Frank Knoefel

• Doctor of Medicine
• Chair in Primary Health Care Dementia Research at Bruyère Research Institute

Home sensor and smart home technologies offer the potential to provide important objective information on daily activities, functional abilities, and caregiving tasks for individuals with cognitive impairment and care partners. Combining information from multiple sensors, such as a bedmat, wearable, and motion sensors, can deliver more informative...

The automobile is considered essential for transportation in most western countries. For many older adults, driving is a key enabler for maintaining an active, engaged, and independent lifestyle, allowing the freedom to be able to get out for work, social activities, shopping, physical exercise, and many other activities. Thus, driving leads to phy...

With an aging population, anticipated increase in dementia cases and the emergence of transitional care units (TCU) serving these individuals, healthcare providers are looking to the future of smart technologies (DementiaTech) to assist in providing care to persons living with dementia (PLWD). Our research aimed to understand how DementiaTech can b...

Mild cognitive impairment (MCI) confers a higher risk of developing dementia. While largely preserved, instrumental activities of daily living (IADLs) may be affected to varying degrees by MCI. The Memory Support System (MSS) is a curriculum and calendar/note-taking system that has proven effective in sustaining independence in IADLs for individual...

Cognitive decline is becoming more prevalent as population ages. Technology offers solutions to help people with cognitive decline age in place. A compassionate approach to care can promote engagement in technology use by older adults with cognitive decline and equitable access. This scoping review summarized research literature on approaches to de...

Background Mild cognitive impairment (MCI) confers a higher risk of developing dementia and may interfere with instrumental activities of daily living (IADLs). The Memory Support System (MSS) is a curriculum and calendar/note‐taking system that has proven effective to sustain independence in IADLs in individuals with MCI and protect mood among supp...

Driving cessation in old age is linked to negative mental and physical health outcomes. Autonomous vehicles offer an opportunity to maintain independence and mobility for older adults. However, vehicle automation can compromise driver engagement, posing risks to drivers and the public. The concern is particularly significant for older and novice dr...

Background The impact of delirium on cognition has not been well‐studied in long‐term care (LTC) residents. This study examined changes in cognition 1 year after a probable delirium episode among LTC residents, compared to LTC residents without probable delirium. We also evaluated whether the relationship between probable delirium and cognitive cha...

Most people as they age, wish to do so with as much independence as possible, to remain in their homes and communities with the health and social services required [1]. This is known as aging-in-place, and it has many benefits for the aging adult as they remain connected to the places and people they know. With aging-in-place, older adults are more...

If we have the good fortune to live into our golden years, we have surely succeeded at life. While aging is universal, just ‘how’ we age will be uniquely our own. While capacity declines can be experienced across our entire lifespan, modifiable risk factors, such as physical inactivity, can have serious implications on our health. The World Health...

In the previous chapter, we introduced a variety of sensors capable of generating a number of data types, however, their data only become useful once they are analyzed and interpreted. In the supportive smart home, this analysis and interpretation is what will initiate actions. For instance, if we assume a digital light camera is like an eye, it wi...

You’ve just finished reading this book and you’ve probably got lots of ideas, and perhaps just as many questions—and these may be different depending on if you are an older adult, informal or formal caregiver, student, engineer/computer scientist, healthcare professional, working in a business, or someone developing health policy.

The proceeding chapters identified challenge areas which still need to be addressed—both purely technological ones and those to improve the measurement of clinical parameters. To summarize, the technological challenges include: At the sensor level, there are challenges with precision, cost, and improving non-intrusiveness. At the level of data move...

There are a number of ways to review the history of anything. There are short histories and long histories. Some are focused on a single event, likely including some lead up, and others focus on themes that evolve over centuries. In this chapter, we are going to have some fun. We will look at the history of homes and how activities in the home have...

Cognition refers to an individual's mental abilities including memory, attention, language, decision-making, performing tasks, and spatial awareness. As we age, some of our cognitive abilities may decline over time, but with normal aging these declines do not significantly impact our ability to perform day to day tasks. Cognitive impairment, howeve...

