Wireless Sensors Grouping Proofs for Medical Care and Ambient Assisted-Living Deployment.

Internet of Things (IoT) devices are rapidly penetrating e-health and assisted living domains, and an increasing proportion among them goes on the account of computationally-weak devices, where security and privacy provisioning alone are demanding tasks, not to mention grouping proofs. This paper, therefore, gives an extensive analysis of such proofs and states lessons learnt to avoid possible pitfalls in future designs. It sticks with prudent engineering techniques in this field and deploys in a novel way the so called non-deterministic principle to provide not only grouping proofs, but (among other) also privacy. The developed solution is analyzed by means of a tangible metric and it is shown to be lightweight, and formally for security.

Individual music therapy for managing neuropsychiatric symptoms for people with dementia and their carers: a cluster randomised controlled feasibility study.

BACKGROUND: Previous research highlights the importance of staff involvement in psychosocial interventions targeting neuropsychiatric symptoms of dementia. Music therapy has shown potential effects, but it is not clear how this intervention can be programmed to involve care staff within the delivery of patients' care. This study reports initial feasibility and outcomes from a five month music therapy programme including weekly individual active music therapy for people with dementia and weekly post-therapy video presentations for their carers in care homes. METHODS: 17 care home residents and 10 care staff were randomised to the music therapy intervention group or standard care control group. The cluster randomised, controlled trial included baseline, 3-month, 5-month and post-intervention 7-month measures of residents' symptoms and well-being. Carer-resident interactions were also assessed. Feasibility was based on carers' feedback through semi-structured interviews, programme evaluations and track records of the study. RESULTS: The music therapy programme appeared to be a practicable and acceptable intervention for care home residents and staff in managing dementia symptoms. Recruitment and retention data indicated feasibility but also challenges. Preliminary outcomes indicated differences in symptoms (13.42, 95 % CI: [4.78 to 22.07; p = 0.006]) and in levels of wellbeing (-0.74, 95 % CI: [-1.15 to -0.33; p = 0.003]) between the two groups, indicating that residents receiving music therapy improved. Staff in the intervention group reported enhanced caregiving techniques as a result of the programme. CONCLUSION: The data supports the value of developing a music therapy programme involving weekly active individual music therapy sessions and music therapist-carer communication. The intervention is feasible with modifications in a more rigorous evaluation of a larger sample size. TRIAL REGISTRATION: Clinicaltrials.gov, number NCT01744600.

Hands-On Experiences in Deploying Cost-Effective Ambient-Assisted Living Systems.

Older adults' preferences to remain independent in their own homes along with the high costs of nursing home care have motivated the development of Ambient Assisted Living (AAL) technologies which aim at improving the safety, health conditions and wellness of the elderly. This paper reports hands-on experiences in designing, implementing and operating UbiCare, an AAL based prototype system for elderly home care monitoring. The monitoring is based on the recording of environmental parameters like temperature and light intensity as well as micro-level incidents which allows one to infer daily activities like moving, sitting, sleeping, usage of electrical appliances and plumbing components. The prototype is built upon inexpensive, off-the-shelf hardware (e.g., various sensors, Arduino microcontrollers, ZigBee-compatible wireless communication modules) and license-free software, thereby ensuring low system deployment costs. The network comprises nodes placed in a house's main rooms or mounted on furniture, one wearable node, one actuator node and a centralized processing element (coordinator). Upon detecting significant deviations from the ordinary activity patterns of individuals and/or sudden falls, the system issues automated alarms which may be forwarded to authorized caregivers via a variety of communication channels. Furthermore, measured environmental parameters and activity incidents may be monitored through standard web interfaces.

An assisted living facility curriculum to introduce geriatrics to first-year medical students.

Many U.S. medical schools have developed curricula in geriatric medicine to address the growing older adult population. At our university, the authors have integrated an assisted living facility (ALF) program into a required first-year clinical skills course. During the 2011 to 2012 academic year, an electronic survey was distributed to 109 first-year medical students prior to and after the program. Eighty-eight percent and 85% of students completed the pre- and postintervention survey, respectively. Students reported a positive attitude toward caring for older adults (92.5% post- vs. 80.2% preintervention), an understanding of the medical and social needs of older adults (89.2% post- vs. 38.5% preintervention), an acquisition of the skills to assess the health of older adults (71% post- vs. 14.5% preintervention), and an understanding of ALFs as nonmedical supportive housing (92.5% post- vs. 70.8% preintervention). The authors' curriculum offers an innovative method to integrate geriatrics education early in medical education and to involve medical students in their community.

Measuring end-of-life care and outcomes in residential care/assisted living and nursing homes.

