Out of Sight, But Not Out of Mind — Technology Tackles Aging-in-Place
By Kate Jackson
Social Work Today
Vol. 4, No. 7, Page 22

If we could, all of us would likely choose to age at home. Technology is helping to make that ideal reality for many people.

Imagine a world in which your aging father’s movements and activities are monitored 24 hours a day, seven days a week. It almost sounds like something from a sci-fi film—as if Big Brother were watching. And it is, but in a positive way.

Technology is making it possible to keep an eye on elders who live at home alone, freeing caregivers from the burden of constant oversight or the worry of how their loved ones are managing alone. It might seem cold, but in fact it appears to improve the elder-caregiver relationship, taking the focus off the care and putting it back on the relationship. It makes elders feel as if someone is looking out for them at all times without invading their privacy or nagging them, and it gives distant caregivers peace of mind that their aging relatives, although they may be out of sight, are still being watched over.

To meet the demands of a growing population of elders who prize their independence and want to stay at home yet who may not feel entirely secure on their own, a number of companies are deploying technology to make homes feel more like safe havens. By equipping the residence with electronic monitoring systems and assistive devices, elders increasingly can age in place longer, eliminating or forestalling the need to make a transition to an assisted-living facility or a nursing home and preventing, in many cases, unnecessary hospitalizations.

Quiet Care
While researchers are exploring more ways to support the aging population, some enterprising firms have rolled out what are sure to be the first generation of home health security products. Living Independently, Inc., a health and elder care company, is already marshaling such technology successfully. In 2002, it launched QuietCare 24/7 Home Health Security System, the first and still the only product of its kind. The technology is simple, unobtrusive, and requires nothing of the elders. Strategically placed wireless infrared activity sensors in the home collect and transmit through a small base station to the company’s command center information about routine yet crucial activities and conditions of daily living. The information is updated every two hours and posted to a secure Web site that is accessible to caregivers. If potentially dangerous conditions exist, the caregiver is notified by a trained telephone operator.

Proprietary algorithms allow the system to identify the details of the elders’ routines, including when they take their medications, what time they go to bed and wake up, when they dress, and when they eat. Sensors in and just outside the bathroom provide information about how long an elder spends there and how many nighttime visits he or she makes. Changes may signal an illness and allow early detection and action. Explains George E. Boyajian, PhD, executive vice president, strategy, research, and development, “if people are using the bathroom too much, they might be sick, or if they’ve stopped using the bathroom when they’re on Lasix, perhaps they’ve stopped taking their medication and you can intervene before it turns into an emergency.” These sensors can also help detect falls or other emergencies by issuing an alert if elders fail to come out of the bathroom in an expected amount of time. Sensors are also placed near the elders’ medication and in their kitchens to indicate whether or not they’re eating and taking medications.

The system learns the occupant’s normal rhythms, tracks activity, and issues alerts—either by telephone, cell phone text message, e-mail, pager, or fax—when activity diverges from the normal pattern. A green alert signifies normal activity, a yellow light suggests that an activity change needs to be explored, and a red alert means immediate attention is necessary. New features, designed to help those among the estimated 4.5 million people with Alzheimer’s who live at home, alert caregivers when elders wander outside the home. The current system also boasts a room temperature sensor that alerts caregivers if the home becomes dangerously hot or cold, and the company expects to be offering telehealth—for example, reporting glucose and blood pressure—by next year. “Caregivers are there perhaps four hours a day, if that, and they don’t know what happens the other 20,” says Boyajian. “With our system, they have a better idea of what happens in the other 20 hours a day.”

This peace of mind is surprisingly inexpensive, especially when compared with the expenditure that would be required for in-home care or placement in an assisted-living nursing home facility. Installation and activation cost approximately $199, and the cost per day, depending on the level of service, ranges from $2 to $3. Perhaps more important, the older adults like it.

QuietCare asks nothing of the elders. They need not wear any devices and they needn’t change their behavior. They can simply forget it’s there. According to Boyajian, “Once we’re inside the house, we have about a 97% acceptance rate. The elders always use it—they don’t turn it off.”

More than a decade of consideration and development went into the system, invented by Drexel University’s faculty members Anthony Glascock, PhD, a gerontologist and professor of anthropology, and David Kutzik, PhD, a technology-minded gerontologist and associate professor of sociology, both spurred on by a desire to improve the well-being of their own aging parents. To determine what activities were important to track, they turned to a cadre of professionals, including physicians, nurses, and geriatric social workers.

QuietCare is at the leading edge of a wave of technological solutions that take elder alerts a step further because it doesn’t merely sound an alarm in an emergency but rather monitors the pace and activities of daily living, and by doing so collects information that can help caregivers anticipate problems before they become catastrophic. Thus, it reduces the need for hospitalization and reduces risks by signaling when attention is necessary.

Because it’s unobtrusive, the system gives elders a greater measure of privacy. It helps keep their children from becoming, in effect, the parents. Further, it requires no special skills or equipment. The system works through a household’s telephone system and dials into an 800 number. It can be used not only in the home but also in assisted-living and nursing care settings, as well as by social service agencies that assist elders and their families.

The Future
QuietCare is just one of a range of products and services produced by a growing number of home health aid businesses cropping up to meet the demands of an aging population that wishes to age in place for as long as possible and forestall, if not eliminate, the need to leave their homes. Future developments—and there are likely to be many—will be made possible by ongoing research by a number of technology companies, such as Intel, General Electric, and Honeywell.

