Posts from 2015-11

Mother Knows Best

Mother+Yoga+S4-660

 Sen.se Silver Mother Hub, Cookies, Smartphone and Tablet Apps

Most Americans will be aging-in-place by choice or necessity according to a National Survey on Housing and Home Modification Issues conducted by AARP. [1] The Administration on Aging reported that 28% of older Americans in 2012 lived alone and among women aged 75 and over almost half lived alone. [2] Many have small, dispersed families with few children to provide caregiving. So, what’s a mother, father or loved one to do to prepare for aging-in-place?

Certified Aging-in-Place Specialists (CAPS) can assess your home environment and unique personal needs and then offer modification recommendations to “make your house a home for a lifetime”. [3] Home monitoring systems provide personally empowering technologies to help us live safely for longer at home by detecting changes in daily patterns of activity and communicating those changes to increase our awareness and engagement in activities that promote our quality of life.

Laurie Orlov, founder of Aging in Place Technology Watch writes: “consumers have much to gain from the potential of technology to support efficient self-care and avoid unnecessary services and costs. These include gadgets and tech-enabled services such as sensor-based activity trackers.” [4] Innovative sensor systems are lowering the cost and simplifying the practice of monitoring daily activity patterns around the home. This proves to be especially useful when aging-in-place.

In this article I will explore the Sen.se Silver Mother system, which uses small wireless sensors called Cookies that may be secured to common household items to detect a person’s daily activities. Cookies measure motion and temperature, transmitting this data to the Mother hub. The Mother plugs into your internet service, connecting the Cookies to the Sen.se server, where their sensor data is processed into meaningful information about daily activity patterns and sent back to your personal computer, smartphone or tablet. Mother’s Apps present this information to you, providing helpful feedback that empowers people to practice the 3 A's: Awareness, Attention and Action. Awareness of our daily activities draws our Attention to the routine patterns that indicate our quality of life, which gives us insight to significant life’s changes that may require Action.

 

Three scenarios illustrate how Mother can help realize the 3 A’s to enhance our quality of life:

Kelly lives independently:

Kelly lives alone in the home she and her husband raised their family. She has continued to accomplish all her activities of daily living at her own pace, but she confided in me, her pace has been slowing down recently. Kelly also feels that she is not sleeping as soundly as she used to and wonders if she should just chalk it all up to age. I suggested to Kelly that she could easily measure her daily activity level and sleep quality with a Silver Mother and a few Cookies. A Cookie was placed on her bed, under the mattress cover, to measure her sleep patterns that look like this:

SleepQuality-2amUp

This sleep quality graph shows that Kelly fell asleep quickly and slept deeply until about 2 AM when she rose for the bathroom. We can see that she never fully settled back down to deep sleep after that and arose at 6:31 AM feeling tired. To see if Kelly’s sleep was affecting her daily activity level, she carried another Cookie in her pocket that counted her daily steps. Soon we could see the obvious: a poor night’s sleep preceded a slow day. I suggested that Kelly use her Activity Cookie as a fitness tracker to provide her with feedback and encourage her to get more exercise. She began taking morning walks with her friend Paula, getting regular exercise and, as her Bed Cookie revealed, sleeping more soundly too. Mother helped Kelly become Aware of her sleep quality and activity patterns, drew her Attention to how they are interrelated and motivated her to take Action to improve her exercise and sleep quality.

Casey is Paula’s Family Caregiver:

Since Paula’s fall, Casey has become extra vigilant. First came the frequent check-in calls, then Casey ordered a Personal Emergency Response System (PERS) so that Paula could call for help at the touch of a button. All this anxious attention made Paula feel more fragile and burdensome. Their phone calls became more like interrogations than conversations once Casey discovered that Paula wasn’t always wearing her PERS. Paula heard from Kelly about how her Silver Mother provides 24/7 vigilance without having to push a button and asked me how it all works. I showed Paula and Casey how Silver Mother can check daily activity patterns by placing Cookies on everyday objects like pill boxes and refrigerator doors to register every time Paula opened and closed them. Now with Mother providing vital cues about Paula’s daily activities, Casey feels a greater sense of connection and peace-of-mind that all is well. Paula feels more secure knowing that, if something went wrong, Casey would be alerted and come to her aid. For example, Silver Mother’s Medication App showed:

Meds-Missed-2

Casey could see that Paula is usually pretty reliable about taking her meds, but on Sunday Casey received emails from Mother that the Noon and Evening Meds had been missed. Furthermore, Paula had not opened her fridge since breakfast. Casey phoned Paula who was feeling quite ill and needed Casey’s hands-on care. Mother helped Casey become Aware of Paula’s regular activity patterns and how well Paula usually took care of herself, drew their Attention when conditions changed and alerted Casey when Action became necessary.

