Ebook: Promoting Independence for Older Persons with Disabilities

This book includes 25 full-length papers submitted for the Third International Conference on Aging, Disability, and Independence (ICADI). ICADI was held in St. Petersburg, Florida, USA, from February 1–5, 2006. These papers were submitted under five of the seven ICADI tracks: (1) Smart Homes; (2) Robotics; (3) Telehealth; (4) Home Modifications and Universal Design; and (5) Assistive Devices and Workplace Adaptations. Full-length papers submitted for the Transportation track appear in two special issues of the journal Topics in Geriatrics Rehabilitation published in 2006.

The focus of ICADIand these papersis on maintaining independenceactive participation in family and community activities. As we age, we face chronic health conditions that have the potential to negatively impact our independence. By using technology (smart homes, robotics, telehealth, other assistive devices), maintaining our mobility, and preventing injuries we can offset much or all of the disabling effects of chronic health conditions.

ICADI brings together a mix of individuals focused on aging, disability and independence, including those involved in research and development, professional practice and services, businesses providing products and services, government and policy planners, and end users and beneficiaries of our research, products, services, and policies. As reflected in this book, ICADI is truly an international conference, with participants from over 45 countries. Assisting us with promotion of this conference, we had close to 100 partner organizations from around the world. In addition, we had 15 sponsors that provided financial support.

This conference, and this book, would not have been possible without the support of the National Institute on Disability and Rehabilitation Research, through the University of Florida Rehabilitation Engineering Research Center on Technology for Successful Aging. The American Occupational Therapy Association served as co-host for ICADI.

The papers in this book provide important content related to aging, disability and independence. They are also a sample of the over 300 ICADI presentations. For those who attended ICADI-2006, this book will provide more in-depth discussion of ICADI presentations. For those who were not able to attend ICADI, this book provides a supplement to the ICADI Conference proceedings, posted at www.icadi.phhp.ufl.edu.

We look forward to seeing all of you at ICADI-2008.

William C. Mann, Abdelsalam Helal, Editors

Agitated behavior is common in persons with dementia, and one of the challenges faced by physicians and caregivers is the detailed and continuous monitoring of such persons. With the use of modern sensor and networking technology, and system directed observation, objective outcomes may be expected and with removal of the manpower requirement, evaluation can be continuous and need no longer be confined to clinical settings. In our work we are putting together an observational system composed of multiple sensors of different modalities to collect data from dementia patients in a hospital ward. Through this feasibility study we will gather data to help automate the detection of the onset of agitation in dementia patients. Eventually, with increasing success rates, the sensor based monitoring system and others based on similar concepts, will be effective tools in Smart Home environments for taking detailed observations of the elderly persons' physical activities and behavioral patterns.

This paper describes how the DTI funded 'Care in the Community Centre' led by British Telecom PLC (UK), has developed a concept model to represent an individual's well-being. The paper goes on to provide an in-depth explanation of the data analysis techniques used to monitor changes in well-being. By combining related sensor events (sensors in the activity based sensor groups), the activity of the client can be inferred. This not only provides an overall assessment and better representation of the data but also highlights significant (i.e. noteworthy) events. The aim to provide caregivers with a tool that enables them to make more appropriate and timely decisions regarding the well-being of their clients. The social interaction of the client with visitors is used as an example activity and is explained in detail to show the capabilities of the system. The data pre-processing and analysis techniques used are heavily reliant on fuzzy sets and fuzzy reasoning techniques in order to deal with the vagueness and incompleteness of the data.

This work describes a 'Smart Home' Service model within the United Kingdom. The community based supported housing scheme accommodates adults with physical disability within their own apartments. These tenants, who had previously lived in a residential facility, are now empowered within the Social Model of Disability to live as autonomously as feasible. User perspectives of autonomous living are reported, enabled by a combination of care packages, environmental design and information and communication technology. A service provider perspective is presented, underpinned by the exploitation of resources (financial or otherwise) from statutory and non-statutory multi-agency involvement. This work reports on an evaluation of the scheme. The strategic context and operational policies at organization level are described as well as service provider and service user perspectives. The applicability of 'Complexity Theory' is considered as a conceptual framework for considering this service model. Complexity Theory facilitates acknowledgment of the inherent dynamics of the system. The dependency on numerous organizations, the connectivity of people and the context of the service are all recognized. This understanding is relevant as service providers move to sustain mainstream Smart Home provision, managing the unpredictability, moving beyond pilot studies.

