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.
Purpose. Types of medication misunderstanding among community-dwelling elderly people were studied. Methods. Community-dwelling people who were at least 65 years of age and who volunteered to participate in a medicationreview program were recruited for the study. A structured interview including a background interview, attitudinal questions, and questions related to dosage, frequency, timing, and what to do if a dose was missed was conducted. Results. A total of 375 people were included in the study. Of these, 232 (62%) showed perfect understanding of their medication regimens. Twenty-eight (7.5%) of the subjects with less than perfect understanding misunderstood a limited aspect of their regimens across multiple medications, most frequently what to do if a dose was missed. These subjects had the least complex regimens, could name their medica-tions and describe their purpose, and rated themselves as having few medical problems. Their lack of knowledge was not attributed to cognitive problems. Twentyseven subjects (7%) did not know multiple aspects of at least one medication and appeared to be at high risk for nonadherence. These individuals had the most complex regimens, had difficulty naming and explaining the purpose of their medications, and rated themselves as less adherent. Eighty-eight subjects (23.5%) demonstrated mixed problems with understanding; they did not show a defined pattern attributable to cognitive or noncognitive factors. Conclusion. A majority of people over the age of 65 years had good understanding of the drugs they were taking.
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
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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