CONTEXT: The two primary residential options for older adults who require supportive care are nursing homes and residential care/assisted living. More than one-quarter of all deaths in the U.S. occur in these settings. Although the information available on end of life in long-term care has been growing, the comparative suitability of various measures to guide this work is unknown. OBJECTIVES: To determine the optimal measures to assess end-of-life care and outcomes in nursing homes and residential care/assisted living. METHODS: A total of 264 family members of decedents from 118 settings were interviewed and provided data on 11 instruments that have been used in, but not necessarily developed for, long-term care populations; Overall, 20 scales and subscales/indices were evaluated. Measures were compared on their psychometric properties and the extent to which they discriminated among important resident, family, and setting characteristics. RESULTS: Prioritizing measures that distinguish the assessment of care from the assessment of dying, and secondarily that exhibit an acceptable factor structure, this study recommends two measures of care-the Family Perceptions of Physician-Family Caregiver Communication and the End of Life in Dementia (EOLD)-Satisfaction With Care-and two measures of outcomes-the EOLD-Symptom Management and the EOLD-Comfort Assessment in Dying. An additional measure to assess outcomes is the Mini-Suffering State Examination (MSSE). The care measures and the MSSE are especially valuable as they discriminate between decedents who were and were not transferred immediately before death, an important outcome, and whether the family expected the death, a useful target for intervention. CONCLUSION: Despite these recommendations, measurement selection should be informed not only on the basis of psychometric properties but also by specific clinical and research needs. The data in this manuscript will help researchers, clinicians, and administrators understand the implications of choosing various measures for their work.

Using life history narratives to educate staff members about personhood in assisted living.

Oral life history narratives are a promising method to promote person-centered values of personhood and belonging. This project used resident oral history interviews to educate staff members in an assisted-living setting about personhood. A single group pre-post test design evaluated impacts on 37 staff members to assess their use of resident videotaped oral history interviews and impacts on their perceived knowledge of residents. Perceived knowledge of residents declined (p = .003) between pretest and posttest. Older staff members were less likely to view a video. Staff members are interested in resident oral history biographies and identify them as helpful for delivering care. Oral history methods might provide an opportunity for staff members to promote personhood by allowing them to expand their understanding of resident preferences, values, and experiences.

A holistic approach to ZigBee performance enhancement for home automation networks.

Wireless home automation networks are gaining importance for smart homes. In this ambit, ZigBee networks play an important role. The ZigBee specification defines a default set of protocol stack parameters and mechanisms that is further refined by the ZigBee Home Automation application profile. In a holistic approach, we analyze how the network performance is affected with the tuning of parameters and mechanisms across multiple layers of the ZigBee protocol stack and investigate possible performance gains by implementing and testing alternative settings. The evaluations are carried out in a testbed of 57 TelosB motes. The results show that considerable performance improvements can be achieved by using alternative protocol stack configurations. From these results, we derive two improved protocol stack configurations for ZigBee wireless home automation networks that are validated in various network scenarios. In our experiments, these improved configurations yield a relative packet delivery ratio increase of up to 33.6%, a delay decrease of up to 66.6% and an improvement of the energy efficiency for battery powered devices of up to 48.7%, obtainable without incurring any overhead to the network.

Active in-database processing to support ambient assisted living systems.

As an alternative to the existing software architectures that underpin the development of smart homes and ambient assisted living (AAL) systems, this work presents a database-centric architecture that takes advantage of active databases and in-database processing. Current platforms supporting AAL systems use database management systems (DBMSs) exclusively for data storage. Active databases employ database triggers to detect and react to events taking place inside or outside of the database. DBMSs can be extended with stored procedures and functions that enable in-database processing. This means that the data processing is integrated and performed within the DBMS. The feasibility and flexibility of the proposed approach were demonstrated with the implementation of three distinct AAL services. The active database was used to detect bed-exits and to discover common room transitions and deviations during the night. In-database machine learning methods were used to model early night behaviors. Consequently, active in-database processing avoids transferring sensitive data outside the database, and this improves performance, security and privacy. Furthermore, centralizing the computation into the DBMS facilitates code reuse, adaptation and maintenance. These are important system properties that take into account the evolving heterogeneity of users, their needs and the devices that are characteristic of smart homes and AAL systems. Therefore, DBMSs can provide capabilities to address requirements for scalability, security, privacy, dependability and personalization in applications of smart environments in healthcare.

Creating an interdisciplinary medical home for survivors of human trafficking.

