ISA: An Integrated Environment for the Digital Inclusion of Elderly

People

Bernhard Kohn

, Klaus Dittrich

, Carmina Coronel

, Martin Litzenberger

Birgit Unger-Hrdlicka

and Karoline Reither

AIT Austrian Institute of Technology GmbH, Giefinggasse 4, 1220 Vienna, Austria

myneva Austria GmbH, Hietzinger Kai 133,1130 Wien, Austria

birgit.unger-hrdlicka@myneva.eu, karoline.reither@myneva.eu

Keywords: Active Assisted Living Technology.

Abstract: Elderly people are increasingly discouraged from using mobile digital devices due to the large number of

applications. In this paper, we present ISA, an integrated system that is intended to simplify the inclusion of

older people in the digital world, by a joint organisation of a digital calendar by care organisation, cared for

person and informal carer. On a tablet computer daily routine such as home care, taking medication, but also

appointments, meetings with friends or relatives can be easily managed by an integrated calendar. In addition,

functions such as video telephony and photo albums are offered for better social interaction with friends and

relatives. A pilot operation was carried out to check whether the system would be helpful in daily activities

or in reducing the burden of informal carers. 12 pairs of participants, each consisting of the person to be cared

for and the informal carer, were recruited for a study. They filled out questionnaires on activities of daily life

and the caregiver burden before and after the test. Evaluation of the questionnaires showed no significant

change of status regarding the activities of daily living or the caregiver burden.

1 INTRODUCTION

Participation of the elderly in the digital world is

becoming more and more important as some basic

services are only available through smartphones with

internet connection. In the near future, registration for

social events or even personal services, such as

booking an appointment at the hairdresser, will only

be possible via digital tools, such as web forms or

smartphone apps. On one hand, existing digital

technologies still pose a huge barrier for some elderly

to participate in daily life and to organize their own

agenda. On the other, care persons are facing an

increasing burden to support the elderly in the use of

the digital technologies or, in many cases, even

having to completely take over these tasks for them.

Existing systems or software often pose a problem

of being not optimized for a use by elderly people or

not having the possibility to use the system by carer

and cared for person cooperatively in a consistent

https://orcid.org/0000-0002-3177-3159

https://orcid.org/0000-0001-6304-0243

https://orcid.org/0000-0002-2101-2188

manner. For example, although a digital calendar may

be shareable among different people across different

platforms, the necessary workflows for a cooperative

usage by a caregiver and elderly are usually not

supported. While the design of user interfaces

optimized for use by elderly are already under

investigation for some time (Iancu & Iancu, 2017;

Kurniawan, 2008; Zhu et al., 2008), cases of

successful implementation and adoption of assistive

solutions are still rare (Haan et al., 2021; Martinez-

Martin & Costa, 2021) and they concentrate more on

the compensation of cognitive deficiencies than on

the support of organizing general daily activities and

fostering digital inclusion.

Baric et al. report on the "RemindMe" system

(Baric et al., 2019) that combines an interactive

digital calendar for the carer with short text message

(SMS) reminders sent to the elderly users. The widely

known SMS service has been chosen, instead of a

smart phone GUI or app, to simplify the interaction

344

Kohn, B., Dittrich, K., Coronel, C., Litzenberger, M., Unger-Hrdlicka, B. and Reither, K.

ISA: An Integrated Environment for the Digital Inclusion of Elderly People.

DOI: 10.5220/0011137300003188

In Proceedings of the 8th International Conference on Information and Communication Technologies for Ageing Well and e-Health (ICT4AWE 2022), pages 344-350

