Smart Home Technologies for Enhancing Independence of Living and Reducing Care Dependence in Older Adults: A Systematic Review.

AIM: To systematically review the potential of smart home technology to enhance the independence of older adults and reduce their dependence on care. Additionally, it sought to examine the positive impacts of such technology on their golden years. DESIGN: A systematic review based on Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). DATA SOURCES: The search was conducted on 8 April 2024. Peer-reviewed studies in PubMed, Embase, Web of Science, IEEE Xplore, Scopus, The Cochrane Library, CINAHL, CNKI, WANFANG DATA and VIP from 1 January 2000 to 8 April 2024 were searched. METHODS: The methodological quality assessment used the Mixed Methods Appraisal Tool (MMAT). Positive findings relevant to this study were extracted from the literature and analysed using thematic synthesis. RESULTS: After meticulously examining 3404 studies, we identified 21 relevant sources for in-depth analysis, including qualitative studies (n = 10), experimental studies (n = 9) and mixed method studies (n = 2). These sources were grouped into five core themes based on the pivotal role of smart home technologies in enabling ageing in place: daily monitoring, assisted living activities, life reminders, functional improvement and emotional companionship. The study found that smart home technology offers numerous benefits to the lives of older adults, including increased independence, psychological support, improved cognitive functioning, enhanced self-management, increased mobility, support for caregivers, promoted social engagement and enhanced quality of life. CONCLUSION: Smart home technology can enhance the independence of older adults' lives, reduce their dependence on care, alleviate the burden on caregivers and promote home-based elderly care. IMPACT: This systematic review contributes to understanding the capability of smart home technology to promote elderly care at home and help better utilise smart home technology to benefit older adults. Older adults and their caregivers should be encouraged to adopt this technology to improve older adults' quality of life. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Real-Time Detection of Sleep Apnea Based on Breathing Sounds and Prediction Reinforcement Using Home Noises: Algorithm Development and Validation.

BACKGROUND: Multinight monitoring can be helpful for the diagnosis and management of obstructive sleep apnea (OSA). For this purpose, it is necessary to be able to detect OSA in real time in a noisy home environment. Sound-based OSA assessment holds great potential since it can be integrated with smartphones to provide full noncontact monitoring of OSA at home. OBJECTIVE: The purpose of this study is to develop a predictive model that can detect OSA in real time, even in a home environment where various noises exist. METHODS: This study included 1018 polysomnography (PSG) audio data sets, 297 smartphone audio data sets synced with PSG, and a home noise data set containing 22,500 noises to train the model to predict breathing events, such as apneas and hypopneas, based on breathing sounds that occur during sleep. The whole breathing sound of each night was divided into 30-second epochs and labeled as "apnea," "hypopnea," or "no-event," and the home noises were used to make the model robust to a noisy home environment. The performance of the prediction model was assessed using epoch-by-epoch prediction accuracy and OSA severity classification based on the apnea-hypopnea index (AHI). RESULTS: Epoch-by-epoch OSA event detection showed an accuracy of 86% and a macro F1-score of 0.75 for the 3-class OSA event detection task. The model had an accuracy of 92% for "no-event," 84% for "apnea," and 51% for "hypopnea." Most misclassifications were made for "hypopnea," with 15% and 34% of "hypopnea" being wrongly predicted as "apnea" and "no-event," respectively. The sensitivity and specificity of the OSA severity classification (AHI≥15) were 0.85 and 0.84, respectively. CONCLUSIONS: Our study presents a real-time epoch-by-epoch OSA detector that works in a variety of noisy home environments. Based on this, additional research is needed to verify the usefulness of various multinight monitoring and real-time diagnostic technologies in the home environment.

Using Smart Home Technologies to Promote Physical Activity Among the General and Aging Populations: Scoping Review.

