home, and how to framework the modalities of modifying and measuring responses to rehabilitation interventions in geriatric populations. Acceptability, usability and adherence are all considered. Content coverage includes how to navigate policies, regulations, standards and how to build business models. The book's editorial team is multidisciplinary, multisectoral, and from very different regions of the world, thus ensuring a comprehensive scope and global approach.

• Offers an overview on the state-of-the-art, advanced technologies used in home healthcare to improve patient safety and care
• Explores the challenges of current practices and discusses new perspectives for future innovations in geriatric rehabilitation services
• Combines the technical aspects of computer science and technology design with the practical aspects of care giving

• Language: English
• Publisher: Academic Press
• Release date: Oct 18, 2021
• ISBN: 9780323851923

Book preview

Chapter 1

Geriatric Smart home technology implementation—are we really there?

K. Ganapathy

Apollo Telemedicine Networking Foundation, Chennai, Tamil Nadu, India

Abstract

Deployment of Smart Home Technologies (SHTs) in the coming decade for geriatric rehabilitation services will cause a paradigm shift. This chapter critically reviews the practical utility of SHTs from a clinician’s perspective, giving an overview of use of SHTs in geriatric rehabilitation. Achieving technical success is not the same as demonstrating a clinical difference in healthcare outcomes. Technology acceptance from the beneficiary’s perspective is essential. Evidence based, thorough, and systematic evaluation is required. Like other disruptive technologies, the potential of SHT to cause a great impact should not be underestimated. SHT connotes excitement often accompanied with hype and unbelievable expectations. Limitations, disadvantages, and the necessity to ensure that SHT is a tool and not an end by itself will be highlighted. This communication will peep into the future and discuss the use of artificial intelligence–enabled chatbots and robots.

Keywords

Smart Home Technologies Limitations; Advantages & Challenges; Patient acceptance of Smart Home Technologies

Learning Objectives

• The primary Learning Objective of this introductory chapter is for the reader to have a balanced view of the use of Smart Home Technologies (SHTs) for geriatric rehabilitation.

• Practical utilitarian value of SHTs from a clinician’s perspective, demonstrating a clinical difference in healthcare outcomes is not the same as achieving technical success.

• Technology acceptance from the beneficiary’s perspective is essential.

• Limitations, disadvantages, and the necessity to ensure that SHT is a tool and not an end by itself will be highlighted.

1.1 Introduction—geriatric landscape

If I had known I was going to live this long, I would have taken better care of myself.—Mae West

"Smart is not just a word; it is an attitude."—Ogwo David Emenike

Though India centric, this introduction could be extrapolated to many other countries as well. The traditional joint family ecosystem prevalent in India for centuries is slowly disintegrating, exposing the vulnerability of elders. The author and his family were looking after his parents even when the latter were 84 and 94 years of age. Four generations living under one roof, in the authors’ opinion was a win-win situation for everyone. There was an excellent quality of life for all. No one felt the absence of Smart homes and even the necessity for rehabilitation. However, the world today is totally different. A report by the Confederation of Indian Industries (CII) suggested that India’s elderly population will grow to 158 million by 2025. By the end of the century, seniors would constitute 34% of the total population. Ensuring adherence to minimum standards of safety and security for elders will require establishing and implementing quality and certification standards across elder care facilities. With increased regulatory and policy support from the government and investment from private sector entities, the senior care segment could emerge as a sunrise industry for India. The CII report points out that a specific legal and administrative policy is necessary [1]. India has around 100 million elderly at present. This may increase to 323 million by 2050, constituting 20% of the population. Among community dwelling residents, one-third over age of 65 and one-half over 80 may experience a fall each year. As of 2017, 92.4% of the elderly in India was physically mobile, implying that they could manage most of their day-to-day responsibilities. Only 5.5% were confined to their homes.

Money is not the only concern for India’s elderly. A survey by HelpAge India estimates that 6% of senior citizens in India live alone. Loneliness is a problem that cuts across classes and is a challenge in cities as well. There are 10%–20% of senior citizens in India probably suffering from loneliness, a condition likely to be exacerbated by the current curbs on movement and contact due to the pandemic [2].People older than 65 years were more likely to share fake news in the United States. The situation in India could be similar with more than 200 million using WhatsApp for the primary source of new information, especially news. Misinformation and anxiety could be compounded during the pandemic [3]. An Agewell Foundation Study found about 85.8% of older adults in India were digitally illiterate. Studies however have shown that older adults are capable of acquiring digital literacy.