Health care providers play an important role in identifying victims of human trafficking and addressing their unique medical needs. In response to a recently published call to action in Obstetrics & Gynecology, an interdisciplinary medical home has been created in central Texas to serve as a model for delivery of care to survivors of human trafficking that is sensitive to their history of trauma, or "trauma-informed." An overview of the topic is provided along with a description of the stakeholders involved and the steps that were taken to create the clinic. This information is presented with the intention of educating health care providers on the long-term medical needs of survivors and on how they can establish a similar clinic in other parts of the country.

Knowledge representations in ambient assisted living--context awareness in smart homes.

This paper introduces a knowledge representation for smart home rules and scenarios. We have created a rule base based on the rules found during a literature review. Following this, a general rule concept was derived from the identified categories. Furthermore, subcategories for certain contexts in the smart home environment were identified and illustrated in the results by means of an extract of the rules found in the literature. Based on this information, a hierarchically structured nomenclature with four axes has been developed and evaluated.

Disseminating ambient assisted living in rural areas.

The smart home, ambient intelligence and ambient assisted living have been intensively researched for decades. Although rural areas are an important potential market, because they represent about 80% of the territory of the EU countries and around 125 million inhabitants, there is currently a lack of applicable AAL solutions. This paper discusses the theoretical foundations of AAL in rural areas. This discussion is underlined by the achievements of the empirical field study, Casa Vecchia, which has been carried out over a four-year period in a rural area in Austria. The major goal of Casa Vecchia was to evaluate the feasibility of a specific form of AAL for rural areas: bringing AAL technology to the homes of the elderly, rather than moving seniors to special-equipped care facilities. The Casa Vecchia project thoroughly investigated the possibilities, challenges and drawbacks of AAL related to this specific approach. The findings are promising and somewhat surprising and indicate that further technical, interactional and socio-psychological research is required to make AAL in rural areas reasonable in the future.

Context graphs as an efficient and user-friendly method of describing and recognizing a situation in AAL.

In the field of ambient assisted living, the best results are achieved with systems that are less intrusive and more intelligent, that can easily integrate both formal and informal caregivers and that can easily adapt to the changes in the situation of the elderly or disabled person. This paper presents a graph-based representation for context information and a simple and intuitive method for situation recognition. Both the input and the results are easy to visualize, understand and use. Experiments have been performed on several AAL-specific scenarios.

Multimodal wireless sensor network-based ambient assisted living in real homes with multiple residents.

Human activity recognition and behavior monitoring in a home setting using wireless sensor networks (WSNs) provide a great potential for ambient assisted living (AAL) applications, ranging from health and wellbeing monitoring to resource consumption monitoring. However, due to the limitations of the sensor devices, challenges in wireless communication and the challenges in processing large amounts of sensor data in order to recognize complex human activities, WSN-based AAL systems are not effectively integrated in the home environment. Additionally, given the variety of sensor types and activities, selecting the most suitable set of sensors in the deployment is an important task. In order to investigate and propose solutions to such challenges, we introduce a WSN-based multimodal AAL system compatible for homes with multiple residents. Particularly, we focus on the details of the system architecture, including the challenges of sensor selection, deployment, networking and data collection and provide guidelines for the design and deployment of an effective AAL system. We also present the details of the field study we conducted, using the systems deployed in two different real home environments with multiple residents. With these systems, we are able to collect ambient sensor data from multiple homes. This data can be used to assess the wellbeing of the residents and identify deviations from everyday routines, which may be indicators of health problems. Finally, in order to elaborate on the possible applications of the proposed AAL system and to exemplify directions for processing the collected data, we provide the results of several human activity inference experiments, along with examples on how such results could be interpreted. We believe that the experiences shared in this work will contribute towards accelerating the acceptance of WSN-based AAL systems in the home setting.

A multi-collaborative ambient assisted living service description tool.

Collaboration among different stakeholders is a key factor in the design of Ambient Assisted Living (AAL) environments and services. Throughout several AAL projects we have found repeated difficulties in this collaboration and have learned lessons by the experience of solving real situations. This paper highlights identified critical items for collaboration among technicians, users, company and institutional stakeholders and proposes as a communication tool for a project steering committee a service description tool which includes information from the different fields in comprehensible format for the others. It was first generated in the MonAMI project to promote understanding among different workgroups, proven useful there, and further tested later in some other smaller AAL projects. The concept of scalable service description has proven useful for understanding of different disciplines and for participatory decision making throughout the projects to adapt to singularities and partial successes or faults of each action. This paper introduces such tool, relates with existing methodologies in cooperation in AAL and describes it with a example to offer to AAL community. Further work on this tool will significantly improve results in user-centered design of sustainable services in AAL.

Evaluation of ambient assisted living interventions--which tool to choose?