BACKGROUND: Health-monitoring smart homes are becoming popular, with experts arguing that 9-to-5 health care services might soon become a thing of the past. However, no review has explored the landscape of smart home technologies that aim to promote physical activity and independent living among a wide range of age groups. OBJECTIVE: This review aims to map published studies on smart home technologies aimed at promoting physical activity among the general and aging populations to unveil the state of the art, its potential, and the research gaps and opportunities. METHODS: Articles were retrieved from 6 databases (PubMed, CINAHL, Scopus, IEEE Xplore, ACM Library, and Web of Science). The criteria for inclusion were that the articles must be user studies that dealt with smart home or Active Assisted Living technologies and physical activity, were written in English, and were published in peer-reviewed journals. In total, 3 researchers independently and collaboratively assessed the eligibility of the retrieved articles and elicited the relevant data and findings using tables and charts. RESULTS: This review synthesized 20 articles that met the inclusion criteria, 70% (14/20) of which were conducted between 2018 and 2020. Three-quarters of the studies (15/20, 75%) were conducted in Western countries, with the United States accounting for 25% (5/20). Activities of daily living were the most studied (9/20, 45%), followed by physical activity (6/20, 30%), therapeutic exercise (4/20, 20%), and bodyweight exercise (1/20, 5%). K-nearest neighbor and naïve Bayes classifier were the most used machine learning algorithms for activity recognition, with at least 10% (2/20) of the studies using either algorithm. Ambient and wearable technologies were equally studied (8/20, 40% each), followed by robots (3/20, 15%). Activity recognition was the most common goal of the evaluated smart home technologies, with 55% (11/20) of the studies reporting it, followed by activity monitoring (7/20, 35%). Most studies (8/20, 40%) were conducted in a laboratory setting. Moreover, 25% (5/20) and 10% (2/20) were conducted in a home and hospital setting, respectively. Finally, 75% (15/20) had a positive outcome, 15% (3/20) had a mixed outcome, and 10% (2/20) had an indeterminate outcome. CONCLUSIONS: Our results suggest that smart home technologies, especially digital personal assistants, coaches, and robots, are effective in promoting physical activity among the young population. Although only few studies were identified among the older population, smart home technologies hold bright prospects in assisting and aiding older people to age in place and function independently, especially in Western countries, where there are shortages of long-term care workers. Hence, there is a need to do more work (eg, cross-cultural studies and randomized controlled trials) among the growing aging population on the effectiveness and acceptance of smart home technologies that aim to promote physical activity.

My smart home: an auto-ethnography of learning to live with smart technologies.

Smart home technology is expected to be widespread in the future and to accommodate a green transition to reduce and time-shift energy consumption. However, smart technologies also have social consequences, which are important to understand. At a basic level, we need to know more about learning to live with these technologies and how they influence our everyday practices and routines. Providing in-depth longitudinal insights into these processes, this paper presents an auto-ethnography of living with smart home technology: a 20-month diary kept by one of the authors. The paper uses theories of practice to investigate details of learning processes when interacting with three selected technologies: smart alarm and lighting management, smart control of heating, and a smart electric vehicle (EV). Theories of learning have a well-established tradition within theories of practice, and the concept of "knowing how to go on" and the concept of practical intelligibility are central in this work. This paper investigates the adoption of new smart technologies and how they interact with learning processes in different material and social contexts. Such an approach can lay the groundwork for further empirical research with a broader set of materials. It can also provide knowledge to assist in the design of better technologies and in developing policies and regulations to promote this.

Electronic Assessment of Physical Decline in Geriatric Cancer Patients.

PURPOSE OF REVIEW: The purpose of this review is to explore state-of-the-art remote monitoring and emerging new sensing technologies for in-home physical assessment and their application/potential in cancer care. In addition, we discuss the main functional and non-functional requirements and research challenges of employing such technologies in real-world settings. RECENT FINDINGS: With rapid growth in aging population, effective and efficient patient care has become an important topic. Advances in remote monitoring and in its forefront in-home physical assessment technologies play a fundamental role in reducing the cost and improving the quality of care by complementing the traditional in-clinic healthcare. However, there is a gap in medical research community regarding the applicability and potential outcomes of such systems. While some studies reported positive outcomes using remote assessment technologies, such as web/smart phone-based self-reports and wearable sensors, the cancer research community is still lacking far behind. Thorough investigation of more advanced technologies in cancer care is warranted.

Weekly observations of online survey metadata obtained through home computer use allow for detection of changes in everyday cognition before transition to mild cognitive impairment.