At Intel, for example, an enterprise called the Proactive Health Research Project—the outgrowth of a study of digital entertainment—is working on the underpinnings of the next generation of products and services. Says Eric Dishman, principal investigator for Intel research, “The project is looking at a broad class of home and everyday technologies that could help people age in place from wherever they choose. We’re exploring what the next cohort of seniors is going to be like, what they’re going to be using on an everyday basis, and how we can leverage that to help them with their health and independence.”

In 1999, Dishman led a group of roughly a dozen social scientists at Intel involved in “People in Practices” research, looking at new uses for technology. By studying the practices of 200 households, it focused on people’s needs and practices with respect to entertainment and the future of television and music technology.

The study subjects, however, quickly let the project know it was on the wrong track. According to Dishman, they said, “We don’t need more glorified ways to watch television. We need some ways to help take care of our aging parents and our own aging bodies.” They described the practical difficulties of caring for relatives while juggling other responsibilities, convincing the project leaders, says Dishman, “that maybe a more powerful way of selling new technologies in people’s lives would be to address their caregiving needs and not just pay attention to their channel-flipping habits.”

In 2002, Dishman and two colleagues launched Intel’s Proactive Health Research lab, focusing on how technology might assist individuals with cognitive decline, cancer, and cardiovascular disease. The project thus far has centered on only one of these areas: how to help people with mild cognitive impairment stay socially active and independent longer. They spent the first year studying 100 households—individuals with a full range of cognitive decline, some with full-blown Alzheimer’s disease, and others with early-stage impairment who were still quite functional. They performed what they call shadow studies—essentially living within the households to determine what really goes on and what the needs truly are.

The project isn’t currently developing products but rather exploring research technologies, most importantly those centered on social health support. Dishman explains, for example, that for individuals with cognitive impairment, a ringing telephone can be terrifying. And when the telephone is avoided out of fear, the elder’s social world can shrink. “There’s some evidence that lack of social interaction can accelerate disease, and good social support can stimulate the brain,” says Dishman.

Intel is performing trials on a system that relies on wireless sensors that measure elders’ social interaction: how much time they spend with others, whether or not they are using the phone, whom they are calling, and when they get visitors. After the baseline data are gathered, he says, they look for a dropoff of normal activity because they believe changes in social patterns may be the best early indicators of cognitive decline, and early detection can lead to earlier treatment and a longer period of independent living. The technology and research may take years to bear fruit, Dishman says, but it’s promising. “We’re putting some of these technologies into studies of large samples of 80-year-olds who are perfectly healthy, and by the time they turn 85, half of them will have some sort of cognitive decline. We’ll be able to retroactively determine if the technologies in place could have helped detect problems in a medically meaningfully way.”

The mission statement of the project, explains Dishman, “is to catalyze a research ecosystem around home health and wellness technologies for the next wave of elders, and in that spirit of catalyzing, our project is very open, and we’re partnering with many other companies and universities.” Together, they’re forging a brave new technological future for the growing number of elders.

— Kate Jackson is a staff writer for Social Work Today.

For more information:
To learn more about QuietCare, visit www.livingindependently.com.
To learn more about Intel’s Proactive Health Research Project, visit www.intel.com/research/prohealth.

E-Pill
Stefan Solvell, president and manager of e-pill, LLC, provider of practical patient compliance and age-in-place products, explains that research has revealed that one-quarter of all nursing home admissions are due to poor medication compliance. Even in the wider population, statistics suggest that on any given day, only one-third of prescriptions written by physicians make it to the pharmacy and are taken on a regular basis, and another one-third are not taken in the way doctors intended for them to be taken. One-third of prescriptions never get filled.

“The statistics are very clear, and it’s obvious that you cannot expect to get efficacy from any drugs unless you take them,” says Solvell. The situation can be exacerbated by age, since elders are likely to be taking multiple medications with often complicated dosing schedules.

In response to this problem, Solvell’s company has created the e-pill, electronic devices that help elders remember to take the appropriate medications, at the right time, and in the right amounts. The e-pill is actually the company’s generic term for all the items in its catalog of products that assist elders with medications.

Solvell had been a vice president of marketing at a large pharmaceutical company and was concerned that no matter how good the medications were, if the patients didn’t take them or take them properly, the drugs were useless. The result of his concern was a variety of patient compliance devices—30 different types of e-pills ranging in price from approximately $35 to several hundred dollars—to meet a variety of needs. For example, some elders simply need reminders to take medications. Others need to be reminded if they have already taken their drugs. There are also special products for people with specific needs, such as patients with Parkinson’s disease or diabetes. This simple technology, he says, not only keeps elders in their own homes longer, but it also helps keep them out of the hospital.

As much as 10% of all hospitalizations in the United States result when physicians need to monitor medication use or ensure compliance. “That’s an expensive way to create compliance,” says Solvell. For elders, the most popular e-pill, he says, would be the automatic pill dispensers—devices that hand out the right medications, at the right time, in the right dosages. e-pills are not covered by insurance at this time, but Solvell envisions a time when healthcare professionals might write prescriptions for these products that will be be filled at pharmacies and by durable medical equipment companies.

For more information, visit www.epill.com, www.medclock.com, www.medicalwatches.com, www.age-in-place.com, and www.eadultadd.com.