Assisted Living

An aging population is fueling interest in assisted living technologies (ALTs) to support independence at home. Numerous ALTs have been developed and deployed, but uptake and use has fallen short of levels predicted by policymakers. A key reason is a lack of understanding of users' needs. In this paper we report findings from the ATHENE (Assistive Technologies for Healthy Living in Elders: Needs Assessment by Ethnography) project, which is funded by the Technology Strategy Board under its Assisted Living Innovation Platform programme. The project aims to produce a richer understanding of the lived experiences and needs of older people and explore how ALT stakeholderssuppliers, health and social care providers -can work with users and carers to 'coproduce' ALTs. We focus, in particular, on the role of 'bricolage' (pragmatic customisation, combining new with legacy devices) by informal carers, such as family members, in enabling ALTs to be personalised to individual needs. Bricolage allows users and family members to take the initiative in 'coproducing' ALTs. that making assisted living work relies on collaboration, involving not only formal carers, but also informal ones. We argue that a new research agenda is needed, focusing on solving challenges of involving users and their informal carers in the straightforward and dependable co-production of ALTs.

We report findings from a study that set out to explore the experience of older people living with assisted living technologies and care services. We find that successful 'ageing in place' is socially and collaboratively accomplished -'co-produced'day-to-day by the efforts of older people, and their formal and informal networks of carers (e.g. family, friends, neighbours). First, we reveal how 'bricolage' allows care recipients and family members to customise assisted living technologies to individual needs. We argue that making customisation easier through better design must be part of making assisted living technologies 'work'. Second, we draw attention to the importance of formal and informal carers establishing and maintaining mutual awareness of the older person's circumstances day-to-day so they can act in a concerted and coordinated way when problems arise. Unfortunately, neither the design of most current assisted living technologies, nor the ways care services are typically configured, acknowledges these realities of ageing in place. We conclude that rather than more 'advanced' technologies, the success of ageing in place programmes will depend on effortful alignments in the technical, organisational and social configuration of support.

Ambient Assisted Living (AAL) environments encompass technical systems and the Internet of Things (IoT) tools to support seniors in their daily routines. They aim to enable seniors to live independently and safely for as long as possible when faced declining physical or cognitive capacities. This work presents the design, development and deployment of an AAL system in the context of smart cities. The proposed architecture is based on microservices and software components. We examined the requirements and specifications of AAL systems in smart homes, in efforts to describe and evaluate how they would be transposable in the case of smart cities. The system has been tested and evaluated in the laboratory; it has been deployed in real life settings within city and is still in use by five elderly people.

This thesis aims to suggest the possible links between macro-scale factors and the implementation of the desired characteristics of a residential care model for the elderly in Tehran, Iran. Macro-scale factors such as social relations, economic factors, and aged-care policies in Iran are likely to have ongoing impacts on the architecture of these environments.

Background Although community-based self-management workshops have been found to benefit older adults with Parkinson’s disease (PD), it is unclear if there could be added value for the couple if the spouse also participated. Methods A quasi-experimental two-wave design (0 and seven week follow-up) was used to explore the effects of a self-management program on the health and relational outcomes of older adults with PD and their spouses in comparison to a wait-list control condition. Thirty nine couples were enrolled and completed the study (19 in the intervention group and 20 in the wait-list control). Results Adjusting for baseline outcome values, spouses in the intervention group had significantly greater engagement in mental relaxation techniques (p < .001; d = 1.28) than those in the control condition at seven weeks. Additionally, moderate effect sizes were observed for increases in the mental relaxation (d = 0.44) and aerobic activity (d = 0.44) of older adults with PD and t...

2 • IEEE ROBOTICS & AUTOMATION MAGAZINE • MONTh 2019 1070-9932/19©2019IEEE S ocial robots have been used to investigate human-torobot engagement—but connection between one person and another is the real key for human emotional wellness. This work explores the role and impact of a social robot in facilitating human-tohuman engagement in an assisted-living community. Older adults, in particular, are a population in need of sufficient social connectedness to promote their well-being. While several studies have sought to investigate how social robots can help to improve older adults’ quality of life, not many have studied their long-term impact on community-level engagement. This work uses a participatory, mixed-methods, humancentered approach to explore how a social robot influenced the social connectedness within a community of older adults over a three-week period. Participants engaged in daily interactions with a social robot and with associated study materials in their common areas...

