Continuous Monitoring and Digital Systems for Elders

Nuno Rocha

1,2

, Raquel Sousa

and Gil Gonçalves

2, 3

Informatics Engineering Department, Institute of Engineering of Porto, Porto, Portugal

Increase Time SA, Matosinhos, Portugal

Informatics Engineering Department, Engineering Faculty, University of Porto, Porto, Portugal

Keywords: Active Ageing, Ambient Assisted Living, RWD, Elders.

Abstract: Ageing of the European population raises issues both socially and economically, creating major challenges

for the traditional care and healthcare paradigm. Recent technological developments generate a favorable

environment for a paradigm shift in the way care and healthcare is provided, by promoting the inclusion of

the elders in the digital society. This paper presents an approach to promote elders inclusion, based on a RWD

platform, capable of being used in multiple devices (including SmartTVs), and in wireless sensor networks.

Studies involving end users have shown how well-adjusted interfaces ease the process of inclusion of IT in

elders’ life. This work has been developed within the frame of the European project HELASCoL.

1 INTRODUCTION

The ageing of the European population is an essential

finding of nowadays and the resulting increase in the

dependency ratio of the elderly leads to a financial

charges exacerbation at national health system (NHS)

level.

Portugal is currently facing problems related to

this demographic change, caused by (FCT, 2014):

• Decreasing birth rate,

• Structural problems in rural areas, related to

migration of population to the coast,

• Given retirement age extension in some

countries, population remains active and

productive for longer.

Following this demographic trend there will be an

increase in the number of people with physical

limitations along with the population isolation,

raising new challenges to the traditional health

system, which will have to be replaced by pension

schemes, in many states in Europe.

The elderly population, age group most affected

by loneliness in today's society, should not be ruled

out in advance of mobile technologies and the

development of applications for this type of devices,

given all the potential that can be used for this type of

audience (Cunha, 2012).

A solution for boosting the speed of assistance in

emergencies and reduce costs associated with

treatment is the challenge that enables timely

prevention of diseases and which will therefore

reduce the costs of health services.

2 MOTIVATION

The inclusion of older people in the digital society

must begin with the communication route and the

most common interface such as television, and then

extended to all types of communication devices.

The project HELASCoL – Helping elders to live

an active and socially connected life by involving

them in the digital society – addresses some of the

problems observed and aims to offer a 360 degrees

methodology involving the elderly in an enriched

communication experience, anywhere, anytime and

to any device with accessible, intuitive, easy to use,

multimodal User Interfaces that allows the study of a

new approach towards this issue (HELASCoL, 2012).

This consortium developed a solution to facilitate

the provision of relevant services in a relevant

channel - Internet - for elderly and their families.

The goal is to allow the elderly and caregivers to

share their daily experiences and help them make use

of existing multimedia services, developing the sense

of closeness and community integration they seek.

This enriched experience that allows users to share

their emotions and experiences in a lively and

interactive way, requires a new approach, both for

services and technologies that support it and can

Rocha N., Sousa R. and Gonçalves G..

Continuous Monitoring and Digital Systems for Elders.

DOI: 10.5220/0005491200810086

In Proceedings of the 1st International Conference on Information and Communication Technologies for Ageing Well and e-Health (ICT4AgeingWell-

2015), pages 81-86

ISBN: 978-989-758-102-1

 2015 SCITEPRESS (Science and Technology Publications, Lda.)

easily be updated with security and clinical features.

This document intended to describe the work and

the results obtained with the development of 3 parts

of the project:

• A general description of the full architecture of

the developed system and application services.

• Technical description of the Services

developed.

• Sensors integration with systems, components

and services completed.

The ultimate goal of this document is to report the

results achieved. These results will be validated

through pilot studies to be carried out in the following

stages of the project.

Figure 1: HELASCoL overview.

2.1 Technologies

The project was developed based on the platform

KeepCare® (Sousa, Alves, & Gonçalves, 2013)

which already had implemented the engine for

monitoring features and was included an open-source

responsive frameworks that incorporates the

principles of responsive web design (RWD)

described by Ethan Marcotte (2011), mostly based on

CSS and JavaScript. The key benefit of using these

frameworks is a reduction in development time.

The Sensor network is achieved by setting up a

central wireless gateway that provides a

communication protocol for sensor devices, which

retrieves bio-signals and environmental data. In order

to increase comfort and mobility, we gave preference

to the use of wearable sensors for health monitoring

(Oliveira, Gonçalves, & Sousa, 2013).