Intentional Community of Friends Living Interdependently:

Since Paula and Kelly are neighbors, I suggested that they might both benefit from sharing some of their Silver Mothers’ “advice”. While at first they were reluctant to share too many personal details, the friends agreed to receive alerts from Mother if either one missed taking their important meds or if the temperature in either of their homes exceeded safe levels.

This summer’s heat wave put Mother to the test. One especially hot afternoon, Kelly got an email and a text message from Mother that Paula’s house had reached 100 degrees, so Kelly called her up and suggested they go out together and cool off at the movie theater. Paula declined, saying that she felt too exhausted to go out. Concerned, Kelly went to Paula’s house and found her suffering from dehydration and heat exhaustion. Mother’s alert brought Kelly’s care – a timely action that may have saved Paula from a life-threatening heatstroke. Silver Mothers can help old friends keep in touch, share Awareness of each-other’s wellbeing, give their Attention to their relationships and have the confidence to take Action in response to troubling changes that may arise in their homes.

Paula and Kelly meet with their group of old friends for lunch every month. When they shared their story with the group, one neighbor who is an active member of the local Village had an aha-moment: just imagine how this technology could help Intentional Communities like Villages, Cohousing and NORCs fulfill their promise to help members live longer and safer in their own homes.

Empowering People with Social Technologies:

Long before products like Sen.se Mother, I developed a networked home sensor system to explore internet-enabled assistive technologies, with funding from the Intel Research Council. I wanted to see how people’s sense of connection, meaning and purpose is influenced by their participation in Peer Care. [5] My most important discovery was not technological – it was empowering people with Social Technologies for Interdependent Care. [6] When we share responsibility for the well-being of each other, we become motivated to take better care of ourselves!

As a gerontechnologist, I have designed, built and evaluated sensor systems, learning the art of monitoring the right activities, placing the sensors properly and fine-tuning systems to best serve each person’s unique lifestyle and home conditions. Like all sensor systems, the Sen.se Mother needs careful consideration to work well, but it is one of the most flexible and affordable systems that I have evaluated. [7] While the setup may be accomplished by a tech-savvy Do It Yourselfer, people with no prior experience connecting network systems and sensors would benefit from help getting started. With proper guidance, setup and training, sensor systems like Silver Mother offer us greater awareness of daily routines and significant changes that may affect our safety and quality of life, while providing opportunities to extend our independence through caring relationships.

For more information, please visit http://carewheels.org/projects/silvermother

References:

[1] Harper L, Bayer A. Fixing to Stay: A National Survey on Housing and Home Modification Issues. AARP Knowledge Management, AARP Programs/Applied Gerontology Group. 2000; http://assets.aarp.org/rgcenter/il/home_mod.pdf

[2] Administration on Aging, U.S. Department of Health and Human Services. A Profile of Older Americans: 2012; http://www.aoa.gov/Aging_Statistics/Profile/2012/docs/2012profile.pdf

[3] National Association of Home Builders, Aging-in-Place Remodeling

http://www.nahb.org/en/consumers/homeownership/aging-in-place-vs-universal-design/aging-in-place-remodeling.aspx

[4] Orlov L. Baby Steps: Will Boomers Buy Into Mobile Health? California HealthCare Foundation. 2015;

http://www.chcf.org/resources/download.aspx?id={373655F8-E700-4898-9033-3AB6B1F5874A}

[5] Riche Y R, Mackay W. Peer Care: Supporting Awareness of Rhythms and Routines for Better Aging in Place. Computer Supported Cooperative Work. 2010; Volume 19, Number 1, 73-104, DOI: 10.1007/s10606-009-9105-z http://www.yannriche.net/papers/JCSCW/PeerCare_JCSCW.pdf

[6] Goodman C. Social Technologies for Interdependent Care. 2014; http://carewheels.org/images/pdfs/Social_Technologies_for_Interdependent_Care.pdf

[7] Sen.se Silver Mother https://sen.se/silvermother/

Home Sweet Smart Home

Given the choice, most of us would prefer to live in our own homes, rooted in our own communities, as we grow older. We desire to continue living safely, independently and comfortably, regardless of age, income or ability level. As we age-in-place, we and our families may want some extra peace of mind. We want to feel safe at home. Our family may want to know that we are OK – up and about enjoying our day. We don’t want to become a burden on our family and they don’t want to neglect our wellbeing.

People have invented many clever ways to cope with their concerns about aging alone at home. For example, my neighbor uses her porch light as a simple security signal. We can check on her well-being by seeing if her porch light is turned on in the evening and off in the morning. Any break in her normal routine signals a potential problem and results in a phone call to enquire if she’s OK. A simple, do-it-yourself, low-tech solution for our healthy aging neighbor.

