A fully automated, passively activated data-acquisition system was developed to allow routine, continuous, nonobtrusive monitoring of selected Activities of Daily Living/Instrumental Activities of Daily Living (ADL/IADLs) and the production of a behavioral record that could be subjected to trend analysis. The monitoring system uses "off-the-shelf" technologystandard heat, motion, vibration, and electric current sensors-to record the presence or absence of selected behavior and the time, date, duration and frequency of occurrence of sensor signals. Unlike other telemedicine and personal response system applications, this approach monitors strictly object-oriented behavioral indicators. Hence, the individual is not required to wear any special apparatus nor press buttons. The individual continues to undertake her/his normal activity as if the system were not in place. Objects in the environment, e.g., pill bottle, the refrigerator door, a kitchen cabinet, are electronically monitored, but not the individual her/himself. Because the system is "software driven," the monitoring of specific tasks can easily be added or subtracted with no real limit in the overall number of tasks to be monitored. The system's installation does not require retrofitting of the residence and is almost invisible once installed; thus, it can be used in a wide variety of residential environments. The system was tested during a 12-day period in the home of a community dwelling 71-year-old non-impaired male who lived alone. Data were collected on four behavioral domains: medication adherence, movement throughout the house, bathroom use, and meal preparation.
A series of evidence-based studies in Europe and the US have been undertaken to systematically collect information on how a particular behavioral monitoring system is used to provide care to elderly and frail individuals. Findings indicate that the system is effective in providing actionable information to care providers, while being easily incorporated into existing care models.Index Terms-Monitoring of chronic medical conditions, Integration of smart applications in healthcare system, Telehealth applications
A team of seven anthropologists conducted a coordinated, cross- cultural investigation to examine how structural and cultural variables shape the strategies people employ to assure themselves a secure old age. Central to the investigation was the goal of determining how people in the societies involved (Hong Kong, the United States, Ireland, and Botswana) perceive old age and its place in the adult life course, e.g. whether they view old age as an improvement or a decrement compared with other stages of life and the characteristics on which they base their views. The seven sites were selected to ensure broad representation in terms of the key structural variables of scale, complexity, subsistence pattern, residential mobility, and population structure. Both across and within sites people differed in their willingness and ability to discuss the concept of the life course. We attribute this variation to five factors: (i) characteristics of the social field, (2) education, (3) cultural salience of age categorisation, (4) predictability of life events, and (5) variability in timing of normative social or work roles.
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The lessons learned from seven years of the testing of a behavioral monitoring system— the Everyday Living Monitoring System (ELMS) — outside the laboratory in the real world are discussed. Initially, the real world was perceived as messy and filled with noise that just delayed and complicated the testing and development of the system. However, over time, it became clear that without embracing the chaos of the world and listening very carefully to its noise, the monitoring system could not be successfully moved from the laboratory to the real world. Specific lessons learned at each stage of development and testing are discussed, as well as the challenges that are associated with the actual commercialization of the system.
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