Ebook: Aging, Disability and Independence

This is book includes 15 full-length papers submitted for the Fourth International Conference on Aging, Disability, and Independence (ICADI) and held in St. Petersburg, Florida, USA from February 20–23, 2008. These papers reflect five ICADI tracks: Livable Homes Communities, Smart Homes and Robotics, Transportation, Work, and Assistive Technology and one ICADI theme: Consumer Perspective.

The broad objectives of ICADI are the synthesis and translation of knowledge about disability and aging, and approaches to maintaining independence and quality of life, while fostering collaborations to support future research in this area. ICADI promotes knowledge translation through a mix of invited and submitted presentations, poster sessions, and networking opportunities with experts from around the world. ICADI-2008, as with previous ICADI's, has provided investigators the opportunity to present their research and development work at the Conference, and to have that work receive wider dissemination through this book, and through the ICADI Conference Proceedings, available at www.icadi.phhp.ufl.edu.

The First International Conference on Aging, Disability and Independence (ICADI) was held in December 1999, in Washington, D.C, and was attended by nearly 300 participants. The Second ICADI was held in Washington in 2003 as the University of Florida Rehabilitation Engineering Research Center on Aging State of the Science Conference and then again in 2006 in St. Petersburg, Florida where over 525 people from 32 countries participated. ICADI is unique in bringing together researchers, practitioners, business leaders and people involved in research and development and related aging policy to focus on issues of aging, disability and independence.

The major focus of ICADI on aging and disability related services, research and development, and policy, brings together a rich mix of motivated and talented individuals (multi-disciplinary and engaged in different sectors and types of organizations) who ultimately impact these services. Further, as an international conference, ICADI provides the opportunity to learn more about the successes, challenges and different approaches to the independence-related needs of elders in different countries. Key Groups include: (1) Research and Development personnel; (2) Practitioners / Service Providers; (3) Policymakers; (4) Business Representatives; (5) Consumers; (6) Professional and Graduate Students.

ICADI 2008 has the support of almost 100 major organizations in “spreading the word” on the conference. We thank them for their help with ICADI. Further, we have a number of organizations, companies and agencies that provide financial support for ICADI, each supporting a specific ICADI track, special event, or need. Without their support, ICADI would not be possible, and we thank each of them. The National Institute on Disability and Rehabilitation Research (NIDRR) is the lead sponsor for this book. We offer a special thank you to NIDRR, for this book, and their past support of the Rehabilitation Engineering Research Center on Aging.

William C. Mann, Distinguished Professor and ICADI Conference Chair, University of Florida

The essence of Universal Design principles rests in the fundamental premise of a flexible, supportive, and nondiscriminatory environment. Unfortunately, conventional housing is generally designed for the singular needs of a romanticized nuclear family without the allowance for disabilities, transitions or creative living solutions. The average household composition is becoming increasingly varied as our society becomes more diverse. The traditional household makeup has expanded to include elderly relatives, caregivers, unrelated adults, and even home businesses. The rapidly aging population and longer life expectancies are leading to a greater number of people with physical and cognitive disabilities. Additionally, housing prices are high for first-time buyers, while many ‘empty nesters’ have more space than they need. These trends demand a new approach to designing environments, which would better accommodate people's changing situations and their varying abilities. By designing flexibility into homes from the beginning, it is possible to reduce one's frequent need to move and also to enable our elders to age in place. With a home's layout and structure designed to allow for a number of varied floor plans, it may be easily modified when the need arises, thus reducing potential remodeling costs and waste, increasing the marketability of a home, and contributing to more stable and sustainable communities. With this truly universal approach, a home would be more than just a shelter. It would be a person's most valuable tool, supporting them throughout their lifespan.

The world is ageing, and Japan is no exception. Japan is the fastest graying society in the world, and a quarter of its population will be over age 65 by 2014. It is inevitable that many older people will experience difficulties in the environment due to capability deterioration. To address these environmental problems, the Japanese Construction Ministry inititated in 1987 a five-year research and development project on design for the ageing society. Design for All Ages was set as the key concept, discarding the traditional idea of “special design for the aged.” It is a clear departure from age segregation that occurs with sheltered housing. Design for All Ages assumes that residents will age in place, and that the dwellings will be able to respond to the changing needs of residents. After all, dwellings are an important component of a person's life, and disability (particularly age-related disability) should not adversely affect people.

During the research and development stages of Design for All ages, we integrated existing knowledge with new ideas derived from experiments. Basic concepts for dwellings that have been adopted include: Safety; accessibility; usability; and affordability. These concepts can be interpreted in terms of design guidelines:

1) Basically flat floor. No door sills, no step differences, unless vitally necessary.

2) Handrail installation at critical places such as stairs, bathroom, toilet, and entrances.

3) Wider corridors and doors.