Dr. Patrick Roden clearly defines aging-in-place-technology as “technology that’s used to assist people in maintaining: safety, independence, health/wellness, social connections and support systems”. Just as people install burglar alarm systems to alert them to a possible intrusion from the outside, as we age alone at home, it makes sense to have a system that detects problems inside the home and connects us to someone who is able to respond with assistance.

My friend’s recent experience provides a great example of this kind of high-tech assistance. He and his wife invited her 92 year old mother to move from Los Angeles to an apartment near them in Lake Oswego, Oregon. They asked me to recommend smart home technology that would support her desire to keep living independently while providing some assurance that she was safe and well at home. I recommended a sensor system that would give them a sense of her daily activity patterns and alert them to significant changes on their smartphones

She was living independently, close to her family, enjoying her grandchildren, getting help with supports like driving – and thriving – until one day when my friend detected that she was not following her normal daily activities. When he called her and got no answer, they drove to her home to find her completely “out of it” – non-responsive, incoherent and very weak. He called 911 and got her to the hospital where she was found to be suffering from kidney shutdown and a serious UTI (urinary tract infection). She is out of the hospital now, but my friend wrote: “We're pretty sure if we had not gone to her place, she would not have made it through the night.”  The sensor system provided crucial information that may well have helped save her life. She also had a Personal Emergency Response System (PERS) – a call-for-help button – but she never pressed it.

PERS are very popular and valuable because older adults who receive help within 1 hour of a fall are nearly 6 times more likely to survive than those who wait longer for aid. PERS can bring help fast after a fall, but they are not fool-proof. If for any reason the help button is not pressed, help may not arrive in time. For this reason, smart home sensor systems offer added security for people living alone because sensors can detect changes in activity patterns that may indicate a crisis, while also providing a daily sense of connection and peace-of-mind when all is well. For example, a sensor placed on the refrigerator indicates that a person is accessing food and drink; a sensor on the medicine cabinet indicates whether medications are being taken on schedule. This information provides an extra sense of connection that can improve communication by providing essential cues about daily activities. It can also help to transform the tenor of check-up phone calls from intrusive interrogations to pleasant conversations.

These smart home sensor systems use wireless technology which simplifies installation. No cameras, microphones or intrusive surveillance systems are needed to detect activity changes that may indicate an incipient problem or an immediate crisis. With the addition of more specialized sensors and vital sign monitors, in-home monitoring systems may provide assessments of Activities of Daily Living and connect with Telehealth Services to deliver in-home care for chronic health conditions. These support systems may improve the quality of life and reduce the risk of preventable hospitalizations or institutionalization of older adults, while also reducing the anxiety of their loved ones.

There’s no simple one-size-fits-all smart home technology for everyone facing the personal challenges of aging-in-place. The choice depends on the level of service required to meet each person’s need and risk, as depicted in this graph:

Graph-AIPTech-SvcLevels-vs-NeedRisk

IADLs: Instrumental Activities of Daily Living including: housework, taking medications as prescribed, shopping and managing money that are necessary for an individual to live independently at home in their community.

ADLs: Activities of Daily Living including: bathing, feeding, dressing, grooming and homemaking that provide a measure of the individual’s basic functional status.

Notice that the level of service increases with the level of need, along with the cost. Privacy tends to decrease with increasing level of service – a necessary compromise between risk and independence. Cost and privacy should be considered when comparing the options between continuing to live at home and moving to a facility. Long Term Care Associates reports that in 2014, the Oregon State median cost for an Assisted Living private, one bedroom was $48,000 per year. Smart Home systems vary in price depending on complexity, monitoring and response service options, ranging in price from $400 to over $1,000 per year. In addition to cost, the choice to stay home with a sensor system should be guided by the current level of need, with the understanding that needs may change over time.

As a Gerontechnologist, I am often asked: “How does one determine which smart home system is right?” The best answer considers the whole person – from their personal goals and home environment to their family circumstances, social circles and community. I share this holistic approach with Certified Aging-in-Place Specialists, Occupational and Physical Therapy practitioners, who can assess your home environment and unique personal needs to develop effective strategies for accommodating individual aging factors. Gerontechnology complements these practices with new tools for personal empowerment and methods to connect and coordinate care.

For example, I have partnered with a Certified Aging-in-Place Specialist to help a family design their “forever home” with recommendations based on principles of universal design, that has enabled the clients to preserve their current lifestyle with maximum independence, dignity and privacy, while ensuring their comfort, safety and security.

There are many options for aging-in-place and many innovative technologies to help people achieve their personal goals for remaining in their own home by addressing their current needs while anticipating and preparing for future changes.  With proper selection, installation, training and support, these technologies can offer an enhanced sense of security, prolonged independence and improved quality of life while also detecting small changes in activity patterns before they become big problems.