The U.S. healthcare industry is undergoing seismic changes brought on in large part by a growing greying population. Homebased care and connected aging with smart environments for seniors are gaining traction as pivotal solutions, with the number of skilled nursing homes in the country stagnating for more than a decade. Fortunately many seniors — 90% — prefer to age in place in their own homes.
Seniors who are aging in place still need support from a caregiver, which is most often a circle of family members or close friends — according to the Family Caregiver Alliance, there are about 34 million Americans providing caregiver support. Home health monitoring will evolve further to connect directly to professional evaluation to lessen the need for caregivers. But before that becomes mainstream, more families are considering a smart home to support their caregiving plan. A smart home system for those aging in place has applications beyond security monitoring and environmental comfort. The smart home can now convey wellness through insight of coordination of the sensors, schedule and sensors, schedule and other automation data.
Activity and inactivity metrics
Wearable fitness trackers have made daily physical activity easily quantifiable, yet steps are not always an adequate estimation of health for seniors. Many seniors use a mobility aid, but for chronic conditions that about 80% of seniors have, such as diabetes, arthritis or COPD, mobility tracking cannot represent health or daily wellness. Counting the number of times a senior leaves home is slightly more useful, but is also limited for drawing actionable conclusions.
For caregivers, noticing a lack of activity is often more indicative of a health emergency or other need for assistance. For example, if a loved one habitually wakes between 8 or 9:00 a.m. and by 9:30 a.m. uses the bathroom door, a coffee pot or opens a window, this timing can become meaningful for estimating their wellness from afar. If no regular activities are reported from the smart home system after the routine time, then this could be an indication for the caregivers or healthcare professionals to contact their loved one or take action. Not using the bathroom door could indicate that they have not risen from bed and could indicate the need for assistance, such as illness or an acute health event such as a stroke or diabetic episode. An alert coordinated with daily activity markers is unobtrusive to the smart home occupant and can be crucial for their safety and health.
Patterns are as important as status
When assessing wellness, physicians consider the patient’s four vital signs: respiration, temperature, pulse rate and blood pressure. In some cases a fifth quasivital sign is added to track the patient’s level of pain. These readings are taken in real time, but show little trend about general health or wellness. Measurements from wearable devices can provide additional insight through data taken over longer periods of time.
Fitness wearables may have gained traction for tracking exercise, but health and safety wearables have the ability to monitor vital signs over time. Unfortunately, mobile personal emergency response devices have not enjoyed sustained success among seniors — more than a third of users abandon their wearable within three to six months of acquisition.
The smart home, however, does have the potential to be a monitoring tool for senior safety and caregiver support. Two immediate advantages stand out: no need for direct occupant use, and greater insight into the user’s wellness though a broader scope of activities. A simple smart light switch in the bathroom, a discreet motion detector in the kitchen or a water sensor near the shower can tell a caregiver whether there have been changes in activities for daily living and track trends over time. Declines in activity over the course of weeks or months could indicate of a growing condition, which can incite caregivers to proactively act.
Using data over time
While historical activity patterns are critical to gauging senior wellness, shortterm deviations are of key interest as well. Inconsistent episodes of significant nonactivity around the home or an upswing bath or bed activity may reflect nothing more than a tired day or a late snack. But when seen habitually, these changes can indicate an onset of a potential medical condition or acute health event worthy of medical attention.
In either case, the caregiver needs this information to effectively adapt the care that they’re giving to their loved one. Patterns are extremely useful for caregivers and physicians in identifying conditions that might otherwise be subtle, such as depression, which is not uncommon in the elderly. Unfortunately, many seniors may not notice patterns or signs for alarm, whether unknowingly or through denial. Taken individually, each might have little medical meaning. Observed over time, however, the number and frequency of infractions becomes a pattern. Here again, smart home monitoring can help play a proactive role in home health care.
The healthcare industry recognizes that this application of smart home data will become increasingly critical in assessing wellness and delivering care. The smart home is in the early stages of data harvesting for the caregiving application; however, the sensor technologies and control systems are already available through the smart product ecosystem, ZWave. Families can set up a custom smart home in their loved one’s house to provide data that can be used to provide better, more proactive care. Other smart home conveniences such as lighting, temperature control and security can also provide peace of mind to the family, and provide additional benefit.
By: Raoul Wijgergangs
Original posting: IoT Agenda, 2017/05/16