Copyright held by the owner/author(s). CHI’20,, April 25–30, 2020, Honolulu, HI, USA ACM 978-1-4503-6819-3/20/04. https://doi.org/10.1145/3334480.XXXXXXX Abstract Most older adults are reluctant to move out of their homes as they age, but multiple chronic conditions and reduced cognitive and physical abilities make living independently extremely challenging. With our population aging rapidly, enabling older adults to take an active role in their health and remain independent while staying at home has become a crucial societal goal. This position paper discusses designing and building VOLI, a voice-based conversational agent for older adults that makes monitoring their well-being and connecting with their doctors more accessible. VOLI builds a pipeline from older adults’ smart speakers at home to the healthcare system and their Electronic Health Records, and allows them to interact with it through dialogue-based interactions. We highlight the challenges and opportunities that our com...

Voice-based Intelligent Virtual Assistants (IVAs) promise to improve healthcare management and Quality of Life (QOL) by introducing the paradigm of hands-free and eye-free interactions. However, there has been little understanding regarding the challenges for designing such systems for older adults, especially when it comes to healthcare related tasks. To tackle this, we consider the processes of care delivery and QOL enhancements for older adults as a collaborative task between patients and providers. By interviewing 16 older adults living independently or semi-independently and 5 providers, we identified 12 barriers that older adults might encounter during daily routine and while managing health. We ultimately highlighted key design challenges and opportunities that might be introduced when integrating voice-based IVAs into the life of older adults. Our work will benefit practitioners who study and attempt to create full-fledged IVA-powered smart devices to deliver better care and support an increased QOL for aging populations. • Human-centered computing → Empirical studies in accessibility.

Regular walking has several physical and psychological benefits for frail older people. However, many residents in long-term care facilities are too sedentary to achieve these benefits. Indoor walking appears to be a feasible way to promote active living among these residents and yet, there is little research that has been done in this regard. The researcher conducted two studies in Central Texas to explore how corridor design features influenced indoor walking behaviors among assisted living residents. In the first study, the researcher carried out six focus groups with 50 assisted living residents, discussing how they perceived the indoor corridor as "walkable." Residents reported that a walkable corridor should be safe, comfortable, and having beautiful/interesting things to see. In the second study, the researcher further examined the relationship between the built environment and walking behaviors among 326 residents from 18 facilities in a major city of Texas. The results indicated that 'perceived looped corridor' and 'number of stories' were significantly associated with residents' A-9 Seating in the alcove fostering social interaction .

Design for the Frail Old: Environmental and Perceptual Influences on Corridor Walking Behaviors of Assisted Living Residents. (August 2009) Zhipeng Lu, B.Arch., Southeast University, China; M.Arch,, Southeast University, China Co-Chairs of Advisory Committee: Dr. Mardelle M. Shepley Dr. Susan D. Rodiek Regular walking has several physical and psychological benefits for frail older people. However, many residents in long-term care facilities are too sedentary to achieve these benefits. Indoor walking appears to be a feasible way to promote active living among these residents and yet, there is little research that has been done in this regard. The researcher conducted two studies in Central Texas to explore how corridor design features influenced indoor walking behaviors among assisted living residents. In the first study, the researcher carried out six focus groups with 50 assisted living residents, discussing how they perceived the indoor corridor as “walkable.” Residents reported t...

The Role and Future Development of Supportive Housing for Older People in Ireland The standard and suitability of older peopleâ?Ts accommodation is vital to their health and quality of life and a key factor in their capacity to take care of themselves or to be cared for should they become dependent. The NCAOP, therefore, welcomes an increased national policy focus on older peopleâ?Ts housing circumstances, as demonstrated in the current partnership agreement, Towards 2016: Ten-Year Framework Social Partnership Agreement 2006-2015 (Government of Ireland, 2006), and the National Action Plan for Social Inclusion 2007-2016 (Government of Ireland, 2007). Click here to download PDF 3m

The decision to relocate or to age in place can be a difficult one, mitigated by a variety of influencing factors such as finances, physical abilities, as well as social and instrumental support from family and others. This study focuses on the stresses of residential relocation to independent and assisted living facilities among older women living in Lexington, Kentucky. Participation entailed three semi-structured interviews as well as saliva and blood sampling over a period of 6 months, beginning within one month of the move. Measures of cortisol were used as indicators of stress reactivity. Distinct patterns of cortisol response have been identified, with those who indicated the relocation was the result of health issues or anticipated health issues showing the greatest degree of physiological stress reactivity. The majority of women reveal satisfactory psychosocial adjustment, with women indicating the move was facilitated by need for caring for ailing family showing the least amount of facility integration. Significant life events appear to be related to social integration, stress reactivity, and perceptions of facility life over the course of the first six months in residence. These results have implications for facility managers with regard to facilitation of new and prospective resident acclimation and possible interventions aimed at reducing adaptation time among those on waitlists for such facilities.