ISBN: 978-989-758-566-1; ISSN: 2184-4984

for the elderly. A study with 20 subjects has been

conducted. Project Freewalker (Litzenberger et al.,

2021) piloted a GNSS based assistive technology that

combined a GNSS dongle with smartphone apps for

caregiver and user, to protect from wandering and

getting lost. Through creation of appointments

defined in a shared calendar, maintained either by the

carer or cared-for person, the application generates

optimized and safe travel directions for the cared-for

persons

In this paper we report on the concept and

software of the ISA project, developed in the

framework of a research project, to test and validate a

system based on a collaborative and maintained

electronic calendar to organize all aspects of the daily

schedule for care and support of an elderly person in

close cooperation with the care person. ISA

implements an intelligent web-based system intended

to assist working individuals in their care and support

duties and the data gathered by the system will be

permanently available to the caring individual. A

tablet installed with the application is placed in the

home of the cared-for person. The application

equipped with an optimized user-interface reminds

and notifies regarding activities, not only such as

eating, drinking, grooming, housework, but also

outside activities such as shopping, exercising, family

meetings, doctor visits. ISA should thereby enable the

user to lead a more self-organized and self-

empowered life and reduce the burden of the carer,

too. It also displays motivational items such as family

photos. Additionally, the possibility for video calls is

integrated. For personal security, the system also

notifies regarding special adverse weather conditions

like heavy rains or thunderstorm and current weather

information. In contrast to RemindMe, both carer and

cared-for person can maintain the ISA calendar and

organize care appointments. In the future the

possibility of directly integrating various services

(e.g., hairdresser) with the providers is planned. A

first pilot study with ISA, in which the system has

been used by 12 users and their informal carers has

been conducted in Austria over the duration of three

months. To analyse the impact of using ISA on the

reduction of stress for the elderly person and of

caregiver burden of the informal carers a

questionnaire was used before and after the test. For

the elderly persons the questionnaire of the Bayer

Activities of Daily Living (Erzigkeit et al., 2001;

Hindmarch et al., 1998) were used whereas for the

informal carer the Zarid Burden Interview (Zarit et

al., 1980) was chosen to get information how strong

the burden of caring is recognized. Although both

questionnaires are more related for cognitive

impaired persons, they should give an indication if an

influence occurs.

The paper concentrates on the technical

description of the software component of ISA and on

the first results of the pilot study and is organised as

follows: The following section gives an overview

over the system features and the system architecture.

In Section 3 the pilot is explained and how the

questionnaire was carried out. The paper closes with

Section 4, the conclusion.

Figure 1: Overview of the features of the ISA system.

ISA: An Integrated Environment for the Digital Inclusion of Elderly People

345

2 ISA SYSTEM

2.1 Features

In Figure 1 a schematic overview of all system

features is shown. The basis of the ISA system is the

calendar. Using the calendar, it’s possible to plan

daily activities. The entry point for the cared for

person is the day view (see Figure 2 top) of the

system. He or she can add special reminders for daily

activities like medication or drinking times, meeting

appointments with friends or relatives (see Figure 2

bottom). Each appointment added to the calendar can

be given a category, one of: appointment out of house,

medication, video call, event or other (see Figure 3

top). For appointments of the category out of house

the user will get a reminder with additional

information regarding the actual weather situation, so

she is reminded to dress accordingly (see Figure 3

bottom). Additionally, the cared-for person can add

video calls (see Figure 4 top) as appointments and

invite the informal carer or other contacts to join. A

photo album (Figure 4 bottom) can be used to share

pictures of family or other events. This should help,

especially in times of the COVID-19 pandemic, to

keep personal contact with family and friends. All

these possibilities are offered by an application for an

android tablet. The user interface is specially

designed for an easy and intuitive use.

Figure 2: Top) overview of appointments, bottom) add new

appointment.

Figure 3: Top) available categories for appointments,

bottom) reminder with weather information

For the informal carer a web portal is offered to

access the calendar, contact list, and photo albums.

The cared for person can grant rights to the informal

carer via an access list, so that the cared for person

maintains control on the data to be shared. If access

right is granted, the informal carer can access and add

pictures to the photo album, add additional contacts

to contact list and view and add appointments.

The ISA systems also offers an API to directly

interface to care organisations, so that home care

appointments can be sent automatically to the

calendar. This feature allows the cared-for persons to

know at which time the home care person will visit

them. In case that a home care appointment is late, the

cared for person can be informed by the care

organisation through the table application (see Figure

5). Additionally, the cared for person or the informal

carer may also cancel appointments if the cared for

person is unable to attend due to unforeseen situations

like doctors’ appointments or hospitalisations.

Additionally, a so-called logic engine is integrated

into the system. The purpose of the logic engine is

twofold. On one hand, it automatically checks if a

new added appointment conflict with an existing one.

This is necessary, as the home care appointments

typically are only available for the next four weeks.

The logic engine derives over this four-week period

when home care appointments are made and hints the

user about potential conflicts. On the other hand, it

analyses the daily activities, especially the medication

intake and home care appointments. If the logic

engine detects unusual behaviour of the cared for

person in her daily routines, it sends a message to the

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346

Figure 4: Top) video call, bottom) photo album.

informal carer to inform her about the observation.

This can give the informal carer an early chance to

contact the cared for person to ask if anything is

wrong. Of course, the cared for person can activate or

deactivate this feature on their own will.

Figure 5: Notification that a care appointment is shifted.

2.2 System Architecture

In Figure 6 the overview of the system architecture is

shown. It consists of three server applications. The

basis of the system is the ISA server, which stores all

the user and calendar data, and provides the web

portal for the informal carer. For the tablet app it

serves a web API to give access to all needed

information. The tablet app can also be notified when

reminders or messages should be shown by this mean.

The second server application is the logic engine.