INTRODUCTION: Subtle changes in instrumental activities of daily living often accompany the onset of mild cognitive impairment (MCI) but are difficult to measure using conventional tests. METHODS: Weekly online survey metadata metrics, annual neuropsychological tests, and an instrumental activity of daily living questionnaire were examined in 110 healthy older adults with intact cognition (mean age = 85 years) followed up for up to 3.6 years; 29 transitioned to MCI during study follow-up. RESULTS: In the baseline period, incident MCI participants completed their weekly surveys 1.4 hours later in the day than stable cognitively intact participants, P = .03, d = 0.47. Significant associations were found between earlier survey start time of day and higher memory (r = -0.34; P < .001) and visuospatial test scores (r = -0.37; P < .0001). Longitudinally, incident MCI participants showed an increase in survey completion time by 3 seconds per month for more than the year before diagnosis compared with stable cognitively intact participants (ß = 0.12, SE = 0.04, t = 2.8; P = .006). DISCUSSION: Weekly online survey metadata allowed for detection of changes in everyday cognition before transition to MCI.

Industry visions of technology for older adults: A futures anthropology perspective.

The negative portrayal of ageing as a human decline burdening society has prompted Ageing Technology industries (AgeTech) to foresee solutions rooted in the Ageing in Place paradigm. These ostensibly neutral future interventions are intertwined with socio-technical dynamics. While Science and Technology Studies (STS) and anthropology scholars have questioned these AgeTech practices, limited literature explores industry's predictions of future AgeTech. Drawing on STS and futures-anthropology literature, I interrogate AgeTech industry visions of future assemblages involving older people, smart home technology, and socio-material discourses rooted in their own discrepancies and dilemmas. To unpack AgeTech futures, my methods include a review of 49 industry reports and 29 interviews with industry experts. Based on the reports, I designed comics to be used in interviews with experts spanning CEOs and managers of companies designing technology for older people, consultants, and aged-care workers based in 12 countries. Ageing futures are far from being neutral or a chronological process, instead they are non-consensual and fragmented. In the review and interviews, I captured future assemblages of a fragmented AgeTech industry in relationships with governments and industry giants. The fragmentation continues unfolding in participants from diverse countries and professions contesting dominant AgeTech narratives. In dissecting future assemblages, I also unpack non-consensual futures based on diverging experts' values (e.g. safety versus activity) and humans' values like control and improvisation challenging predictive and surveillance technology. AgeTech Futures transcend physical matters or assemblages of technologies and humans. They encompass future normativities, tensions, divergent values, and ideological concepts. I propose not only alternatives to the visions found in industry narratives, but also encourage scholars to understand the AgeTech industry's dilemmas.

Integration of Smart Home and Building Automation Systems in Virtual Reality and Robotics-Based Technological Environment for Neurorehabilitation: A Pilot Study Protocol.

Technological innovation has revolutionized healthcare, particularly in neurological rehabilitation, where it has been used to address chronic conditions. Smart home and building automation (SH&BA) technologies offer promising solutions for managing chronic disabilities associated with such conditions. This single group, pre-post longitudinal pilot study, part of the H2020 HosmartAI project, aims to explore the integration of smart home technologies into neurorehabilitation. Eighty subjects will be enrolled from IRCCS San Camillo Hospital (Venice, Italy) and will receive rehabilitation treatment through virtual reality (VR) and robotics devices for 15 h per day, 5 days a week for 3 weeks in the HosmartAI Room (HR), equipped with SH&BA devices measuring the environment. The study seeks to optimize patient outcomes and refine rehabilitation practices. Findings will be disseminated through peer-reviewed publications and scientific meetings, contributing to advancements in neurological rehabilitation and guiding future research.

Reliability and validity testing of the ASSIST functional performance index.

Reliability and validity testing of the ASSIST Functional Performance Index (AFPI) was conducted, focusing on persons with physical disabilities (PwPD). The AFPI was iteratively developed to assess persons' needs for Mainstream Smart Home Technologies (MSHT) as Assistive Technology (AT) and to measure the impact of a service delivery model for MSHT. The AFPI consists of 46 items organized by functional domains. A total of N = 22 PwPD completed the AFPI twice. The median response time between these two time points was four days. Test-retest reliability of overall scores was assessed using the Intraclass Correlation Coefficient model (ICC, 3.1). The weighted kappa coefficient was applied to conduct an item analysis, demonstrating moderate to substantial agreement in all but one of the items. During the second administration, validity was established by correlating the number of hours of assistance and total AFPI scores with the SCI-FI Self-Care and Basic Mobility Short Form Questionnaires. Results indicate that the AFPI demonstrates good to very good validity as an assessment tool and outcome measure in recommending and evaluating the impact of MSHT for PwPD. Future studies, including more participants and persons with cognitive and sensory disabilities, may further establish the clinical utility of the AFPI.