1.2 Background—aging elders their global distribution

Currently, 7% of the world’s population is now over 65 years of age. The proportion of older people is expected to rise to 20% by 2050 [4,5]. In the European Union, 20% of population will be over 65 years of age by 2025 [6]. Compared to 2017, the number of persons aged 60 or older is expected to triple by 2100, rising from 962 million to 2.1 billion in 2050 and 3.1 billion in 2100. In Singapore alone those aged above 65 will double by 2030 to 900,000, accounting for 25% of the population [7]. Number of people aged over 85 (those most likely to require health and social care) will continue to rise. Between 2017 and 2040, the figure is estimated to increase from 1.4 to 2.7 million people. As per The Japan Times, 28% of Japanese are 65 years of age or older. By 2060, one in every 2.5 people will be 65 years or older. Following this trend, the elderly may comprise up to 38.4% of the population by 2065. Worldwide, by 2050 it is predicted that more people will be older than 60 years than under 15 years. Adults 85 and older in the United States will triple between 2015 and 2060—making it the fastest-growing age group over this time period. These statistics speak for themselves. Gerontology is here to stay.

1.3 Necessity for rehabilitation in the elderly

World Health Organization estimates that 15% of the world’s population has some form of disability. Rehabilitation has a key role in decreasing level of disability. Application of advanced technologies in rehabilitation is a promising opportunity to attain this goal. In the last few decades, residential aged care facilities have been ensuring a safe friendly environment [8]. Setting meaningful, individualized rehabilitation goals is an essential part of the rehabilitation process [9]. New services, applications, and devices are being offered to prevent, compensate, care, and enhance daily life functioning of senior citizens Rehabilitation for impaired older adults is more effective and more fun [10]. A comprehensive geriatric assessment is necessary to individualize care for older adults [11]. The elderly have complex physical, cognitive, social, and emotional needs. Life expectancy of old people has increased. We also need to keep in mind that biological aging is not always a function of time. The prevalence of chronic, disabling diseases (cardiovascular diseases, diabetes mellitus, ophthalmological, neurological, locomotor, mental, chronic disorders, etc.) increases with aging.

1.4 Introduction to geriatric rehabilitation

Essential to geriatric rehabilitation is communication, specifically improving sensory impairment of vision and hearing. Prevention of falls and delaying osteoporosis can improve quality of life and longevity. Addressing malnutrition can promote healing and energize elders to participate in a formal rehabilitation program. Functional loss of mobility and inability to perform activities of daily living (ADLs) often lead to depression [12]. Assistive robots have been used to power wheelchairs, prosthetic limb controls, peripheral nervous systems, and home automation systems [13]. Technology readiness level for Smart homes and home health-monitoring technologies is low placement in a care facility, especially against an individual’s wishes, and has been associated with depression, social isolation, and greater dependency in completion of self-care tasks. Older adults (almost 85%) prefer to obtain care in their homes rather than a healthcare institution [14]. Elderly, handicapped patients, and those with locomotion difficulties particularly when living alone can benefit from Smart homes [15]. Costs for elderly care range from $900 to over $5000 per month. Initial studies indicate that staying at home-—or aging in place, as it is called—results in better health outcomes than moving to a care facility, especially when cognition and depression is the problem. Little attention has been paid to ethical challenges of Smart home applications for those approaching end of their lives.

1.5 Challenges in geriatric rehabilitation

Disability burden is related to number of coexisting chronic conditions. Poor performance occurs in all three disablement domains—body structure and function, activities, and participation. Multimorbidity compounds problems in rehabilitation [16]. Significant decrease in physical, cognitive, and sensory capabilities is an age-related phenomenon. Other influencing factors also cannot be accurately predicted as unexpected life events such as widowhood can make a difference. Smart home technology (SHT) is increasingly directed toward elders to enhance quality of life. Challenges, barriers, and beneficiary’s acceptance of technology need to be considered. Including pleasurable experiences, which allows aging occupants to have fun while living in a Smart home and interacting with Smart devices, is a recent addition [17]. Informed consent is an ongoing process and not a single isolated event as decisions could change depending on initial experience, concerns regarding depersonalization, and introduction of new processes [18]. Sensorimotor rehabilitation forms an important part of the care provided after brain injury. This aims to restore loss of motor control and increase independence and quality of life. This is based on neural plasticity, the ability of the nervous system to reorganize its structure, function, and connections in response to training [19]. Understanding that plasticity is a fundamental property of the adult human brain, neuro-rehabilitation has taken a new meaning. Creating new neural pathways could be considered a disruptive technology [20]. A home for the elderly should offer peace, safety, security, and tranquility. Building a Smart home for elders requires involvement of licensed, skilled, and professional developers.