The final Guidelines were based on the discussions of effectiveness, design and economic feasibility, climatic conditions, and cultural tradition. However, simply issuing guidelines does not ensure they will be put into practice. Japan has a strong mechanism for implementation: the Japan Housing Loan Corporation (HLC). The HLC has given prospective clients lower interest rates for housing mortgages, and has been a driving force of economic growth since its establishment in 1950. The Corporation took a decisive step in 1996 in establishing barrier-free or energy conscious design to be eligible for lowest interest rates. Along with the Guidelines, consumer education was provided through various approaches. As a result, construction of barrier-free dwellings increased, and the majority of newer dwellings were built to be basically barrier-free.

Older dwellings were and still are poor in terms of barrier-free design. In addition, aged persons who are more vulnerable and experiencing difficulties in daily living tend to live in problematic dwellings with many barriers. To address these problems, the Japan Housing Finance Agency (the successor to HLC) assists with remodelling of older people's dwelling, though most government subsidized mortgages have been discontinued.

Informal learning environments, such as aquaria, are attracting an increasingly diverse visitor population as the number of people with disabilities living in the community has grown. Although general guidelines exist to assist informal learning environments in designing accessible spaces, the guidelines are not specific enough nor do they guarantee that the spaces will be usable by all visitors. This paper reports on the findings from a post-occupancy evaluation that was conducted at the Georgia Aquarium that: 1) documented the current exhibit display and interpretation design practices; 2) provided visitor feedback on the usability of exhibit displays and interpretation; and 3) discussed the needs of visitors with disabilities.

In this paper, we propose an integrated structure of intelligent techniques to enhance easy-controllability of service robots for the elderly and people with disabilities in a smart home environment. Intelligent techniques have been implemented in human-robot interfaces according to the 3 categories of intelligence, toward enhancing controllability. First, a gesture-recognition system has been implemented toward a more intuitive/natural human-robot interface. Second, a task planning system plays a role to simplify possible commands by the user to control various kinds of devices/robotic agents, for given well-structured tasks. Third, we applied a life-long learning system for intention reading of the user to provide service tasks automatically in advance of his/her explicit command instruction.

As Telecare becomes increasingly a component of care models, there must be a shift away from the current emphasis on the technology used to collect and transfer data, toward a focus on the information provided to caregivers and the subsequent actions and outcomes. In response to this need, the Caring Home Initiative, a multi-year, multi-site study that collects evidence on the use of Telecare in real world care environments, was undertaken.

Researchers in each of six current Caring Home Sites are using a common set of instruments: 1) an intake protocol to collect comparable information on each of the clients; 2) the TAO (i.e., “trigger-action-outcome”) web-based data entry system with alert, trend and query forms to record each time information provided by technology is used in care provision; 3) an interview schedule for the actual users of the system and, where possible, a family member of the user; and 4) a questionnaire given to formal caregivers.

The findings of the CHI show that: first the information provided by an integrated Telecare system is reliable, valid and most importantly, timely; second, automated, continuously updated, electronic wellbeing records can be generated by the imPACS (i.e., analytics and decision support) component of the system; and third, the integrated system can also automatically generate continuously updated care delivery records.

The main lesson learned from the CHI is that if the goal of Telecare is to produce a product for use by caregivers, then integration among the three levels—technology, care and informatics—is essential.

The RoboCare Domestic Environment (RDE) is the result of a three year project aimed at developing cognitive support technology for elderly people. Specifically, the domestic environment is equipped with sensors, intelligent software components and devices which cooperate to provide cognitive support to the assisted person. The RoboCare interaction capabilities have been concentrated in a robotic mediator that acts as the main communication channel between the users and the intelligent domestic environment. This paper presents an evaluation of elder perceptions of assistive robots and smart domestic environments. Results show how the acceptability of robotic devices in home settings does not depend only on the practical benefits they can provide, but also on complex relationships between the cognitive, affective and emotional components of an individual's images of robots. Specifically, we analyzed a number of evaluation criteria related to the robot's appearance, the way in which it communicates with the user, and the perceived usefulness of its support services. Among these criteria, the paper proposes and reports an evaluation of the Proactive interaction modality (where the system takes the initiative) and On-demand interaction (in which the user explicitly requests a service). Users reported the On-demand support services in personal safety scenarios as particularly useful, but less useful in situations which are not critical. The paper also provides a discussion which can be useful for the design of future assistive agents and socially interactive robotic.

This paper introduces a new enabling method for open innovation, called living labs. Living labs are spaces where companies, public organizations such as councils or health and welfare organizations and communities can work together to develop and prototype new products, technologies and services in real environments embedded in the community or market place. We describe the steps being taken to establish a living lab in Northern Ireland, called TRAIL (Technologies for Rurality, Ageing and Independent Living). The objective of TRAIL, achieved through community-facilitated and user-driven studies, is to create service and product innovations that will enable rural and ageing citizens to live independently in the heart of their communities. TRAIL will develop pilot products and services for this sector of the community, with the added benefit of validating and fine-tuning the innovation methods. Importantly, TRAIL will support a fusion of innovation models, technology and integrated community care-based approaches.