Factors that predict the acceptance and adoption of smart home technology by seniors in Australia: a structural equation model with longitudinal data.

Smart Home Technology presents an exciting opportunity to support seniors living independently in their homes. Despite widespread interest in Smart Homes, seniors' readiness to adopt Smart Home Technology is low. To determine the factors underpinning Australian seniors' acceptance and adoption of Smart Home Technology using an extended UTAUT model that includes Trust, Resistance to Change and Technology Anxiety. A longitudinal study was conducted to validate the proposed model prior to and after the implementation of a pilot Smart Home Modification program for seniors. Structural Equation Modeling has been applied to test the proposed hypotheses using a sample of 60 seniors in regional Australia. Perceived Usefulness is an important predictor of Smart Home Technology adoption by seniors. Trust was found to indirectly predict adoption of Smart Home Technology via Perceived Usefulness. This study showed that Perceived Usefulness and Trust are critical factors for the acceptance and use of SHT by seniors, validating the extension of UTAUT with a Trust factor. This makes a unique theoretical contribution to the literature with implications for aged care providers and policymakers to consider seniors' perceived usefulness and trust in the design, development, and implementation of Smart Home solutions.

Smart home healthcare for chronic disease management: A scoping review.

Objective: Chronic disease is the leading cause of morbidity and mortality on a global scale. Recent use of intelligent home environments for remote health monitoring has allowed patients to feel safe at home. By encouraging patient engagement and, if necessary, care delivery, smart home environments may be a useful method for managing chronic diseases at home. The purpose of this study is to synthesize the evidence on the usage of smart healthcare in the home for chronic illness management. Methods: We conducted a scoping review using the Joanna Briggs Methodology and searched three databases from 2017 to 2022 for original research papers on smart healthcare, smart home technology, home-based technology, home monitoring, and physiological monitoring for chronic illness management. We did a descriptive study on the pertinent data we collected, as well as an analysis of whether the devices met its objectives. Results: The final analysis included nine papers, the majority of which were randomized controlled trials. All of the studies were carried out in developed countries. The gadgets or smart healthcare in these studies are categorized based on the technology used and the outcomes measured. Respiratory, weight, and ballistocardiograph measurements, as well as changes in questionnaire ratings, hospitalization, activity monitoring, device acceptability, medication adherence, exercise capacity, and body function, were all measured. Conclusion: Smart healthcare applications boost health by monitoring health and wellness, recording physical activity and rehabilitation, and improving overall quality of life. Not all smart home applications, however, served their intended purpose. As a result, more research into the efficacy of smart healthcare is needed to improve its application for chronic illness treatment.

Providing mainstream smart home technology as assistive technology for persons with disabilities: a qualitative study with professionals.

PURPOSE: Mainstream smart home technology (MSHT) is becoming increasingly powerful, affordable, and relevant to improving environment control, independence, and participation of people with disabilities. This study examined how MSHT is delivered as assistive technology (AT) by practitioners of various disciplines and roles and collected their perspectives on the challenges and important considerations during the delivery process. METHODS: Practitioners with at least 1 year of experience providing MSHT as AT were interviewed individually or in small groups of 2-3 participants. Researchers developed guiding questions based on the AT service delivery process and applied an inductive qualitative analysis to generate common themes from the data. RESULTS: While all 15 participants confirmed the potential benefits of MSHT to people with disabilities, most followed an informal service delivery process and encountered various challenges, including challenges related to technology updates and compatibility, difficulty in keeping up with technology changes and advancement, funding for MSHT and services, client Wi-Fi/Internet access and quality, and security and privacy concerns. Participants also emphasised the importance of assessment and technology trialling during the delivery process and shared strategies for device customisation and client training. CONCLUSIONS: This study provides first-hand information about the current practice of MSHT service delivery, as well as insights into areas where support is likely needed. The results could inform the development of new tools and resources to support MSHT service delivery. More research is required to develop and evaluate viable service delivery models for mainstream technologies to be used as AT.IMPLICATIONS FOR REHABILITATIONPractitioners who have experience delivering MSHT as AT confirmed the benefits of MSHT for improving independence, safety, and social connection of people with disabilities.Practitioners emphasised the importance of assessment prior to device selection even though MSHT can be readily purchased off the shelf.Practitioners need support for device trialling, installation, troubleshooting, and keeping up with constantly evolving MSHT.More research is needed to develop and evaluate service delivery models for mainstream technologies as AT for people with disabilities.