Some of the provided services are supported by

external APIs. These services are ensured to be secure

and reliable.

2.2 Elderly User

Elders are affected by physical decline but also by

mental decline. The ageing process involves a more

delicate psycho-physical balance. This means that

people are more fragile in dealing with personal or

environmental changes. Without proper preparation,

you can put at risk the balance and disorienting person

in everyday life. Here we try to summarize the most

important points of these aspects.

Physical Aspects

• Visual impairment – difficulty seeing small

details and hearing impairment

• Limited manual skills – limited sense of touch

and reduced fine motility

Psychological Aspects

• Afraid of unknown devices, go into a panic

easily

• Difficulty with complicated procedures and

learning new tasks

• Confused by too many information

• Strong connection with past life in family,

memories and personal objects

Personas are a proven design tool that, when

coupled with user-centered and participatory design

techniques, can ground the design process to model

the specific needs of the targeted elderly. We set out

to iteratively define two personas (male and female)

through a combination of observations, past team

experience and field pilots to better adjust and predict

some needs in terms of user experience.

John is eighty-nine years old who raised three

sons in the same house where he lived for his entire

marriage. He was able to take care of himself and was

autonomous until recently when he moved to a

retirement community. He now needs to see his

doctor routinely every few months to take care of

diabetes and high blood pressure.

John’s diabetes is currently well controlled with

diet and exercise, although sometimes he feels light

headed and tired from his blood pressure medication,

so as part of his daily routine he takes a daily 2 mile

“constitutional”. Luckily, the retirement community

is not too far from his family and friends who are with

him during these walks.

Jane, an eighty-three-year-old came from upper

socio-economic status. Both John and Jane have a

positive attitude towards technology in that they

believes technology may help them assess their own

wellness, although they present a sense of oddity

towards devices and wires.

Neither expresses concerns about potential

privacy risks regarding their personal information,

and both believe that the potential benefits of health

IT outweigh potential privacy concerns.

Each is a member of a retirement community that

has regularly scheduled social events.

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Habits

Research also suggests working with scenarios: User

scenarios are “informal narrative descriptions”

(Carroll, 1999) about a persona or personas

(hypothetical archetypes of actual users) and their

activities, emphasizing the goals the user wants to

reach with a specific product, the persona’s

expectations concerning particular systems and the

most critical tasks that she wants to execute.

Scenarios can be described in different ways

including text, speech, photographs and video clips

(Isacker, Slegers, Gemou, & Bekiaris, 2009).

The daily activities and habits of the people are aimed

at maintaining their mobility and autonomy. Services

developed to perform certain operations on line could

imply a decrease in the mobility and autonomy of the

persons.

Environment

One important place in the elderly apartment is the

location of the agenda or the calendar where the

activities are scheduled and clearly visible.

The living environments are a small space in the

sheltered flat that makes it difficult to envisage the

introduction of a device that integrates the

environment becoming "seamless" after a certain

time of use.

The idea of placing the points of access in the

common areas could help to perceive a degree of

comfort between the user, the device and services

thanks to the mediation of the institution staff. These

“common stations” could help elderly people less

familiar with the technology to access the IT

solutions, bringing themselves a step closer to desire

a personal device.

RWD has improved multi-device, multi-browser

visual layout but it’s only the first step in building

responsively.

2.3 Requirements

When a new object comes in the daily life of people,

they have to recognize their property. This task is

accomplished through the association between the

new object with other similar artifacts in use. The new

object has to find a place in the experience of every

day habits and common artifacts that are usual for the

user (Campbell, 2015). For example, for many elderly

a tablet or a computer is an artifact only to receive

information, share information or pass a call and that

is a task that demands a particular kind of effort in the

transfer process to link the screen to other type of

artifacts like the phone. This might be done only by

cooperation between the user, the interface, the other

persons and the objects involved in the telephone

activity.

Biographical connections between actors, human

and non-human (Latour, 1994), that exist in the world

of the user must communicate in a fluid manner. That

is, interfaces, must communicate in a common

language and give a clear feedback to the user. The

aim of feedback to the user is to increase the control

and knowledge of the person over this world, not to

control him.

This way, feedback to the user must integrate the

physical and psychological aspects that we wrote

above and find sense and place in the environment of

the user. Also, find and analyze the link that the user

makes with past experiences and integrate the same

logic into the new artifact. The number of tasks

required for an activity with a new artifact must be

lower than the common sequence already in place.