2021 Nursing staff strategies: Mitigating falls risks associated with unit design (C. Radwan, B. Hahm, M. Kazem-Zadeh, G. Powell-Cope, S. Ahrentzen, S. Luther, R. Shorr) Environmental Design Research Association (EDRA) 52nd Annual Meeting, Detroit, MI, May 19-23.

A minimal wearable system to monitoring remotely normal free-living activity (e.g. laying, sitting, standing, and slow walking) of patients in their home space is proposed. Owing to its wireless features, the system can represent a useful tool to be implemented in a long-time patient monitoring system. These systems are useful for the clinical out coming or for minor chronic pathologies not requiring hospitalization.

Ambient Assisted Living environments projects arise as technological responses of the scientific community to problems associated with the populationageing phenomenon. In theory, these environments should allow de-localization of healthcare services delivery and management to the home, thus containing the economic and social costs associated with old age. The VirtualECare project is one of those environments, enhanced with proactive techniques for a better user experience, focused on elderly chronic patients, through the ability of constant learning and adaption based in user interaction and its contexts. This learning and, consequently, adaption needs, however, unequivocally user identification, especially in multi-user environments. Traditional identification techniques and methodologies are not suitable for these scenario since, usually, require user interaction and wireless identification technique (e.g. RFID, Bluetooth) are very exposed to personification. In order to obtain the expected results we needed a more advanced technology. One possible, appropriate and already fairly developed technique is Facial Recognition. In this paper we present the VirtualECare project approach to Facial Recognition authentication techniques its advantages, disadvantages and possible implementations paths.

Nantucket is one of only a few Massachusetts communities that offers its elderly residents local assisted living and skilled nursing care partially subsidized by local taxpayers. When contemporary standards of care required modernizing Our Island Home to meet those standards, the question arose: Would a 45-bed facility meet the future needs of this isolated island community? A demographic analysis predicted a widening gap between availability and need within 15 years, disrupting local families’ capacity to supplement local institutional care with frequent personal visits to loved ones and obliging Nantucket residents to seek other distant arrangements. The analysis recommended sizing the future facility to accommodate a projected 63 % increase in the future needs of Nantucket families with elderly residents. This case study illustrates two distinct contributions of applied demographic analysis: identifying immediate necessary decisions and clarifying distant long-term tradeoffs for public choice.

Troubling deficits exist in palliative care (PC) of older adults under the prevailing ''terminal care''-oriented model. We previously described a PC model-TLC-that provides a blueprint for remedying these shortfalls. In this model, PC is envisioned as Timely and Team-oriented, Longitudinal, and Collaborative and Comprehensive. We present results of the Palliative Care in Assisted Living pilot, comparing two TLC model-based, facility delivered interventions for improving the PC of elderly assisted living residents in Sacramento, California, a growing and under-researched population. The less intensive intervention involved one assessment followed by a PC improvement recommendation letter to the resident, family member, primary provider, and facility staff, while the more intensive intervention involved assessments and letters every three months. Primary outcomes were SF-36 Physical (PCS) and Mental (MCS) Component scores and recommendation adherence. Eighty-one subjects enrolled (mean age 85), 58 in the more and 23 in the less intensive group. A loved one attended 56% of baseline assessments. Most subjects expressed a preference for maintaining current quality of life over prolonging life at reduced quality. None were eligible for hospice care. A total of 418 recommendations (mean 5.1 per subject) were generated concerning symptoms, mood, functional impairments, and advance directives. We found no significant differences in recommendation adherence between more (42%) and less (44%) intensive groups, and no significant changes in PCS and MCS scores within or between groups. However, a loved one's attendance of the baseline assessment was associated with improved PCS scores (p ¼ 0:04). Our pilot study had methodological limitations that could account for the lack of significant outcome effects.

Prolonged sedentary behavior is associated with increased risk for chronic conditions, and due to technological advances, the working population is in office settings with high occupational exposure to sedentary behavior. Recent technological innovations in conversational artificial intelligence have also made possible to likely influence activity patterns. These activity patterns can be objectively measured using an Actigraph. PURPOSE: The purpose of this study was to estimate the physical activities in response to conversational artificial intelligence stimuli-Alexa's voice activated commands using Amazon Echo. METHODS: Fifteen (24±12.58 years, body mass index: 25.07±5.05 kg/m 2 ) sedentary female office workers were recruited from Berks community office locations. Each participant wore an Actigraph Link GT9X wrist accelerometer for the entire workweek to measure physical activity patterns. After obtaining baseline activity levels every half hour over an 8-hour work day for the first 2 days, participants responded to Alexa's pre-set voice commands which progressed from generic "stand-up" to more specific "walk to the bathroom" for the next three workdays. Commands were programmed every half hour for an 8-hour workday for the last 3 days. RESULTS: Participant's average HR: 74.4 ±11.72 bpm, systolic BP: 120.51±12.71 mm/Hg, and diastolic BP:76.62±6.08 mm/Hg was assessed. A paired-samples t-test was conducted to compare the number of steps taken during baseline (without Alexa) and with Alexa settings. There was a significant increase in the steps for Alexa (234.58±78) steps compared to baseline (150.45±39.93) steps; t(11)=-4.29, p = 0.001. CONCLUSION: There was a 56% increase in the number of steps with Alexa prompts. This suggests that conversational AI, voice-enabled devices like Amazon Echo could potentially influence physical activity patterns.