The Irish population aged 65 years and over is increasing and it is predicted that this trend will accelerate over the next 30 years. Projections highlight that those aged 65 and over will number 0.5million by 2011, an increase of 26% representing 14% of the population. In order to anticipate the needs of this increasing segment of our population, a survey of ageing people's needs in Ireland was commissioned. The overall aim of the survey was to determine the needs and requirements of ageing people with respect to assistive technologies in the home. The survey found that a majority of ageing people were willing to embrace the use of technology which would enable them to age in place. However, while acknowledging the benefits of technology and the automation of systems and functions, respondents were concerned that human interaction may be replaced by technical systems over which they would have no control. Furthermore, such technologies must be non-intrusive, failsafe, affordable, easy-to-use and their use must be ethical.

A two-year randomized controlled trial to identify effectiveness of smart homes, using X10 technology was conducted, comparing 34 treatment and 44 control home-based frail elders. Despite decline in health, the treatment group maintained their physical and cognitive functional statuses. The majority of smart home users reported great benefits, and recommended it to others. The application of smart home technology to retrofit existing houses will most likely assist elders to continue living in their own home. Choosing X10 technology, this project intended to assess the benefits of SH function in independent living among home-based frail elderly. For this project, both stand alone devices (for window and door safety tied with motion sensors and chimes, and remote control for TV/VCR, radio, and lighting) and computer controlled devices (for lighting, coffee maker, and medication reminder) were used. The purposes of this two-year SH intervention study were to: 1) test the possibility of application of commercially available X10 technology to make existing houses of frail elderly smart; 2) identify the user's subjective evaluation of SH functions; and 3) assess the effectiveness of the combined computer use and SH functions on participants' functional status and depression.

This work addresses the issue of designing for privacy in smart homes. We identify several principles to guide privacy management in smart homes, propose and analyze several general privacy management techniques, and evaluate existing privacy management efforts in ubiquitous computing. We conclude by explaining how existing work is not contextually expressive enough to give inhabitants the level of control they should have over their personal information. The contributions of this work are threefold: an increased understanding of the notions of privacy and designing for privacy within smart homes and the proposal of new solutions to handling privacy related issues within smart homes, and the facilitation of the acceptance of smart home technology into mainstream society.

This article describes the highlights of the first two years of activities of RoboCare, an Italian research project aimed at developing intelligent software and robotic agents which can enhance the quality of life of elderly people at home or in a health-care institution. These two years of research have produced several innovations related to the use of robotics, sensory, and activity monitoring technology in the elder-care context. This paper provides a summary of the main contributions of RoboCare in its first two years of activities. Rather than describing in detail the specific techniques we have developed, for which we point the interested reader to related work, our aim is to highlight some specific issues which our results have given rise to in the context of AI applications in elder care. More specifically, the paper is dedicated to exposing the principal strengths and weaknesses of our technology in this application scenario.

In this paper, we propose a steward robot system in the human-friendly assistive home environment for the independent living of persons who are elderly or disabled. In the view of extended concept of services robot, steward robot becomes an efficient intermediate agent between the potential user and the complex control environment with its learning and emotional interaction capability. Two different types (software type and hardware type) of steward robots are introduced which have been developed in the Intelligent Sweet Home (KAIST).

Many people with mobility impairments have difficulty using ordinary wheelchairs for a variety of reasons. Powered wheelchairs can alleviate many inconveniences, but require battery charging and transferring between bed and wheelchair may be difficult. We developed a robotic wheelchair to resolve these problems. The robotic wheelchair can operate in three modes: manual, semi-autonomous, and autonomous. In autonomous mode, it can perform autonomous docking to both the battery charging station and the mechatronic transfer robot system.

In an implementation project in The Netherlands a small investigation was made of the most urgent needs of older home care clients. Two potential user groups for the development of specific care-arrangements were indicated: “older persons becoming lonely and inactive”, and “partners/caregivers of patients with dementia.” The care-arrangement “Attention Care” is aimed at supporting lonely persons and the care-arrangement “Monitoring of Behavior” is aimed at providing surveillance at a distance to support the care giving relative of a person with dementia. Both care arrangements use video telephony to communicate with professional caregivers. In February 2005, field trials started, which will continue until the end of November 2005. Evaluation of data gathered during this trial is discussed.

As a small rural VA Medical Center, we have embraced the challenges of providing high quality, accessible health care. Utilizing a business planning process with strong clinical leadership, we developed and implemented a successful home-telehealth program whose patients' profile includes advanced age, chronic disease processes and the desire to remain independent. The challenges of the rural environment provided opportunities for creative programming. Collaboration between technology, staff and patients have had statistically positive results for our patients and Medical Center.