1.6 Technology acceptance by senior citizens

The technology acceptance model is an information systems theory that models how users accept and use a technology. The actual system use is the end-point where people use the technology. Behavioral intention is a factor that leads people to use the technology. This is influenced by the attitude, which is the general impression of the technology. When users are presented with a new technology, several factors influence their decision about how and when, they will use it. These include perceived usefulness—the degree to which a person believes that using a particular aid would enhance his/her efficiency. Perceived ease-of-use is the degree to which a person believes that using a particular system would be free from effort." If the technology is easy to use, then it is more accepted. External variables such as social influence are an important factor to determine the attitude. Perceptions are individualistic, depending on age, gender, circumstances, and time to device use. They included concerns about cost (42%) and a lack of familiarity with the technology (32%). Facilitators to device use included training prior to device use (61%) and tailoring devices to the functional needs of older adults (34%) [21]. mHealth devices and services are complex interventions that have to be integrated into an older person’s life to facilitate effective use. People over 65 generally use fewer new technologies—including the Internet, smartphones, and other digital devices—and use them less frequently than younger people. Older, less educated, and less affluent people, as well as people with disabilities, appear to use them even less often [22]. Developers, providers, and policymakers should make sure that older people are included in decisions about technology use [23]. Transforming older adults into lead adopters of a new 24/7 lifestyle of being monitored, managed, and at times motivated, to maintain their health and wellness using technology is indeed a challenge [24]. Awareness of psychological and contextual factors is needed to facilitate aging in place through the use of technology [25]. Privacy can often be a barrier for older adults’ adoption of Smart home IT [26]. Although an Internet-of-Things-based Smart home solution can provide an improved and better approach to healthcare management, yet its end user adoption is very low. Performance and effort expectancy, expert advice, and perceived trust are critical. Effort expectancy is the leading predictor of Smart homes for healthcare acceptance among the elderly [27].

1.7 Introduction to Smart homes

A Smart home is a convenient home setup where appliances and devices can be automatically controlled remotely with an Internet connection, using a mobile or other networked device [28]. Devices in a Smart home are interconnected through the Internet, allowing the user to control functions such as security access to the home, temperature, lighting, and a home theater remotely. The global home automation market was valued at about $53.5 billion by 2022. SHT for the elderly needs to specifically cover safety, health, physical activity, social engagement, and leisure. Safety is about detecting and mitigating, if not removing, hazards from the user’s environment. Social engagement relates to the Smart home functions that allow the elderly to combat social isolation, connecting the elderly with friends and family. Leisure activities are about how a Smart home can allow users to spend their free time. Technology-enabled physical activity relates to active engagement in Nonsedentary activities [29].

Smart locks, Smart lighting, apps, and gadgets for entertainment and communication, motion sensors and alerts, audio-enabled devices, medication reminders, and other technology-enabled wellness tools form a Smart home [30]. Smart locks can be programmed to grant access only to authorized personnel. Door cameras and Smart locks can be customized to allow individuals with mild impairments to be independent for longer. Smart homes increase domestic comfort, convenience, security, and leisure, reducing energy use through optimized home energy management. Automation, affordance, physical and psychological support promote independence. Acceptance is a key issue. Numerous initiatives worldwide have been developed to explore the use of motion sensors, radio frequency sensors, video cameras, wearable devices, and other applications that target older adults. The majority of the identified projects (71%) include technologies for functional monitoring (such as bed sensors, activity/motion sensors, and gait monitors). Water temperature sensors, stove sensors, and automatic light activation are examples.

Creating a connected home. Pressure-sensing floors, Smart furniture, and medical sensors, in addition to integrated appliances would require Smart devices to interpret context [31]. Older adults are likely to accept Smart-home technologies, if they helped achieve physical activity and independence-preserving privacy. The Smart homes movement links housing, technology, engineering, sociology, and healthcare in relation to robotics, sensors, telehealth, ergonomics, communications, social care, and safety. Most Smart-home technologies could be used with little assistance or training. Some safety concerns were identified related to malfunctioning of technology; highlighting the importance of contingency systems for events such as power