This paper discusses suggested evaluation frameworks' appropriateness for a study introducing Ambient Assisted Living (AAL) interventions. Specifically, we look at how well proposals cover these dimensions: impact on society, impact on professionals, and impact on patients. We discuss three widely used approaches for such assessments: RE-AIM, MAST, and UTAUT. Our assessment showed careful selection of elements from all three models seems needed to sufficiently cover the dimensions. RE-AIM provides a broad framework; MAST adds aspects of transferability and ethics, and UTAUT adds perception of technology and future use. All these approaches lack pivotal aspects concerning inclusion of patients' or citizens' point of view in a study's planning phase. To ensure rigor and include meaningful use from citizens' perspective, we added these aspects to our study.

Going digital: adoption of electronic health records in assisted living facilities.

This pilot study examines the associations between structural characteristics and the adoption and subsequent use of electronic health records (EHR; resident demographics, clinical notes, medication lists, problem lists, discharge summaries, and advance directives) as a process characteristic in assisted living facilities (ALFs). The study is guided conceptually by Donabedian's Structure-Process-Outcome (SPO) model. Primary survey data were collected from a randomly selected sample (N = 76) in Florida during 2009-2010. Analysis included descriptive and bivariate statistics. Descriptive results indicated that ALFs most frequently used an EHR to record medication lists. Characteristics, including size, profit status, resident case mix, and staffing, were associated at the bivariate level with the use of one or more functional domains of an EHR. Thus, the use of EHRs in ALFs is correlated with facility characteristics.

"Fit and fabulous": mixed-methods research on processes, perceptions, and outcomes of a yearlong gym program with assisted-living residents.

This study's mixed-methods design sought to understand how to encourage assisted-living (AL) residents to initiate and continue exercise in a gym setting. Ten residents participated in this yearlong program. Processes developed and perceived benefits were understood through interviews and observations. Changes in active time, lower body strength, and workload were evaluated using direct measures. Findings indicated that AL residents regularly used exercise machines (mean participation = 53.8%) and increased active time and lower body strength (p = .02) when adequately prepared and supported. Participants prioritized gym time and developed pride and ownership in the program. They described themselves as exercisers and developed a sense of belonging to their new home. Friendships with one another, staff, and university partners were nurtured in the gym setting. When provided space, equipment, trained staff, and additional resource support, AL residents' quality of life and life satisfaction were enhanced in several domains.

Wireless sensor networks for ambient assisted living.

This paper introduces wireless sensor networks for Ambient Assisted Living as a proof of concept. Our workgroup has developed an arrhythmia detection algorithm that we evaluate in a closed space using a wireless sensor network to relay the information collected to where the information can be registered, monitored and analyzed to support medical decisions by healthcare providers. The prototype we developed is then evaluated using the TelosB platform. The proposed architecture considers very specific restrictions regarding the use of wireless sensor networks in clinical situations. The seamless integration of the system architecture enables both mobile node and network configuration, thus providing the versatile and robust characteristics necessary for real-time applications in medical situations. Likewise, this system architecture efficiently permits the different components of our proposed platform to interact efficiently within the parameters of this study.

AmI and deployment considerations in AAL services provision for elderly independent living: the MonAMI project.

The MonAMI project aims to investigate the feasibility of the deployment of open platforms for Ambient Assisted Living (AAL) services provision based on Ambient Intelligence (AmI) and to test user acceptance and the usability of the services. Services were designed to provide support in the areas of environmental control, security, well-being and leisure. These services were installed and evaluated in a Spanish geriatric residence. The participants included elderly persons with disabilities, nursing home care givers and informal carers. The concept of the open platform proved to be satisfactory for the provision of the services in a context aware framework. Furthermore, the usability of the technology was viewed positively and the overall results indicate that this system has the potential to prolong independent living at home for elderly people with disabilities. Deployment was proven successful and awareness of open-platform AAL service delivery was raised in local communities throughout Europe.

Understanding dissemination and implementation of a new intervention in assisted living settings: the case of function-focused care.

Function-focused care (FFC) was developed to change the philosophy of care in assisted living (AL) to one in which nurses, direct care workers (DCWs) and other members of the health care team work with residents to optimize function and time spent in physical activities. The purpose of this article is to describe dissemination and implementation of FFC within the two assisted living communities in Maryland that were randomized to our FFC for assisted living intervention (FFC-AL). The reach, efficacy/effectiveness, adoption, implementation, and maintenance (RE-AIM) model was used to evaluate dissemination and implementation of FFC in these communities. A total of 171 residents and 96 DCWs consented to participate in the study and outcomes based on data collected from the participants as well as evidence for dissemination and implementation at the site level are provided. Findings can be used to guide others in dissemination and implementation of similar interventions in AL communities.