The evaluation of applications or systems within dynamic environments is complex. The existence of multiple hardware and software items which share the same space can provoke concurrency issues and result in erratic interactions. A sudden change within the environment can result is dramatic changes both to the user and application itself which can pass unnoticed in traditional evaluation methodologies. To verify if a component is compatible with a given environment is of paramount importance for areas like pervasive computing, ambient intelligence or ambient assisted living (AAL). In this paper, a semi-automatic platform for evaluation is presented and integrated with a TeleRehabilitation system in an AAL scenario to enhance evaluation. Preliminary results show the advantages of the platform in comparison with typical observation solutions mainly in terms of achieved data and overall ease of use.

The kitchen environment is one of the scenarios in the home where users can benefit from Ambient Assisted Living (AAL) applications. Moreover, it is the place where old people suffer from most domestic injuries. This paper presents a novel design, implementation and assessment of a Smart Kitchen which provides Ambient Assisted Living services; a smart environment that increases elderly and disabled people's autonomy in their kitchen-related activities through context and user awareness, appropriate user interaction and artificial intelligence. It is based on a modular architecture which integrates a wide variety of home technology (household appliances, sensors, user interfaces, etc.) and associated communication standards and media (power line, radio frequency, infrared and cabled). Its software architecture is based on the Open Services Gateway initiative (OSGi), which allows building a complex system composed of small modules, each one providing the specific functionalities required, and can be easily scaled to meet our needs. The system has been evaluated by a large number of real users (63) and carers (31) in two living labs in Spain and UK. Results show a large potential of system functionalities combined with good usability and physical, sensory and cognitive accessibility.

The use of telemedicine is becoming increasingly popular in assisting with the home management of People with Dementia (PwD) by offering services to the carers that may enhance their ability to care for their relative for longer. A computerized platform, ALADDIN, was evaluated in its usefulness to reduce carer burden and distress and to improve their quality of life, in an attempt to delay institutionalization of PwD. ALADDIN offers educational material about dementia to carers and provides the opportunity to contact other carers and clinicians. ALADDIN also facilitates remote monitoring of the PwD and their carers by the clinicians to enable speedy delivery of appropriate intervention. The ALADDIN platform was piloted at three European sites, and used by thirty carers of PwD living in the community (platform group). The platform group and a control group of thirty PwD and their carers were assessed at baseline, 3 months, and 6 months. The results showed a significant improvement in...

Ambient Assisted Living (AAL) is becoming crucial to help governments face the consequences of the emerging ageing population. It aims to motivate independent living of older adults at their place of residence by monitoring their activities in an unobtrusive way. However, challenges are still faced to develop a practical AAL system. One of those challenges is detecting failures in non-intrusive sensors in the presence of the non-deterministic human behaviour. This paper proposes sensor failure detection and isolation system in the AAL environments equipped with event-driven, ambient binary sensors. Association Rule mining is used to extract fault-free correlations between sensors during the nominal behaviour of the resident. Pruning is then applied to obtain a non-redundant set of rules that captures the strongest correlations between sensors. The pruned rules are then monitored in real-time to update the health status of each sensor according to the satisfaction and/or unsatisfaction of rules. A sensor is flagged as faulty when its health status falls below a certain threshold. The results show that detection and isolation of sensors using the proposed method could be achieved using unlabelled datasets and without prior knowledge of the sensors' topology.

Ambient Assisted Living (AAL) is becoming crucial to help governments face the consequences of the emerging ageing population. It aims to motivate independent living of older adults at their place of residence by monitoring their activities in an unobtrusive way. However, challenges are still faced to develop a practical AAL system. One of those challenges is detecting failures in non-intrusive sensors in the presence of the non-deterministic human behaviour. This paper proposes sensor failure detection and isolation system in the AAL environments equipped with event-driven, ambient binary sensors. Association Rule mining is used to extract fault-free correlations between sensors during the nominal behaviour of the resident. Pruning is then applied to obtain a non-redundant set of rules that captures the strongest correlations between sensors. The pruned rules are then monitored in real-time to update the health status of each sensor according to the satisfaction and/or unsatisfacti...

