Technology for Adaptive Aging (2004) / Chapter Skim
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7 Everyday Health: Technology for Adaptive Aging
7 Everyday Health: Technology for Adaptive Aging
Pages 179-208
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From page 179... ...
Novel approaches range from implanted and wearable technology to distributed networks embedded in the living environment to in-home delivery of health services from remote locations. These technologies target several pressing health needs of older adults, including promoting physical function and social interaction, facilitating early diagnosis, enabling self-monitoring of health status, and assuring 179
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From page 180... ...
to increase the quality and years of healthy life. Just as advances in science and technology converged to spawn invention of the health clinic in the 1700s,1 contemporary developments in these same arenas may herald the birth of a new era in which healthcare is increasingly based in the home and community, enabled by a range of pervasive, embedded computing and communications technologies.
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From page 181... ...
. Blood vessels become thicker and more rigid with age, with blood pressure fluctuating more widely in response to catecholamines, exercise, and postural changes.
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From page 182... ...
This change in body composition also lowers energy requirements and increases the risk of micronutrient deficiency, glucose intolerance, and immune dysfunction. Although increased fat mass may protect older adults from hip fracture and hypothermia, it is an independent risk factor for many chronic disorders (e.g., heart disease, stroke, cancer, diabetes, and osteoarthritis)
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From page 183... ...
Medications may be prescribed by several different clinicians and contribute to polypharmacy, or consumption of a large number of medicines with possible additive or interactive effects. Older adults use more health resources despite access barriers that include transportation difficulties, lack of proximity to health providers and facilities, and high out-of-pocket costs for uninsured expenses.
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From page 184... ...
Although most exhibit remarkable vitality, when deterioration occurs the consumption of health resources and the need for support increase considerably. Changes in lifestyle may also result, as when fear of falling undermines confidence in walking and leads to deconditioning or when embarrassment about memory loss or urinary incontinence causes withdrawal from social contact.
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From page 185... ...
In terms of location, devices may be implanted in, worn by, or within reach of an older adult. They may be part of an embedded network of devices within the living environment, or even provide in-home access to resources based some distance from Health Status Physical Function Domain Social Interaction Adaptation Remote Cognitive Environmental Function Personal/Mobile Primary Tertiary Secondary Operation of Level of Prevention Site FIGURE 7-1 Three-dimensional model of health-related technology.
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From page 186... ...
Sometimes a low-bandwidth connection that lets a person know someone on the other end of the line is "there" may be more powerful than an immersive, high-bandwidth video link. Similarly, the adoption of multimedia technologies such as DVD, personal videorecorders, and mobile "entertainment" devices means that elders will increasingly have multiple channels through which health information, coaching, and social support can reach them.
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From page 187... ...
Most of these devices are being targeted for use by medical professionals, but as they become cheaper and more available, and as even simple household devices like bathroom scales, thermometers, and blood pressure cuffs are being connected to the Internet, consumers will begin to purchase and use this kind of equipment, whether or not their physicians are prepared to deal with that fact. More and more, devices are becoming embedded into "everyday technologies" like cell phones that can monitor heart rate, PDAs that know how many steps we have taken, or clothing such as the VivoMetrics LifeshirtTM system that tracks "Every Breath, Every Heartbeat."3 As much as we need to move beyond clinic-centric thinking, it is clear from the kinds of technologies mentioned above that we also need to escape our past conceptions of computing and communications technologies.
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From page 188... ...
6) describes this new technology paradigm as "embedded networks," or "EmNets" for short, indicating that Computing and communications technologies will be embedded into everyday objects of all kinds to allow objects to sense and react to their changing environments.
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From page 189... ...
. The other is about "Jim" and "Jennie" who still live together in their home in spite of Jim's multiple health problems: high blood pressure, diabetes, and increasing cognitive decline due to Alzheimer's (see Box 7-2)
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From page 190... ...
In the discussion that follows, we weave the stories of Sarah and Jim and Jennie into the fabric of a conversation about core technologies and capabilities that are emerging in an embedded networks paradigm. The list of nine research areas below (see Table 7-1)
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From page 191... ...
How would such a network get installed, who would care for it, and what would happen in the event of its failure if it were to become Sarah's lifeline to the rest of the world? Wireless broadband for the home is one of the foundational technologies for EmNets, as it provides a building block for many of the capabilities described above.
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From page 192... ...
With the Health Insurance Portability and Accountability Act (HIPAA) and future legislative mandates protecting private data, security technologies must be built into these wireless networks to protect everything from low-bandwidth raw data (a sensor tracking how often someone uses the restroom or how restless he or she is at night)
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From page 193... ...