As mentioned previously, aging is often characterized by the accumulation of chronic medical conditions. We mentioned the musculoskeletal system and more specifically, osteo-arthritis, in the section on mobility. Similarly, the heart and circulatory system are affected by such conditions as hypertension, arrhythmias, and coronary artery disease; th...

When we see commercially made images of older adults, they often include the person with a cane or walker. Similarly, commercial videos often have them shuffling along at a snail’s pace. While society should not generalize to all older adults, it is true that mobility can be a highly visible sign of aging. Indeed, mobility is an important function...

Population aging is transforming our society in myriad and interesting ways, and so is information and communication technology (ICT). ICTs consist of a “diverse set of technological tools and resources used to transmit, store, create, share or exchange information” (UIS 2020). More unambiguously, they are devices (e.g., smartphones, computers, tab...

If you really want to keep your house safe, you should hire security guards to watch your house 24/7. However, most of us cannot afford that kind of staffing. The next best thing, then, is to install a security system. Essentially, we would buy a set of sensors that provides a version of ‘watching’ the house. We may buy sensors for the doors and wi...

So far, we have presented some challenges associated with aging and examples where supportive smart home technologies could provide support to those wishing to age in place. However, we have only considered these in a simple one-dimensional way: here is a health challenge, and here is a technology that may support it. In reality, there are other fo...

Activities of daily living (ADLs) are broadly grouped into basic activities of daily living (bADLs), more complex instrumental activities of daily living (iADLs), and enhanced activities of daily living (eADLs). BADLs include activities such as dressing, bathing, feeding oneself, personal care, and toileting (Lawton and Brody Lawton MP, Brody EM (1...

Background Sleep disturbances affect 60‐70% of persons living with dementia (PLWD) affecting prognosis and care burden. Sleep studies typically employ actigraphy, however, it is intrusive and lacks information on location. This study explores the use of ambient sensors, to compare nighttime rest patterns of higher and lower functioning PLWD. Metho...

Background: Decisions around driving retirement are difficult for older persons living with cognitive decline and their caregivers. In many jurisdictions, physicians are responsible for notifying authorities of driving risks. However, there are no standardized guidelines for this assessment. Having access to a driving risk assessment tool could hel...

Background: Home-based sensor technologies can detect information on daily activities, such as sleep, activity level, and time spent together. This is relevant information for care partners of individuals with cognitive impairment as it can detect early changes in daily activities and cognition. The challenge is how to present thousands of data po...

Home‐based sensor technologies can detect information on daily activities, such as sleep, activity level, and time spent together. This is relevant information for care partners of individuals with cognitive impairment as it can detect early changes in daily activities and cognition. The challenge is how to present thousands of data points to care...

Background: Driving cessation is difficult for persons living with cognitive decline (PLWCD) and their caregivers (CG). Physicians are often required to notify authorities of driving risks, and typically base decisions on paper-based cognitive assessments and on-road tests. This study examines experiences surrounding cessation and CG’s views regard...

italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">Goal: The evaluation of respiratory events using audio sensing in an at-home setting can be indicative of worsening health conditions. This paper investigates the use of image-based transfer learning applied to five audio visualizations to evaluate thr...

Objective: Medications can increase the risk of delirium due to drug toxicities, polypharmacy, and drug interactions. This study examined potentially inappropriate prescribing (PIP) of medication and its association with probable delirium among long-term care residents. Approach: We conducted a cross-sectional study of long-term care residents in O...

Supportive smart home technology, for older adults living with dementia and their informal care partners, has shown some benefits in private homes. In this study, a supportive smart home system is being implemented in a hospital alternative level of care setting. This case report describes how a team of researchers and healthcare managers are navig...

Driving enables access to meaningful occupations which determine health in older age [1] and the automotive industry is investing significantly in technology to assist and automate the driving task [2]. Little is known regarding the challenges posed by this new technology on the engagement of older drivers [3–5]. Immediate ecologically-valid resear...