Ambient Assisted Living (AAL) systems aim to enable the elderly people to stay active and live independently into older age by monitoring their behaviour, provide the needed assistance and detect early signs of health status deterioration. Non-intrusive sensors are preferred by the elderly to be used for the monitoring purposes. However, false positive or negative triggers of those sensors could lead to a misleading interpretation of the status of the elderlies. This paper presents a systematic literature review of the sensor failure detection and fault tolerance in AAL equipped with non-intrusive, event-driven, binary sensors. The existing works are discussed, and the limitations and research gaps are highlighted.

In this paper we discuss the potential of using the Living Lab methodology as an approach to ensuring universal access when designing for senior citizens. Our understanding of Living Labs is based on a recent study of 32 Living Labs cases, identifying central activities and issues in different applications of the methodology. We describe a Danish Living Lab project initiated to design for better quality of life for senior citizens in Sølund, a nursing home in Copenhagen. Two crucial concepts from the Living Lab methodology -co-creation and context -act as the core concepts for our analysis of user participation and universal access in Living Labs in general and in the Sølund Living Lab specifically. In our conclusion we suggest areas that should be given special attention when designing Living Lab projects and selecting user participants.

1.1 Introduction 1.2 An overview of healthcare systems 1.3 Ambient assisted living and enhanced living environments 1.4 Conclusions Acknowledgements References Biographies 2 Enhanced living environments from the viewpoint of socioecological psychology Tama ´s Martos and Viola Sallay Abstract 2.1 Introduction 2.2 Socioecological psychology as a framework 2.3 Concept of 'human niche construction' as a universal human phenomenon 2.4 Home as a niche 2.4.1 Emotional processes in the home: lessons learnt with the Emotional Map of the Home Interview 2.5 Legacy of Self-determination theory 2.5.1 Core concepts of SDT 2.6 Putting it all together: socioecological psychological aspects of ELE 2.6.1 ELE as niche construction 2.6.2 ELE and home niches: the potential places of technology in a complex system 2.6.3 Constructing ELE solutions in home niches: the importance of psychological need support 2.7 Conclusions Acknowledgements References Further reading Biographies

The number of elderly people living alone in their homes is permanently growing in the whole western world. Because of the deteriorating capabilities to sense and interact with the environment, such as memory, eye sight, hearing and mobility, the ageing populations often live with significantly degraded life quality. Many also suffer from chronic diseases that require medical treatment and periodical examinations. Different Assisted Living Systems have been proposed to cope with the problems. The goal is to enable the elderly people to live longer in their preferred environment, to enhance the quality of their live and to reduce the expenses of the public health care. The Assisted Living Systems are based on a lot of sensors, actuators and multimedia equipment, providing for the autonomy of people and assisting them in carrying out their daily activities together with available interaction with remote relatives and friends. The applied approaches and implementations are specific that limit the dissemination of the results between the object oriented groups. Besides, most of the projects require considerable funding for implementation. For the time being and especially for some countries with lower Gross Domestic Product, the efforts may be directed to creation of low-cost assistive systems performing some basic tasks, related to the need and health status of the living alone adults or disabled people, e.g. automatic fall detection and signalization, as well as instantaneous monitoring the photopletismographic signals together with permanently available communication interface between the caregiver and the user.

Inside the Medicine Cabinet…Do you know your staff's common medication usage and how it can impact their practice? Nursing Management. March 2009 ***Reprinted with permission.. No further reproduction is authorized without written permission from the Lippincott, Williams, and Wilkins. This version of the document is not the version of record. Figures and/or pictures may be missing from this format of the document.*** *** Note: *** Note: This is not the final published version Article: A growing number of Americans use prescription and nonprescription medications on a regular basis. An aging population, rapid development and release of new medications, and changes in health practice are all responsible for increased usage.1 Indeed, in any given week, 81% of adults in the United States take at least one medication (prescription or over the counter [OTC]) and at least 50% take a prescription medication.2 Prevalence of use increases with age and by gender, with older women having the greatest medication use.2,3 Most Americans are also likely to take more than one medication (see Table ). While medications are being used by most Americans, there's little information on the specific medications being used by RNs. Nurses working in hospital settings are faced with high job stress, staffing shortages, and increasing patient acuity and care needs. Many common medications are known to have adverse reactions that may interfere with work performance.