It is served by a separate server. The decision to

separate the logic engine from the ISA base was to

ease the parallel development of the two components.

The communication between the ISA server and the

logic engine is realized by several dedicated

endpoints. For each change of the calendar (e.g.,

adding, changing, or deleting an appointment) the

ISA server asks for approval by the logic engine. By

this design the logic engine receives the complete

information of active appointments and can check, if

there is any conflict with any existing appointments

for a given user. Additionally, the logic engine

records each reminder of appointments. By this the

logic engine can check several corner cases,

- Is a home care appointment cancelled?

- Is the cancellation time under a certain time

range, where it may cost a cancellation fee?

- Is there an overlap within a time range, where

usually a home care appointment takes place?

- Is there an overlap with another appointment?

Depending on the results of this analysis next step

will be executed. E.g., if the cancellation of a home

care appointment within the next 24 hours is detected,

the user will be notified, that the cancelation may cost

a cancelation fee. If a conflict of appointments is

Figure 6: ISA System architecture: ISA Server, Logic

Engine and weather service.

ISA: An Integrated Environment for the Digital Inclusion of Elderly People

347

detected, the user will be reminded, that another

appointment is planned at the same time, and if she

would like to proceed or choose a different time.

An additional task of the logic engine is to detect

unusual behaviour. Unusual behaviour can be

assumed, for example, if a cared for person frequently

cancels home care appointments, or if reminders for

medications aren’t acknowledged. In the case of the

not acknowledged reminder the logic engine triggers

the ISA server to send a message to the user. If the

acknowledgement is not given by a user several times

a week, a message to the informal carer is send, to

notify about the situation. Of course, such a strict

monitoring must be explicitly approved by the cared

for person and the general aim is not to enforce strict

monitoring. The aim of this function is to give the

informal carer a hint, that there might be something

not in order and that they could ask sensitively about

medications or cancelled home care appointments.

The logic engine can be configured to follow different

workflows, depending on the care organisation the

user is registered with. The workflows allow to

configure which type of messages should be send,

like SMS, emails or by other message applications.

By this different connection methods and different

type of users can be defined according to the needs of

the care organisation.

The third server application is the weather service.

By the separation of the weather service from the

other components, the local weather provider could

be easily exchanged. The weather service provides

two different services. Each user using the ISA

system will be registered by the place he is living

(over the area code) at the weather service. In regular

time intervals (every 10 mins) the weather service

asks an external weather information provider if there

is any local warning for extreme weather situations

like heavy rain, strong wind, thunderstorms and other

similar situations. If there is warning, each user living

in the affected area will be notified by the tablet about

it. Additionally, it provides a web endpoint for the

ISA server, so that any reminder on an out of house

appointment will be accompanied with weather

information. This gives the user an indication on what

appropriate clothes to wear.

3 PILOT STUDY

The ISA system was piloted in a field trial from

October 2021 till the end of December 2021. The

pilot was accompanied by a set of questionnaires to

get a measure if the usage may help to reduce the

daily stress of the cared-for persons and for the

informal carers.

For the pilot a care organisation (Vienna Red

Cross) and one research project partner searched for

candidate pilot participants of cared for persons and

informal carers. Due to the Covid pandemic the

response of potential study participants was

moderate. In total 12 candidates were involved in the

pilot study. The cared for persons have an average age

of 74 years ranging from 64 to 95 years. The group

consists of 5 women and 7 men. The informal carers

had an average of 39 years ranging from 29 to 64

years, consisting of 7 women and 5 men.

All of them answered the questionnaire before the

beginning of the pilot and within three weeks after the

end of the pilot.

3.1 Questionnaires

As questionnaire for the cared-for persons the Bayer

Activities of Daily Living (Bayer ADL) was chosen.

The questions were in German language and

consisted of 25 questions regarding different daily

activities. Each question could be assigned a value

between 1 and 10, and 'does not apply' was also a

possible answer. Higher values meant more difficulty

executing the activity. At the end, all answered values

are summed up to give an overall score and a mean

value for all answered questions is calculated.

Depending on the mean value the Global

Deterioration Scale (GDS) for the person has be

assigned (Erzigkeit et al., 2001).

The Zarid Burden Interview (ZBI) questionnaire

was chosen for the informal carer. This questionnaire

has the intention to score the burden of a partner of a

cognitive impaired person in home care. Although no

cognitive impaired person was involved in the pilot,

this questionnaire was assumed to be the best

approach to score the burden the informal carer is

experiencing. The Zarid Burden Interview consists of

22 questions in German language. Each question

could be assigned a value between 0 and 4. Higher

values meant higher burden. The total sum of the

values gives the overall score. Scores between 0 and

20 indicates no or little burden, 21-40 mild to

moderate burden, 41-60 moderate to severe burden,

61-88 severe burden.