Research into methods to assess heart rate and respiration rate through non-contact means has been ongoing for many years [1], and this work has expanded in scope in recent years following the publication of two methods in 2012 and 2013, respectively: video magnification (VM) [2] and remote photoplethysmography (rPPG) [3]. Both methods are founded...

Background Changes in mobility are associated with cognitive decline in older adults. Mobility is frequently assessed in the clinic setting at episodic intervals. Passive sensors within a home‐based technology platform allow for unobtrusive collection of mobility and gait information over an extended time period. This method of high‐frequency data...

Ubiquitous sensing technologies are a well recognized concept these days. An individual with a rudimentary understanding of technology intuitively understands that their cell phone can track their whereabouts, detect their activity and communicate with their home devices. With the increased capability of technology, measurements have become finer a...

Individuals with mild cognitive impairment are at risk of cognitive and physical decline. Virtual reality (VR) exercise may provide beneficial physical and cognitive exercise. The objectives of this study were to assess the feasibility and safety of home-based VR exercise and to provide pilot data for physical and cognitive efficacy. Eleven individ...

Cognitive decline resulting from Dementia of Alzheimer’s Type (DAT) can lead to reduced ability to perform complex daily tasks required for independent living, including driving an automobile. This study explores the ability of untrained observers to classify driving safety using short video clips of simulated driving through intersections; it also...

Objectives: To estimate the prevalence of probable delirium in long-term care (LTC) and complex continuing care (CCC) settings and to describe the resident characteristics associated with probable delirium. Design: Population-based cross-sectional study using routinely collected administrative health data. Setting and participants: All LTC and...

The population of older adults (>65 years old) is growing both in Canada and abroad. In 2018, there were 6.4 million older adults (aged 65 and over, with 1.6 million aged 80 or older) in Canada [1]. This population is expected to increase to between 12.3 and 16.1 million (aged 65 and over, with between 4.7 and 6.3 million aged 80 or older) by 2068...

Decisions related to driving safety and when to cease driving are complex and costly. There is an interest in developing an off-road driving test utilizing neuropsychological tests that could help assess fitness-to-drive. Serial trichotomization has demonstrated potential as it yields 100% sensitivity and specificity in retrospective test samples....

Background Conventional methods assessing activities related to caregiving rely on self‐report with caregivers providing estimations of time and resources directed to these activities, which vary over time and can be difficult to reliably estimate retrospectively. Home‐based assessment platforms using sensors to collect objective information on dai...

Introduction More than half of persons with dementia will experience night-time wandering, increasing their risk of falls and unattended home exits. This is a major predictor of caregiver burnout and one of the major causes of early institutionalization. Methods Using smart home technologies such as sensors, smart bulbs, pressure mats and speakers...

The current pandemic associated with the novel coronavirus (COVID-19) presents a new area of research with its own set of challenges. Creating unobtrusive remote monitoring tools for medical professionals that may aid in diagnosis, monitoring and contact tracing could lead to more efficient and accurate treatments, especially in this time of physic...

Historically, the lack of patients sleep histories has caused low identification of Sleep Apnea (SA) and referral rates. Moreover, the costly and time-consuming nature of polysomnography (PSG) as a standard clinical test for detecting SA and the lack of sleep clinics have created a demand for suitable home-based monitoring devices. Pressure measure...

Polysomnography (PSG) is the standard test for diagnosing sleep apnea. However, the approach is obtrusive, time-consuming, and with limited access for patients in need of sleep apnea diagnosis. In recent years, there have been many attempts to search for an alternative device or approach that avoids the limitations of PSG. Pressure-sensitive mats (...

Losing the capacity to drive due to age-related cognitive decline can have a detrimental impact on the daily life functioning of older adults living alone and in remote areas. Semi-autonomous vehicles (SAVs) could have the potential to preserve driving independence of this population with high health needs. This paper explores if SAVs could be used...

Older adults report that driving provides a sense of independence and wellbeing. For some older adults, driving cessation becomes necessary due to their health status having an impact on their ability to drive safely. Decisions related to driving cessation are difficult and often left to the clinical judgement of primary care physicians. There is a...