3 MAIN GOALS

We intend to define a set of standards for elderly

users’ interfaces and achieve this by developing a

web application based on two areas of use by the

elderly – Social and Monitoring (health and

environment).

Health monitoring aims to daily monitor clinical

values associated with chronic diseases that most

affect the elderly, to increase the immediate

perception of the state of the user and to facilitate the

reading and communication of these values to formal

or informal caregivers as well as the veracity of these

values.

The social module of the application aims to be

able to reduce the isolation arming the elderly with

cognitive and physical stimulation tools, by including

serious games targeted for this purpose, as well as the

encouragement of communication through

synchronous and asynchronous conference

mechanisms, making use of the system steadier.

It's a final goal the improvement of advanced

features for this platform in terms of interfaces, the

user's perspective, optimizing access to visually

intuitive way to these features.

It is expected feedback collection form field

pilots, which should provide the discovery of the

main difficulties in use of the application and

allowing us to assess the degree of satisfaction of

goals. The main objective of the field trials is to

evaluate the user acceptability and effectiveness of

the HELASCoL platform.

Finally the display mode of the product

application shall be adaptable to the characteristics of

the elderly user, with faster navigation with a more

ContinuousMonitoringandDigitalSystemsforElders

enjoyable, intuitive and fluid experience for the user.

4 RESULTS

A set of external services is used to achieve some

features such as user authentication and calendar

sharing. Issues with authentication such as account

hacking are delegated for an API. Guest invitations

and calendar sharing invitations are handled by

google.

Figure 2: WebApp main user interface.

4.1 Social Services

The social section of the web application provides the

user access to the configuration of personal contacts,

calendar and oriented games for the stimulation of

cognitive abilities. It is complementary to the

previous section, a facilitator of recreational activities

and social life and important for a healthy and

stimulating maintenance of life.

Contacts: This module ensures the display of user

contacts, allows the user to add and delete contacts

and also associates a user account invited to contact.

Calendar: This module ensures the display of shared

calendars with the user, allows the subscription of a

new calendar, enables the detail view as each calendar

events and even add a new calendar.

Games: This module provides the user with access

to a set of predefined game-oriented maintenance of

cognitive functions such as memory and mental

calculation function in addition to the fun and

interactivity with others.

4.2 Communication Services

The communication section of the web application

provides mechanisms for inter user communications

such as chat and video calls.

Non Real Time – Chat: This feature allows the user

to view the status of other users in the chat, send and

receive text messages with another application user

and even invite a user from the list of contacts but has

not yet accessed the chat. Through this service, it’s

possible for two users to exchange messages with

each other instantly and also, messages are stored to

be read later.

Real Time - Video Chat: For real time conversation

a video chat room is enabled via WebRTC. Only two

users are allowed per video chatroom. This line of

conversation enables real time video and audio

communication as long as both users are logged in.

At any time the call can be terminated, closing the

video and audio channels.

4.3 HELASCoL Webapp

The application base is a service that manages the

communication with the sensors and the

synchronization with the remote server. The service

implements an interface in order to allow the main

application, communicate with this service, allowing

the user to change the state of connection with the

sensors through the UI as other relevant parameters

for monitoring. When the Gateway connects to the

service it retrieves data and the application makes

calls to the Service.

This service also uses TimerTasks that allow a

portion of code to be executed promptly. Thus it was

possible to implement reconnection mechanisms to

sensors in the case of sensors are disconnected for any

reason, as they leave the reach or come into

hibernation.

Health Monitoring: The application provides a self-

monitoring service. This service enables data

collection and threshold configuration for blood

pressure, glucose, O2, heart rate, weight, body

temperature and a bed sensor which indicates if the

user is lying in bed.

Home Monitoring: The application provides a

house monitoring service. This service enables data

collection and threshold configuration for humidity,

temperature, CO levels, CO2 levels and water usage

in kitchen and bathroom.

4.4 Mobile Gateway

Through continuous monitoring of health status of an

individual, the gateway facilitates assistance quickly

in emergencies, since when anomalies are verified

alerts for the caregiver and / or centralized emergency

system are automatically issued.

The gateway communicates with wireless sensors

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to continuously monitor the vital signs, or any other

parameter that is desired to monitor, and processes

this information to provide a set of services such as:

• Monitoring management

• Manual values insertion

This module consists of a smartphone with the

mobile application which is responsible for the

acquisition and processing monitored data collected

by Bluetooth® wireless sensors, and send to the

central server.