3.2 Results

Table 1 summarizes the results for the Bayer ADL

questionnaires. In case of the cared for person only

for 4 persons a change in the score before/after the

pilot is observed, whereas for the other 8 person no

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348

change could be seen. The total sum of the changes

cancels out. To further analyse the results, we select

all those questions from the Bayer ADL related to

subjects which might be impacted by using the

application like keeping appointments and support by

reminders for medication etc. In total 5 questions

could be separated. The results of the score can be

seen in Table 2. In this restricted questionnaire there

is no change in the average value of 10 persons

observed, in 2 persons a change by -2.3% respectively

-16.7% is seen. The increase of scores in Table 1 can

be attributed to questions with subjects that are not

directly related to the app.

Table 1: Results of the Bayer ADL questionnaire. In the

column before/after pilot the average value of all questions

score is shown, the difference is given both in absolute and

in percentage.

Id Before

pilot

After

Pilot

Difference

[abs]

Difference

[%]

1 1.0 1.0 0.0 0.0

2 1.0 1.0 0.0 0.0

3 1.0 1.0 0.0 0.0

4 8.6 8.6 0.0 0.0

5 2.4 2.7 0.3 12.5

6 1.4 1.4 0.0 0.0

7 8.5 8.4 -0.1 -1.2

8 1.0 1.0 0.0 0.0

9 1.0 1.0 0.0 0.0

10 1.8 1.5 -0.3 -16.7

11 2.0 2.1 0.1 5.0

12 1.2 1.2 0.0 0.0

Table 2: Results of the Bayer ADL questionnaire restricted

to questions directly connected to the usage of the app. In

the column before/after pilot the average value of all

questions score is shown, the difference is given both in

absolute and in percentage.

Id Before

pilot

After

Pilot

Difference

[abs]

Difference

[%]

1 1.0 1.0 0.0 0.0

2 1.0 1.0 0.0 0.0

3 1.0 1.0 0.0 0.0

4 8.4 8.4 0.0 0.0

5 1.3 1.3 0.0 0.0

6 1.4 1.4 0.0 0.0

7 8.8 8.6 -0.2 -2.3

8 1.0 1.0 0.0 0.0

9 1.0 1.0 0.0 0.0

10 1.5 1.3 -0.3 -16.7

11 1.2 1.2 0.0 0.0

12 1.0 1.0 0.0 0.0

In Table 3 the results of the Zarid Burden Interview

evaluation are shown. There are only relatively small

changes in the ZBI scores before and after the pilot.

Only in one case the caregiver burden is increased

from one burden level (scores between 0-20) to the

next burden level (21-40), but the absolute change of

the score is only 3, which compared to the burden

range of 20 score points is a relatively small increase.

In total, all 12 informal carers report no or little

burden.

Table 3: Results of the ZBI questionnaire. In the column

before/after pilot the sum of questions scores is given, the

difference is given both in absolute and in percentage.

Id Before

pilot

After

Pilot

Difference

[abs]

1 13 12 -1

2 13 12 -1

3 4 5 1

4 13 14 1

5 0 0 0

6 17 18 1

7 0 0 0

8 12 8 -4

9 1 1 0

10 20 23 3

11 11 7 -4

12 2 7 5

4 CONCLUSIONS

We have presented the ISA system for digital

inclusion of elderly people. The system is capable to

provide services like calendar and appointment

administration, photo albums can be shared with

friends or relatives, also video telephony can be used.

A pilot with 12 participants, pairs of cared for persons

and informal carers, has been conducted and was

accompanied by questionnaires before and after the

pilot (B-ADL for cared for persons, ZBI for informal

carer). The scores of questionnaires are used to

evaluate whether the ISA system is helpful for

facilitating the daily activities of the cared for persons

and if it was able to reduce the caregiver burden.

Evaluation of the questionnaires showed no

significant change of status regarding the activities of

daily living or the caregiver burden. We attribute the

results to a still too high complexity of usage of the

apps and the implemented workflow of jointly

organising a calendar and daily routines. Thus, the

results are somewhat unsatisfactory as they indicate

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349

that even for a system tailored for digital inclusion of

elderly, the measured acceptance was low.

Future work is to provide the web-based portal as

a mobile app, so that the functionality for the informal

carer is always accessible on the mobile phone.

ACKNOWLEDGEMENTS

This project has received funding in the program

“benefit” by the Austrian Federal Ministry for

Climate Protection, Environment, Energy, Mobility,

Innovation and Technology (BMK).

We would like to thank the Vienna Red Cross for

their contribution in running the pilot.

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