Aims: Occupational performance coaching (OPC) helps people reengage in personally valued occupations despite physical or cognitive challenges. We explored the potential of OPC in the context of assisted living. Methods: An instrumental case study was used. A student occupational therapist provided OPC to one resident in one assisted living facility. Interviews with the resident, a family member, and the Health and Wellness Director, and the student's journal notes were analyzed to explore the experience of OPC and determine critical considerations for OPC in this environment. Results: Positive effects were noted for the resident and the residence. Critical considerations for OPC in this environment included an increased facilitation role for the coach, and the importance of an appreciation of potential stress for family and contributions by residence staff. Conclusions: OPC is feasible and potentially effective in assisted living with greater consideration of family needs and staff involvement.

Developed societies are currently facing severe demographic changes: the world population is ageing at an unprecedented rate. This demographic trend will be also followed by an increase of people with physical limitations. New challenges are being raised to the traditional health care systems, not only in Portugal, but also in all other European states. There is an urgent need to find solutions that allow extending the time people can live in their preferred environment by increasing their autonomy, self-confidence and mobility. AAL4ALL is a project currently being developed in cooperation with 34 Portuguese interdisciplinary partners, from industry to academia, R&D and social disciplines, which employs a novel conceptual approach through the development of an ecosystem of products and services for Ambient Assisted Living (AAL) associated to a business model and validated through large scale trial. This paper presents a comparative perspective of the needs and attitudes towards technology of the AAL users and caregivers identified in the analysis of a set of three different surveys: a users survey targeted at the Portuguese seniors and pre-seniors; an informal caregivers survey targeted at the family, friends and neighbours who provide care without any financial compensation; and a formal caregivers survey targeted at physicians, nurses, psychologists, social workers, and direct-care workers providing care to elders. The first results indicate that AAL solutions must be affordable, user friendly and have a true perceived benefit to their users.

Objective: This study aims to assess potentially severe class D drug-drug interactions (DDDIs) in residents 65 years or older in assisted living facilities with the use of a Swedish and Finnish drug-drug interaction database (SFINX). Design: A cross-sectional study of residents in assisted living facilities in Helsinki, Finland. Setting: A total of 1327 residents were assessed in this study. Drugs were classified according to the Anatomical Therapeutic Chemical (ATC) classification system and DDDIs were coded according to the SFINX. Main outcome measures: Prevalence of DDDIs, associated factors and 3-year mortality among residents. Results: Of the participants (mean age was 82.7 years, 78.3% were females), 5.9% (N ¼ 78) are at risk for DDDIs, with a total of 86 interactions. Participants with DDDIs had been prescribed a higher number of drugs (10.8 (SD 3.8) vs. 7.9 (SD 3.7), p < 0.001). A larger proportion of residents with DDDIs suffered from rheumatoid arthritis or osteoarthritis than those not exposed to DDDIs (24.7% vs. 15.4%, p ¼ 0.030). The most frequent DDDIs were related to the concomitant use of potassium with amiloride (N ¼ 12) or spironolactone (N ¼ 12). Carbamazepine (N ¼ 13) and methotrexate (N ¼ 9) treatments were also frequently linked to DDDIs. During the follow-up, no differences in mortality emerged between the participants exposed to DDDIs and the participants not exposed to DDDIs. Conclusions: Of the residents in assisted living, 5.9% were exposed to DDDIs associated with the use of a higher number of drugs. Physicians should be trained to find safer alternatives to drugs associated with DDDIs. Potentially severe, class D drug-drug interactions (DDDIs) have been defined in the SFINX database as clinically relevant drug interactions that should be avoided. Of the residents in assisted living, 5.9% were exposed to DDDIs that were associated with the use of a higher number of drugs. The most frequent DDDIs were related to the concomitant use of potassium with amiloride or spironolactone. Carbamazepine and methotrexate were also linked to DDDIs. No difference in mortality was observed between residents exposed to DDDIs and residents not exposed to DDDIs.

