Is research on 'smart living environments' based on unobtrusive technologies for older adults going in circles? Evidence from an umbrella review.

CONTEXT AND AIMS: To enable ageing in place, innovative and integrative technologies such as smart living environments may be part of the solution. Despite extensive published literature reviews on this topic, the effectiveness of smart living environments in supporting ageing in place, and in particular involving unobtrusive technologies, remains unclear. The main objective of our umbrella review was to synthesize evidence on this topic. METHODS: According to the PRIOR process, we included reviews from multiple databases that focused on unobtrusive technologies used to analyze and share information about older adults' behaviors and assessed the effectiveness of unobtrusive technologies to support ageing in place. Selection, extraction and quality appraisal were done independently by two reviewers. RESULTS: By synthesizing 17 published reviews that covered 191 distinct primary studies, we found that smart living environments based on unobtrusive technologies had low to moderate effectiveness to support older adults to age in place. Effectiveness appears to be strongest in the recognition of activities of daily living. The results must, however, be interpreted in light of the low overall level of evidence, i.e., low methodological value of the primary studies and poor methodological quality of the literature reviews. Most reviews concluded that unobtrusive technologies are not mature enough for widespread adoption. CONCLUSION: There is a necessity to support primary studies that can move beyond the proof-of-concept or pilot stages and expand scientific knowledge significantly on the topic. There is also an urgent need to publish high quality literature reviews to better support policy makers and funding agencies in the field of smart living environments.

A Mixed Reality Cognitive Orthosis to Support Older Adults in Achieving Their Daily Living Activities: Focus Group Study With Clinical Experts.

BACKGROUND: Mixed reality is an emerging technology that allows us to blend virtual objects into the actual user's environment. This can be realized using head-mounted displays. Many recent studies have suggested the possibility of using this technology to support cognition in people with neurodegenerative disorders (NDs). However, most studies have explored improvements in cognition rather than in independence and safety during the accomplishment of daily living activities. Therefore, it is crucial to document the possibility of using mixed reality to support the independence of older adults in their daily lives. OBJECTIVE: This study is part of a larger user-centered study of a cognitive orthosis using pure mixed reality to support the independence of people living with NDs. This study aimed to explore (the difficulties encountered by older adults with NDs in their daily life to ensure that pure mixed reality meets their needs, (the most effective interventions with this population to determine what types of assistance should be provided by pure mixed reality technology, how the pure mixed reality technology should provide assistance to promote aging in place, and the main facilitators of and barriers to the use of this technology. METHODS: We conducted a descriptive, qualitative study. A total of 5 focus groups were completed with occupational therapists who had expertise in the disease and its functional impacts (N=29) to gather information. Each focus group met once for a 1-hour period. All sessions were held over a 3-month period. A semistructured interview guide was used. All group interviews were audiotaped with the consent of each participant to facilitate the data analysis. We conducted inductive qualitative analysis in four stages using a thematic analysis approach: full transcription of the audio recordings, first-order coding of the transcribed data, second-order coding from the first-order code list, and data reduction and matrix development. RESULTS: The results suggested that the main difficulties encountered by this population were in remembering to complete tasks, initiating the tasks, and planning the tasks. Several interventions are used to improve the independence of this population, such as prevention, simplification or facilitation, adaptation, and compensation. The use of pure mixed reality in older adults with NDs to promote independence and safety at home is promising and may respond to several clinical functions identified by the participants. Finally, pure mixed reality has good potential for use in this population and involves certain facilitators and obstacles, such as resources, technical aspects, and social considerations. CONCLUSIONS: The cognitive orthosis that will be developed in light of this study will act as a proof of concept for the possibility of supporting people with NDs using pure mixed reality.

Smart Assistive Technology for Cooking for People With Cognitive Impairments Following a Traumatic Brain Injury: User Experience Study.

BACKGROUND: User experience (UX), including usability, should be formally assessed multiple times throughout the development process to optimize the acceptability and integration of a new technology before implementing it within the home environment of people living with cognitive impairments. OBJECTIVE: The aim of this study is to identify UX issues, notably usability issues, and factors to consider for the future implementation of the COOK (Cognitive Orthosis for Cooking) within the home of individuals with traumatic brain injury (TBI) to identify modifications to improve the technology. METHODS: This study comprised two rounds of UX evaluations, including extensive usability testing, which were completed in a laboratory context: 3 sessions with 5 experts and, after improvement of COOK, 2 sessions with 10 participants with TBI. Each session included the use of scenarios and questionnaires on UX and usability. RESULTS: Both rounds demonstrated good usability outcomes and hedonic qualities. Various usability issues were identified by participants, such as navigation inconsistencies, technical bugs, and the need for more feedback. Factors to consider in the future implementation of COOK were also mentioned by participants with TBI, including environmental (eg, space available and presence of pets) and personal factors (eg, level of comfort with technology, presence of visual deficits, and preferences). CONCLUSIONS: By evaluating UX, including usability, various times throughout the development process and including experts and end users, our research team was able to develop a technology that was perceived as usable, pleasant, and well-designed. This research is an example of how and when people with cognitive impairments (ie, people with TBI) can be involved in evaluating the UX of new technology.

Using a cognitive orthosis to support older adults during meal preparation: Clinicians' perspective on COOK technology.

INTRODUCTION: Occupational therapists promote safety and autonomy of older adults with cognitive impairments. A technology, named COOK, offers support on a touch screen installed next to the stove to support task performance while correcting risky behaviors. We aimed to document (1) the functional profiles according the diagnosis (2) the types of interventions used to increase autonomy in the kitchen (3) the facilitators and obstacles to the implementation of COOK with this clientele. METHODS: Four focus groups were conducted with occupational therapists (n = 24) and were transcribed and analyzed using thematic analysis, including coding and matrix building. RESULTS: Occupational therapists identified different (1) functional profiles and (2) interventions for both diagnoses. The use of COOK (3) could be more beneficial in mild cognitive impairment, as many barriers occur for the use in Alzheimer's disease. Some parameters, such as digital control of the stove and complex information management, need to be simplified. DISCUSSION: According to occupational therapists, this technology is particularly applicable to people with mild cognitive impairment, because this population has better learning abilities. CONCLUSION: This study documented the specific needs of older adults with cognitive impairments as well as interventions used by occupational therapists. The perspectives of caregivers should be captured in future research.