Aging population ratios are rising significantly. Health monitoring systems (HMS) in smart environments have evolved rapidly to become a viable alternative to traditional healthcare solutions. The aim of HMS is to not only reduce costs but to also provide timely e-health services to individuals wishing to maintain their independence. In this way, elderly people can avoid, for as long as possible, any interaction with healthcare institutions (e.g. nursing homes and hospitals), which in turn reduces pressure on the health system. To fully realise this vision of seamless e-health services supporting people in need of them, a number of challenges that need further investigation still exist. To this end, we provide an overview of the current state of the art for smart health monitoring systems. We review HMS in smart environments from a general perspective and with a particular focus on systems for the elderly and dependent people. We look at the challenges for these systems from the perspective of developing the technology itself, system requirements, system design and modelling. We present a consolidated picture of the most important functions and services offered by HMS for monitoring and detecting human behaviour including its concepts, approaches, and processing techniques. Moreover, we provide an extensive, in-depth analysis and evaluation of the existing research findings in the area of e-health systems. Finally, we present challenges and open issues facing the smart HMS field and we make recommendations on how to improve future systems.
Existing e-health monitoring systems mainly operate in isolation from the requirements of modern healthcare institutions. They do not include optimized techniques which learn the patient's behavior for predicting future important changes. We propose a new context-aware e-health monitoring system targeted at the elderly and isolated persons living alone. It monitors daily living activities and evaluates dependency based on geriatric scales used by health professionals. Its adaptive framework collects only relevant contextual data for evaluating health status. By monitoring the achievement of daily activities, the system learns the behavior of the monitored person. It is then able to detect risky behavioral changes by using our novel forecasting approach based on the extension of the Grey model GM(1, 1). In order to evaluate our system, we use a Markovian model built for generating long term realistic scenarios. By simulation, we compare the performances of our system to traditional monitoring approaches with various synthetically generated scenarios and profiles. Results show that with minimal sensing and data collection, our system accurately evaluates a person's dependency, predicts its health condition, and detects abnormal situations while preserving system resources.
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