Smart Floor Mats for a Health Monitoring System Based on Textile Pressure Sensing: Development and Usability Study.

BACKGROUND: The rise in single-person households has resulted in social problems like loneliness and isolation, commonly known as "death by loneliness." Various factors contribute to this increase, including a desire for independent living and communication challenges within families due to societal changes. Older individuals living alone are particularly susceptible to loneliness and isolation due to limited family communication and a lack of social activities. Addressing these issues is crucial, and proactive solutions are needed. It is important to explore diverse measures to tackle the challenges of single-person households and prevent deaths due to loneliness in our society. OBJECTIVE: Non-face-to-face health care service systems have gained widespread interest owing to the rapid development of smart home technology. Particularly, a health monitoring system must be developed to manage patients' health status and send alerts for dangerous situations based on their activity. Therefore, in this study, we present a novel health monitoring system based on the auto-mapping method, which uses real-time position sensing mats. METHODS: The smart floor mats are operated as piezo-resistive devices, which are composed of a carbon nanotube-based conductive textile, electrodes, main processor circuit, and a mat. The developed smart floor system acquires real-time position information using a multiconnection method between the modules based on the auto-mapping algorithm, which automatically creates a spatial map. The auto-mapping algorithm allows the user to freely set various activity areas through floor mapping. Then, the monitoring system was evaluated in a room with an area of 41.3 m2, which is embedded with the manufactured floor mats and monitoring application. RESULTS: This monitoring system automatically acquires information on the total number, location, and direction of the mats and creates a spatial map. The position sensing mats can be easily configured with a simple structure by using a carbon nanotube-based piezo-resistive textile. The mats detect the activity in real time and record location information since they are connected through auto-mapping technology. CONCLUSIONS: This system allows for the analysis of patients' behavior patterns and the management of health care on the web by providing important basic information for activity patterns in the monitoring system. The proposed smart floor system can serve as the foundation for smart home applications in the future, which include health care, intelligent automation, and home security, owing to its advantages of low cost, large area, and high reliability.

Bridging gaps in the design and implementation of socially assistive technologies for dementia care: the role of occupational therapy.

Dementia is a global health challenge, and people living with dementia (PLWD) are especially susceptible to reduced engagement in meaningful occupations, including social participation. In the past few decades, socially assistive technologies continue to be developed amidst a rapidly evolving technological landscape to support the social health of PLWD and their caregivers. Examples include social robots, virtual reality, smart home technology, and various digital technologies, such as mobile applications for tablets and smartphones. Despite an increasing body of research and interest in this field, several gaps relating to the design and implementation process of socially assistive technologies continue to undermine their relevance for PLWD in daily life. In this paper, some of these gaps are highlighted and the role of occupational therapy in the design and implementation of socially assistive technology is presented. In the design process, occupational therapists are uniquely skilled to advise and advocate for the tailoring and personalisation of technology to address the occupational needs of PLWD. In the implementation of socially assistive technologies, occupational therapists are skilled to educate, train, and conduct ongoing evaluations with PLWD and their caregivers, to incorporate socially assistive technologies into their routine and daily lives. We recommend that occupational therapists should continue to be acquainted with such technologies through continuous professional development and educational curricula. Moreover, we highlight the necessary collaboration between occupational therapists, technology developers, and researchers to enhance the process of designing and implementing socially assistive technology, so that their relevance for PLWD and their caregivers can be maximised.Implications for rehabilitationDevelopers and designers of socially assistive technology should consider the disease trajectory of different types of dementia, as well as the different needs, abilities, preferences, occupations and routines of people living with dementia (PLWD) and/or their caregivers.Collaborations between technology developers, researchers, and occupational therapists should take place iteratively throughout the process of designing and implementing socially assistive technology to maximise their relevance and applicability for people living with dementia and their caregivers.To continue enhancing the current role of occupational therapy in socially assistive technology provision, occupational therapists should keep up to date with socially assistive technology that are being developed to support the social health of PLWD.

Smart home automation technology to support caring of individuals with Alzheimer's disease and related dementia: an early intervention framework.