Background: Loneliness is common among older people and implies poor prognosis. Still only few studies have explored loneliness, its prevalence and associates in nursing homes and assisted living facilities. Objectives: The purpose of this study was to examine the prevalence, associated factors and prognosis of loneliness among older people in institutional settings. Design and settings: A cross-sectional study with 3.6-year follow-up for mortality was conducted in nursing homes and assisted living facilities (N = 61) in Helsinki, Finland in 2011. Participants: Participants of the study were all residents (N = 4966) in nursing homes and assisted living facilities. The original participation rate was 72%. We excluded residents with dementia diagnoses, with severe dementia on the Clinical Dementia Rating Scale (CDR), non-responders and participants with no reliable information on mortality. The total number of participants in this analysis was 2072. Measurements: We asked the residents about loneliness with the question "Do you suffer from loneliness?" Respondents evaluated their own health (self-rated health; SRH). The CDR, Psychological well-being Score (PWB) and Mini-Nutritional Assessment (MNA) served to assess the residents. We collected the mortality data from central registers. Results: Of the residents, 9% stated that they suffered from loneliness often or always, and 26%, sometimes. Loneliness was associated with poor SRH, disability, mobility problems, higher cognitive function, depression and poor PWB. The risk for mortality was significantly higher among the "sometimes lonely" (HR 1.19; 95% CI 1.05 to 1.35) and for the "always lonely" (HR 1.28; 95% CI 1.06 to 1.55) than among the "not lonely" residents (p for linearity < 0.001 adjusted for age, sex and comorbidities). Conclusions: Loneliness has severe consequences in institutional settings and therefore deserves more attention in nursing home care and research. Developing interventions to alleviate residents' loneliness in order to improve their general well-being is important.

The KnowSense framework, presented in this work, supports monitoring behavioral aspects of individuals in goal-oriented scenarios, within controlled, pervasive environments. Semantic Web technologies, such as OWL 2, are extensively employed in KnowSense to represent sensor observations and application domain specifics as well as to implement hybrid activity recognition and problem detection solutions. Although the framework can be beneficial in a variety of domains that require multi-sensing and goal-oriented data analytics such as smart homes, it is currently applied in the eminent field of healthcare. In this proof-of-concept health application, it provides the semantic models and intelligent detection of Instrumental Activities of Daily Living (IADLs) to assist in the clinical assessment of autonomy at different stages of dementia.

Individuals with Mild Cognitive Impairment (MCI) currently have few treatment options against memory loss. Solutions for caring for the elderly both efficacious and cost-effective are given by Ambient Assisted Living (AAL) architecture, promising the improvement of the Quality of Life (QoL) of patients. QoL factors that are important for the MCI patients include mood, pleasant engagements, physical mobility and health, and the ability to perform activities of daily living. In this paper, we propose a daily activity reasoner that monitors, measures and analyses in real time several everyday events for building habits diary and detecting abnormal behavior of the user, part of an effective AAL system. The proposed solution is based on a combination of mean shift clustering algorithm. The reasoner offers two primary functionalities: habits building and duration and frequency of events. The reasoner can predict the behavior and detect (slow or fast) changes that might indicate modificati...

Ambient assisted living (AAL) technologies can provide assistance and support to persons with dementia. They might allow them the possibility of living at home for longer whilst maintaining their comfort and security as well as offering a way towards reducing the huge economic and personal costs forecast as the incidence of dementia increases worldwide over coming decades. However, the development, introduction and use of AAL technologies also trigger serious ethical issues. This paper is a systematic literature review of the on-going scholarly debate about these issues. More specifically, we look at the ethical issues involved in research and development, clinical experimentation, and clinical application of AAL technologies for people with dementia and related stakeholders. In the discussion we focus on: (1) the value of the goals of AAL technologies, (2) the special vulnerability of persons with dementia in their private homes, (3) the complex question of informed consent for the...

Activity recognition technology is one of the most important technologies for life-logging and for the care of elderly persons. Elderly people prefer to live in their own houses, within their own locality. If, they are capable to do so, several benefits can follow in terms of society and economy. However, living alone may have high risks. Wearable sensors have been developed to overcome these risks and these sensors are supposed to be ready for medical uses. It can help in monitoring the wellness of elderly persons living alone by unobtrusively monitoring their daily activities. The study aims to review the increasing trends of wearable devices and need of multimodal recognition for continuous or discontinuous monitoring of human activity, biological signals such as Electroencephelogram (EEG), Electrooculogram (EOG), Electromyogram (EMG), Electrocardiogram (ECG) and parameters along with other symptoms. This can provide necessary assistance in times of ominous need, which is crucial for the advancement of diseasediagnosis and treatment. Shared control architecture with multimodal interface can be used for application in more complex environment where more number of commands is to be used to control with better results in terms of controlling.

Activity recognition technology is one of the most important technologies for life-logging and for the care of elderly persons. Elderly people prefer to live in their own houses, within their own locality. If, they are capable to do so, several benefits can follow in terms of society and economy. However, living alone may have high risks. Wearable sensors have been developed to overcome these risks and these sensors are supposed to be ready for medical uses. It can help in monitoring the wellness of elderly persons living alone by unobtrusively monitoring their daily activities. The study aims to review the increasing trends of wearable devices and need of multimodal recognition for continuous or discontinuous monitoring of human activity, biological signals such as Electroencephelogram (EEG), Electrooculogram (EOG), Electromyogram (EMG), Electrocardiogram (ECG) and parameters along with other symptoms. This can provide necessary assistance in times of ominous need, which is crucial for the advancement of diseasediagnosis and treatment. Shared control architecture with multimodal interface can be used for application in more complex environment where more number of commands is to be used to control with better results in terms of controlling.