The proportion of older people in the population is rising, as is the proportion of older driving licence holders. The needs and abilities of older drivers therefore need to be considered in vehicle design. Our research is focussing on the multidisciplinary identification of design requirements for aged drivers. Research on older drivers has become a field of interest in various research domains and technical areas but coherent results are still missing. We need interdisciplinary approaches directly aimed at supporting older road users. We suggest a functional analysis in order to assist us in identifying the actors, aims and limits of our system. Our analysis is motivated by the need to contrast diverse perspectives to obtain new knowledge and research directions. The functional analysis allows us to make statements about the knowledge needed by designers and the interrelation of actors and factors according to system. It also helps us to formulate further research recommendations for car design requirements for older drivers.

Modifications to personal workstations and architectural changes to the work environment are some of the most common types of accommodation used to facilitate work performance by people with mobility impairments (Zolna, Sanford, Sabata, & Goldthwaite, in press). However, workplace accommodations may vary by what mobility function the person finds to be difficult. For instance, one might modify a personal workstation to reach their desk or equipment, but a different kind of accommodation to a personal workstation could be used to improve seating for those remaining at the desk or using a computer for long periods of time.

Moreover, those who use a wheelchair may use different types of accommodations than those who are ambulatory. For example, architectural changes made to mitigate environmental barriers such as getting up stairs might be different to accommodate a person in a wheelchair than to accommodate an ambulatory person with balance or vision problems. Therefore, research regarding workplace accommodations for people with mobility impairments should examine the specific functional limitation(s) addressed by the accommodation.

Science, technology, engineering and math (STEM) educators aging with or into disability may need accommodations in order to teach. Survey results show that STEM educators are mostly using architectural accommodations and equipment that may be already in place (e.g., ramps, LCD projector) and are less likely to be using specialized assistive technology. Although they are receiving accommodations for their primary job tasks, they are not always receiving accommodations for other aspects of their job, such as participating in professional development. Most educators are satisfied with their workplace accommodations, but almost one-third were not. In addition, many educators are determining and paying for their own accommodations, with less input from employers and rehabilitation professionals than would be expected. In order to retain educators as they age with or into disability, these issues must be addressed so that they can obtain accommodations that will effectively and comprehensively meet their workplace needs.

Employers are looking for ways to retain older employees past retirement age. Changes in computer technology and improvements to ergonomics in the workplace make changes to traditional computer workstations more feasible. In response to these trends a study was conducted in which computer operators worked from five different postures. Results indicate that adjustments to arm supports and placement of computer peripherals impacts posture preferences, and that age-related trends warrant further research into this topic.

A conceptual framework of workplace accommodation issues associated with the employment of people with disabilities and the aging was developed to help identify policy barriers and opportunities, using online policy Delphi Method, an iterative polling instrument used to assess key issues and intervention options. This paper presents the results of research conducted toward articulating policy initiatives that address the key issues critical to the development of effective approaches for the implementation of workplace accommodations.

The role of device-assisted vision rehabilitation is to recommend assistive technology to ameliorate vision disabilities that people with impaired vision identify as being problematic. “Competitive enablement” is a conceptual approach wherein individual consumers evaluate the functional utility of competing device interventions while performing a series of self-identified problematic tasks of high functional relevance to the individuals themselves. Adherence to this approach lessens abandonment rates and produces significant impacts in both functional and psychosocial domains.

An ultrasonic urine sensor was developed to improve the quality of life for older people with urinary incontinence. The sensor was first designed for medical use and is now used in the clinical guideline of the Japanese Urological Association. Improvements were undertaken to make the sensor easy to use. The new approach is described in this paper.

In an era in which the world population of individuals aged 65 and older constitutes nearly 500 million people, the accessible design of information is increasingly important. Closed-captioning, originally designed to make televised information accessible to deaf and hearing-impaired individuals, now benefits millions of people with a wide range of abilities. The United States, which has legislated captioned television for over thirty years, can be considered a world leader in the practice from which many countries, including Japan, may learn. Yet even in the U.S. there is no effective style of captioning for elders and people with low-vision. The captioning of short clips, such as TV commercials and short video, is especially lacking.

In our research we are establishing a methodology for appropriate captions for people with low vision, based on the Universal Design process pertaining to TV commercials. In Experiment 1 we examined the ways participants' visual behaviors were affected when their visual acuity was artificially reduced while viewing closed-captions, and the effects of reduced visual acuity on contents comprehension. In Experiment 2 we examined the participants' eye movement as they watched Japanese closed-captions at various speeds with no sound.

We realized that 1) participants' tended not to look at the captions when their visual acuity was reduced making it more difficult to read, 2) for participants with visual acuity lower than 0.25, captions were unreadable, 3) participants were affected by the caption speed when they had diminished visual acuity, and thus, they could not see the caption, and 4) eye movement is a valid index in researching people's viewing and comprehension of film clips. The results also indicate that closed-captions are currently unsuitable for viewers with lowered visual acuity, even for those viewers with slightly reduced visual acuity.

We now know that we must develop closed-captions that consider viewers with low-vision. We also know that total fixation time on captions calculated from eye movement is an especially valuable tool for researching the visual behaviors of viewers. This technology will not only aid the captioning process, but will also make the growing areas of new and online media accessible to millions of people.