4.5 Sensor Network

Sensors are devices that produce output for evaluation

and or processing by the node while actuators are

devices that require input driven by the same node

Wireless Sensors Network: The SUPSI wireless

sensor network (WSN) concept consists of a sensor

network based on smart nodes (node and connected

sensor/actuator) able to read and possibly write

general purpose input/output lines either analog or

digital. These lines are connected to sensors or

actuators.

Bed Sensor: The bed sensor is based on a component

that changes the electrical resistance when a force is

applied vertically. By putting this component under

the mattress and measuring its resistance it is possible

to detect when a person is or not in bed and then

monitor the sleep cycle.

Water in Bathroom and Kitchen Sensor: This

water sensor is based on a piezoelectric microphone

that generates a continuous electric signal

proportional to the acoustic noise level. By

positioning this sensor on the water pipe it is possible

to detect when the water is flowing inside by

performing a fast Fourier transform (FFT) analysis

running on the node.

Bio Sensors: The vital signs can be gathered by a

chest strap or wearable t-shirt sensor that uses

Bluetooth® to provide vital signs readings such as

heart rate, speed and distance which provide access to

the users’ parameters and potential alerts that may

arise based on pre-configured thresholds.

Other vital signs and health data such as weight,

blood glucose, blood pressure and oxygen levels can

also be monitored with wireless devices, fully

integrated with the system. These devices

communicate via Bluetooth® to increase the ease of

use and learnability by the targeted users.

5 FIELD TRIALS

The first field trial was organized in cooperation with

the elderly home of Giubiasco (FCPA), in

Switzerland and intends to verify:

• Usability, the quality of user experience and the

acceptance of the HELASCoL solution by the

primary users i.e. the elderly people;

• Assess the usability of the secondary users (the

caregivers and the family members);

• The effectiveness of the HELASCoL solution

in terms of promoting the integration of the

older adults in the social community through

the use of ICT and Internet services, to avoid

their loneliness and helping them to live an

active and socially connected life;

• The actual usage of HELASCoL platform by

the elderly in terms of frequency of use,

duration of sessions, interlocutors of

communication, etc;

• Finally, to test the overall HELASCoL system,

fully integrated and operating in a real life

scenario from a technical point of view.

The application was set up in a shared PC in a

common place inside the sheltered flat building,

where elderly could freely use the platform to gain

confidence with the services. At all times a user

manual was made available to avoid panicking by the

users.

A single training session for the elderly was

executed for two groups. Before this training the

purpose of this project was explained to elderly,

relatives and home staff.

During the participant recruiting phase we aimed

to introduce the technology to elders and relatives to

build the network of social contacts. For this trial, the

high priority was the shared agenda and the video

chat.

The evaluation of the results was made by directly

follow-up of the users while using the system and

through satisfaction questionnaires after the

experience.

The results obtained with this set of trials were

shared with the institution that seemed interested in

keeping the solution with additional features and

several sets of devices.

6 CONCLUSIONS

The definition of design standards and metrics for the

development of health systems interfaces for the

elderly and the integration of new features for a web

ContinuousMonitoringandDigitalSystemsforElders

application capable of remotely and in real time

connect healthcare professionals and patients seeks to

be implemented by promoting the increased

adherence and facilitate the incorporation of the use

of information systems in elders day-to-day activities.

The HELASCoL WebApp was introduced in the

elderly home by means of a shared PC installed in a

common area. The elderly can freely use the platform

to gain confidence with the services.

In general, the users were all very happy and

curious with the interface and its capabilities.

Some contents need further development as it was

not so easy to comprehend.

Users were extremely pleased with games such as

Sudoku and Crosswords.

Some items are described with clinical or

technical terms, such as “send email” or “my

account”. These must be adjusted to the user’s

perception in order to relate to their daily routines

without the help of someone every time you want to

use the platform.

At this stage, as further trials are to be planned, we

are planning to perform a demo installation of the full

sensors network in a sheltered flat and increase the

number of participants as well as points of service.

ACKNOWLEDGEMENTS

This research was partially supported by project

HELASCol funded by the Ambient Assisted Living

Joint Programme (#aal-2009-2-085).

We would like to acknowledge the contributions

of the other partners of the HELASCoL consortium:

Kecelcom, Kapsch BusinessCo, SUPSI, Fondazione

Casa per Anziani Gubiasco and Kecel Local

Government.

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