PURPOSE: Home automation technology comprising of Internet of Things and Smart gadgets is a rapidly growing industry that is projected to have a major scope for ageing-in-place and caregiving. This study examined the feasibility and cost-benefits of a personalized home automation intervention for care of individuals with Alzheimer's disease and related dementia (ADRD) with emphasis on their safety and independence, and reduction of care burden. METHODS: A mixed method intervention study was conducted with five dyads each comprising of a caregiver and care recipient with ADRD. Each dyad received personalized home automation intervention with individualized goals centred on home safety, activity engagement, and caregiver-recipient connectivity. The goals were created and monitored using goal attainment scaling (GAS). The dyads were followed up after three months with a home visit and interview. Goal attainment scoring and thematic analysis of the interviews were conducted to examine the findings from the study. RESULTS: All dyads indicated positive goal attainment between pre and post intervention. Goals that were met were complimented by the categories of peace of mind, self-efficacy, and care recipient engagement, while unmet goals as well as complexities with the technology were elucidated under challenges. Overarching and conceptually linked themes from the study were unfamiliarity, value, and timing. CONCLUSION: Home automation technology has the potential to be adapted to promote independence and safety of individuals with ADRD while relieving care burden. Nonetheless, we propose an early intervention framework to overcome identified challenges and optimize the technology's usability and sustainability.IMPLICATIONS FOR REHABILITATIONHome automation involving Internet of Things and Smart gadgets has gained rapid popularity owing to the comfort and connectivity they provide to mainstream consumers.The technology has an emerging significance to ageing-in-place and care of individuals with Alzheimer's Disease and Related Dementia (ADRD) as it can be adapted and implemented to enhance home safety and activity engagement of the care recipients while also strengthening their connectivity with the caregivers.Unfamiliarity with the technology compounded by the progression of ADRD can, however, be detrimental to its adoption.Individualized focus and early integration of the technology for caregiver-care recipient dyads can mitigate these challenges and optimize its usability and long-term value in relation to ageing-in-place and caregiver wellbeing.

Indoor Temperatures in the 2018 Heat Wave in Quebec, Canada: Exploratory Study Using Ecobee Smart Thermostats.

BACKGROUND: Climate change, driven by human activity, is rapidly changing our environment and posing an increased risk to human health. Local governments must adapt their cities and prepare for increased periods of extreme heat and ensure that marginalized populations do not suffer detrimental health outcomes. Heat warnings traditionally rely on outdoor temperature data which may not reflect indoor temperatures experienced by individuals. Smart thermostats could be a novel and highly scalable data source for heat wave monitoring. OBJECTIVE: The objective of this study was to explore whether smart thermostats can be used to measure indoor temperature during a heat wave and identify houses experiencing indoor temperatures above 26°C. METHODS: We used secondary data-indoor temperature data recorded by ecobee smart thermostats during the Quebec heat waves of 2018 that claimed 66 lives, outdoor temperature data from Environment Canada weather stations, and indoor temperature data from 768 Quebec households. We performed descriptive statistical analyses to compare indoor temperatures differences between air conditioned and non-air conditioned houses in Montreal, Gatineau, and surrounding areas from June 1 to August 31, 2018. RESULTS: There were significant differences in indoor temperature between houses with and without air conditioning on both heat wave and non-heat wave days (P<.001). Households without air conditioning consistently recorded daily temperatures above common indoor temperature standards. High indoor temperatures persisted for an average of 4 hours per day in non-air conditioned houses. CONCLUSIONS: Our findings were consistent with current literature on building warming and heat retention during heat waves, which contribute to increased risk of heat-related illnesses. Indoor temperatures can be captured continuously using smart thermostats across a large population. When integrated with local heat health action plans, these data could be used to strengthen existing heat alert response systems and enhance emergency medical service responses.

Safely and Actively Aging in Place: Older Adults' Attitudes and Intentions Toward Smart Home Technologies.

As smart technology use is growing in residential environments, research on how such technologies can provide opportunities for safely and actively aging in place by integrating physical activity into daily routines and reducing sedentariness is scarce. This study investigated older adults' intentions to use and attitudes toward currently available smart home technologies that could contribute to safe and active lives in and around home. The focus was on four representative technologies: smart lighting, smart door locks, smart fire prevention devices, and smart home systems/home automation. This paper presents the results of a sequential mixed-methods study comprised of online and in-person surveys (n = 129), and a focus group of community-dwelling older adults, aged 50+ (n = 15). Ordinal regression analyses indicated that perceived usefulness consistently predicts older adults' attitudes and willingness to use smart home products. While smart fire prevention devices were viewed most favorably due to their potential safety benefits, perceived affordability significantly influenced older adults' intentions to use them in their homes. The focus group findings underscore technology skepticism, privacy concerns and return on investment as significant determinants of attitudes toward the smart design products. The study has implications of designers and manufacturers by providing insights on how to prioritize smart home technology integrations to homes.