What can researchers learn about the aging process itself by having access to a widespread database of longitudinal biological data? Activity Sensors and Behavioral Diagnostics Although biosensors have become a headline- and venture capitalgrabbing topic, a smaller but equally important technology research area is activity sensors that enable a kind of everyday behavioral diagnostics that may redefine how we engage in prevention and early detection and monitor adherence to treatment.
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From page 194... ...
Information Fusion and Inference Engines Although Sarah, Jim, and Jennie are unlikely to know or care about the underlying "artificial intelligence" technologies used in their sensor networks, it is important to mention the need for computer science research to transform raw sensor data, both biological and behavioral, into useful, meaningful information. Neither Sarah's daughter nor her primary care physician is likely to want every bit of raw data in the weight and motion sensors that could be placed in her bed to monitor how well she is sleeping.
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From page 195... ...
-- to identify classes of activities that need to be tracked and the sensor approaches that can even begin to provide the raw data to such an inference system. Personal Health Informatics In an age when Sarah is still trying to get her complete medical record from her old doctor, now that she has found a new physician closer to her new apartment, and Jennie finds it difficult to know all of the medicines that Jim is supposed to be taking for his diabetes, high blood pressure, and Alzheimer's, it is almost impossible to imagine the kind of lifelong database needed -- and created -- by embedded networks in the home.
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From page 196... ...
Different people are likely to respond to different kinds of prompts or reminders, and many may well prefer something more abstract, private, even playful. The refrigerator is an excellent example of how the home network can not only afford sensor input, but also serve as an actuator network -- as a means of controlling and animating the environment far beyond today's home control networks used for lighting, heating, and music.
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From page 197... ...
, calls for a paradigm in which embedded networks of multiple kinds of computing devices allow systems to act more proactively on our behalf when we want them to. This transition is more necessity than nicety because there will be hundreds if not thousands of computing elements in our homes, and no human will be able to pay attention to each and every component.
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From page 198... ...
Eventually, the information may become so difficult for her to track and translate from medical jargon that she may consult a virtual personal medical assistant, much like the one being developed at the University of Rochester Center for Future Health,8 regarding which medication she should administer to Jim for his headache. Many Alzheimer's family caregivers experience severe burnout, depression, and exhaustion because of the around-the-clock care demanded by their charges.
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From page 199... ...
Embedded networks will afford mass customization so that each device can adjust its interaction paradigm according to the needs and preferences of the user. At the simplest level, Sarah's "connected home" can know which room she is in, which device she is closest to, and which device or interface she prefers based on a trend analysis of her past usages.
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From page 200... ...
How can those systems adapt and "grow old" with a person to meet increasing needs for medical, physical, cognitive, and social support? Remote Community and Collaboration This last but certainly not least important research area for aging in place concerns the social interaction domain.
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From page 201... ...
Granted, today's elders may not have access or abilities to use solutions like these, but we need to begin research today to build evidence for or against the utility of embedded network capabilities applied to aging-in-place challenges. These technologies can be reworked to start to test some of these new social support and caregiving paradigms -- and to build a body of knowl
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From page 202... ...
Identification: Finding and Prioritizing Problems to Pursue Recognizing that research resources are limited, we must ask: What are the most important, high-impact problems that embedded network technologies and proactive computing should try to address? Within each of the support domains, what kinds of behavioral changes and interventions are most needed to improve health status, physical and cognitive function, and social interaction?
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From page 203... ...
These can be done by human factors experts, interaction designers, and social scientists working with engineering teams and health professionals to create an array of artifacts for "testing" with elders, their informal care networks, and their professional caregivers. A rigorous, iterative process from simple sketches or storyboards to "vision videos" to onscreen animations to "informances"13 to concept prototypes (often called "wizard-of-oz" prototypes)
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From page 204... ...
What capabilities have we missed or mischaracterized that will likely impact the home health "platform" over the coming decade? Also, what core technologies and capabilities will be developed for other applications like digital entertainment and home security that can be exploited for home health and aging-in-place purposes?
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From page 205... ...
Greater utilization of cooperative agreements and contracts will be needed to bring together the various players who can develop and evaluate these complex technologies. Several questions arise: How can "open-source" research platforms for the home be constructed across competing universities and businesses to help accelerate home health research and development efforts?
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From page 206... ...
from which inferences are made about an individual's health status, physical function, cognitive function, and social interaction. The economic benefit of these health-related technologies remains an open question.
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From page 207... ...
" perhaps we will discover that the promise of everyday health through embedded technologies is not only about improving the health and well-being of our older population, but is about enabling all of us to live the well-lived life. REFERENCES Berger, J
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From page 208... ...
. Proactive computing.
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