The UF Center for Telehealth's AlzOnline project provides Internet and telephone-based support, information, and skills training to caregivers of persons with progressive dementia. Since its inception, AlzOnline has worked through community service leaders to provide caregivers of persons with progressive dementia, looking for relief in the day-to-day tasks of caregiving providing education and support. In year 2004 and 2005, AlzOnline had over 240,000 visits to its web-based services.

Telehealth applications are being developed and marketed to meet the challenges of an aging society. Preliminary research into viability, however, has concentrated predominately on cost effectiveness and technological efficiency; moral, legal, and ethical issues remain largely unaddressed in research, evaluation, and practice. This panel discussion examines such issues as privacy, confidentiality, paternalism, equity of access and the role of government and marketplace in shaping the future of this emerging field.

This study is part of a larger project, exploring how to deploy the Internet as a tool to assist home care for people with Alzheimer's disease. This study followed a qualitative paradigm, investigating how the caregivers obtain online information resources for their regular online activities. The participants had four approaches to seek resources for their regular online activities and they usually started the information search with search engines like Yahoo or Google or with their preferred resources. The results provide a base in understanding caregivers' Internet behavior and provides guidance for improving Internet/web design and increasing use of websites.

Assistive Technology (AT) demonstration and evaluation centers are necessary for the accurate dissemination of information to the consumer and to verify the kinds of tools that would best suit the needs of the disabled. Evaluation and demonstration labs are often not available due to perceived costs. The need to “try before you buy” is also a very important aspect of proper AT provision. This paper describes the Oklahoma model showing low-cost ways of providing these services.

This paper documents the design and production of a Universal Cabinet concept created for use in the kitchen and bath. In order to address the needs of a broad range of stakeholders, including users, builders, developers and manufacturers, this functional prototype integrates a height adjustable work surface, clear knee space and requires no specialized modification for installation. To facilitate technology transfer, it has been refined and constructed using the latest Computer Numeric Controlled machine technology.

This paper will describe the policies which facilitate the provision of home modification services to older Australians. It will review the national and state based funding schemes which provide cost-free and low-cost home modification services and examine the nature and availability of these services. Research in Australia examining the nature of home modifications, design features associated with injuries and the efficacy of home modifications will also be discussed.

Performing a sit to stand transfer is a prerequisite for many activities of daily living. In fact, most people perform this transfer many times each day; when getting out of bed, after sitting at the table for a meal and during toileting. However, this transfer has been defined as one of the most biomechanically difficult functional tasks, which only becomes more difficult as people age [21]. To aid this transfer, particularly for older people performing a toilet sit to stand transfer, equipment or home modifications are generally prescribed. The home modifications commonly consist of the installation of a grabrail. However, there remains much debate among therapists worldwide as to the correct positioning and orientation for grabrails. This study aims to provide a comprehensive overview of the existing literature to identify the effects of grabrail orientation on the body and areas which require further research. To complete this research project a systematic review protocol was adopted. This is a rigorous process which ensures that all relevant and available literature on a given topic is located, reviewed and analysed. A specific search strategy was developed to ensure a comprehensive search of all data sources was completed. The data included in this review was obtained from a variety of sources including electronic databases, the World Wide Web and legislation and regulatory documents. A strict inclusion and exclusion criteria were developed to ensure only the most important and relevant information was included in this review. A total of 27 articles and 15 national and international legislation and regulatory documents were located and included in this systematic review. A majority of the research located was completed in the United States of America and Australia. Many of the articles were biomechanically oriented and focused on the older population, who more regularly use grabrails. All of the articles included in this systematic review agreed that some form of arm support, be it grabrails or armrests, provided support to the body while performing a sit to stand transfer. However, no clear recommendations could be made on which orientation of grabrail assists the person without causing undue stress. From the results, specific biomechanical stresses were identified for each grabrail orientation. Further research is required in this area to develop improved guidelines for therapists, policy makers, home modification providers and consumers alike.

Good quality lighting in the home can make the difference between seeing and not seeing for someone with vision impairment. This presentation will discuss a systematic review that investigated whether wayfinding light systems are capable of providing adequate illumination to enable safe and independent mobility. It will outline the research that is currently available on lighting for people with vision impairment and how this information can be used within the home modification industry.

Universal design can allow people to age in place. The purpose of this research is to assess the safety, accessibility, functionality, and aesthetic appeal of universal design in a state of Missouri pilot project for senior residential living. Resident rating was higher for universal design features than for non-universal design in all four categories.