Activity recognition technology is one of the most important technologies for life-logging and for the care of elderly persons. Elderly people prefer to live in their own houses, within their own locality. If, they are capable to do so, several benefits can follow in terms of society and economy. However, living alone may have high risks. Wearable sensors have been developed to overcome these risks and these sensors are supposed to be ready for medical uses. It can help in monitoring the wellness of elderly persons living alone by unobtrusively monitoring their daily activities. The study aims to review the increasing trends of wearable devices and need of multimodal recognition for continuous or discontinuous monitoring of human activity, biological signals such as Electroencephelogram (EEG), Electrooculogram (EOG), Electromyogram (EMG), Electrocardiogram (ECG) and parameters along with other symptoms. This can provide necessary assistance in times of ominous need, which is crucial for the advancement of diseasediagnosis and treatment. Shared control architecture with multimodal interface can be used for application in more complex environment where more number of commands is to be used to control with better results in terms of controlling.

This group-randomized trial implemented and evaluated an intervention to reduce staff burden and improve family and resident outcomes by helping families create meaningful roles for themselves in residential care/assisted living and nursing homes. Across 24 sites, families (N = 490) and staff (N = 397) provided data over six months about family involvement, family and staff well-being and attitudes, and resident quality of life. Intervention subjects participated in workshops and created service plans to identify family roles. For families, the intervention decreased burden and improved resident quality of life but also increased guilt and conflict. Staff reported less burnout and greater partnership with families, and felt families were more empathic. Consequently, there are benefits to increasing family involvement, but attention must be paid to potential barriers and negative outcomes.

Research within residential care/assisted living (RC/AL) settings has shown that the attitudes of personal care (PC) staff towards their organization, and its residents and families, can affect the quality of resident care. This paper describes the perceptions, experiences, and attitudes of PC staff and their supervisors and considers these data in the context of non-hierarchical staffing patterns -a philosophically expected, yet unproven tenet of RC/AL. Using data collected from 18 RC/AL communities, these analyses compared the characteristics, perceptions, experiences, and attitudes of PC staff (N=250) and supervisors (N=30). Compared to supervisors, PC staff reported greater burden, frustration, depersonalization, hassles, and feeling significantly more controlling of, and less in partnership with, families (p<0.05). Because the PC staff experience is crucial for their and resident outcomes, more work is needed to create a work environment where PC staff are less burdened and have better attitudes towards work and families.

Background: : Older adults living in assisted living facilities (ALFs) are at risk for physical and mental health decline that precipitates nursing home placement. There is a need for an exercise program that improves the quality of life (QOL) for older adults living in the ALFs. This study's primary purpose was to investigate the feasibility of an Enriched tai chi (ETC) intervention program on improving the QOL of older adults living in an ALF. . Method: : A convenience sample of six older adults living in the same ALF attended the ETC program for 16 consecutive sessions two times per week for 8 weeks. A pre-test and post-test one-group design was used. The 36-Item Short Form Survey and the Beck depression inventory were used to measure QOL and mood at baseline, the 4th week, and the 8th week of the study. Results: : Wilcoxon sign rank test on pre and postintervention SF-36 scores were significant (p < .05). Pretest and post-test intervention changes in mood were significantly improved (BDI; p < .05). Conclusion: : These findings suggest the ETC program may be a feasible intervention to improve the QOL of older adults in ALFs, warranting the need for further research.

Although many older adults wish to live independently, remaining in their own homes as long as possible, they may face obstacles such as transportation issues, social isolation, upkeep of the home, and increasing inhome care costs, which prevent them from doing so. The use of technology within the home, through technology-based assisted living systems, has the potential to alleviate some of these obstacles. Incorporating human factors principles to maximize safety, efficiency, and usability is key to the development of these systems.

The paper describes the development of Living Hub: a laboratory for research, experimentation and training based on the Living Lab model, integrated with the use of the Simulation technique, to optimise the study of the interaction between people, environments, and technology. The lab aims to support the design of capacitating technologies and responsive environments that can adapt to the needs of their users, with reference to the home context. Located in Liguria, a region with the highest rate of ageing in the world, Living Hub focuses experimentation on innovative models for the care of the frail through different levels of scalar/modular integration of enabling technologies in the built environment.