Exploring the effects of California's COVID-19 shelter-in-place order on household energy practices and intention to adopt smart home technologies.

To contain the spread of the novel coronavirus (COVID-19), local and state governments in the U.S. have imposed restrictions on daily life, resulting in dramatic changes to how and where people interact, travel, socialize, and work. Using a social practice perspective, we explore how California's Shelter-in-Place (SIP) order impacted household energy activities. To do so, we conducted an online survey of California residents (n = 804) during active SIP restrictions (May 5-18, 2020). We asked respondents about changes to home occupancy patterns and household energy activities (e.g., cooking, electronics usage) due to SIP restrictions, as well as perspectives toward smart energy technologies. Households reported increased midday (10am-3pm) occupancy during SIP, and this increase is related to respondent and household characteristics, such as education and the presence of minors in the home. Examining change in the frequency of household activities during SIP, presence of minors and increased midday occupancy proved important. Finally, we considered relationships to intention to purchase smart home technologies, with the presence of minors and increased activity frequency relating to greater intention to purchase. These findings demonstrate how household activities and occupancy changed under COVID restrictions, how these changes may be related to energy use in the home, and how such COVID-related changes could be shaping perspectives toward smart home technology, potentially providing insight into future impacts on household practices and electricity demand.

Occupational Therapy and the Use of Technology on Older Adult Fall Prevention: A Scoping Review.

Introduction: Falls are the second leading cause of accidental or non-intentional deaths worldwide and are the most common problem as people age. The primary purpose of addressing falls is to detect, prevent, treat, and reduce their incidence and consequences. Previous studies identified that multifactorial programs, an interprofessional team, and assistive technology are required to address falls in older adults effectively. Accordingly, the research question is as follows: what are the scope, type of studies, and approaches and strategies to fall risk using technology in the existing occupational therapy literature regarding interventions to address the effects of falls in older adults on daily living? Methods: This scoping review was carried out in January 2020 through Biblioteca Virtual de Salud España, C.I.N.A.H.L., Cochrane Plus, OTSeeker, PubMed, Scopus, and Web of Science. Results: Twelve papers were included. We analyzed the year and journal of publication, authors' affiliation, and design of the study, and thematic categories. There were three themes: participants' characteristics, type of intervention, and fall approach and type of technology used. Discussion and Conclusions: The literature obtained is scarce. It is considered to still be an emerging theme, especially when considering the use of technology for occupational therapy.

The feasibility and acceptability of smart home technology using the Howz system for people with stroke.

Purpose: To assess the feasibility and acceptability of the Howz smart home system for stroke survivors.Materials: Howz uses smart home technology to monitor users' activity in the home and machine learning algorithms to detect when their activity changes. This information made available to the user and a named contact (usually a family member) via the Howz app. If activity changes, an alert is then sent to the user and the named contact.Methods: Howz was installed in the homes of 19 stroke survivors who lived alone. The sensors installed; the number and nature of alerts; adverse events; any technical difficulties and how Howz was used were recorded. We also interviewed participants and their named contacts about their views and experiences of using Howz eight weeks after installation.Results: Installation was effective; no technological problems or adverse events were reported. All participants chose alerts regarding "getting up" and activity during the day and at night. There was a mean of 1.1 (sd 1.2) alerts/person. Participants found the system unobtrusive and were positive about it. They found it easy to use and would recommend it to others with stroke. The most frequently reported benefit was that Howz gave peace of mind for the users and/or the family/named contact that help would be at hand if needed.Conclusions: The Howz system was feasible and acceptable for stroke survivors. It gave users and their family an enhanced sense of security and peace of mind that help would be at hand if needed.Implications for rehabilitationAlthough most stroke survivors are elderly and often suffer physical, visual and cognitive disabilities which are often considered as barriers to using smart home technology, this project has demonstrated the well-developed smart home technology is feasible and acceptable.Users were able and willing to engage with the technology (to varying degrees) and had no concerns about invasion of privacy.The main benefit of the Howz system is an enhanced sense of security for the user and their family that help is at hand if needed.