Enabling Assistive Technologies to Shape the Future of the Intensive Senior-Centred Care: A Case Study Approach

Abstract

Nowadays, the proportion in the older ages and the average life expectancy is increasing dramatically throughout the world. The health problems associated with wealthy and aged populations has been an issue of great concern to a broad and expanding number of people. Appropriate healthcare ITC-based technologies and services have to cope with this situation. Some specific challenges related to senior-centred care as well as impediments to acceptance of health-related digital approaches by elderly persons are underlined in this paper. The assistive technologies play a major role in increasing, maintaining, or improving the functional capabilities of seniors as well as in creating the opportunities for ageing in place. This paper aims to illustrate how an ongoing eHealth solution can be further upgraded by integrating some of the latest assistive technologies devices. A brief presentation of some representative devices (such as wearable sensors, mHealth apps and inhome monitoring system) highlights their benefits for the senior healthcare delivery. The current phase of the "Conceptual Model for a Platform of Integrated Services based on Cloud for Home Monitoring of Seniors affected by Dementia (MSIMDD)" project is put in. A proposed extended architecture of MSI-MDD platform is provided emphasizing the benefits of the integration of the most appropriate assistive technologies for an improved remote senior-centered healthcare service delivery.

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ISSN: 1220-1766 eISSN: 1841-429X 343
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Studies in Informatics and Control 26 (3) 343-352, September 2017
1. Introduction
The global ageing population is increasingly
growing coupled with a major increase in
life expectancy, due to the improvements in
healthcare service delivery, food supply and
nutrition, but also due to the innovation and
developments in technology and science.
“Compared to 2017, the number of persons aged
60 or above is expected to more than double by
2050 and to more than triple by 2100. In Europe,
25% of the population is already aged 60 years or
over. That proportion is projected to reach 35% in
2050. Globally, the number of persons aged 80 or
over is projected to triple by 2050.” [22]
A growing number of seniors has an increased
impact on the whole levels of society, from
the individual changing position inside his/her
family, to the new national and international
strategies, programmes or approaches aiming to
best tackle the challenges and demands brought
by the ageing population.
Longer life expectancy and incoming number
of seniors with associated multimorbidity have
dramatically raised the cost associated with
the health and social systems, which is more
and more often perceived as a burden on social
insurance programs, healthcare service delivery
or pension systems.
Enabling Assistive Technologies to Shape the Future of the
Intensive Senior-Centred Care: A Case Study Approach
Adriana ALEXANDRU, Marilena IANCULESCU*
National Institute for Research and Development in Informatics,
8-10 Averescu Avenue, Bucharest, 011455, Romania
adriana@ici.ro, manina@ici.ro (*Corresponding author)
Abstract: Nowadays, the proportion in the older ages and the average life expectancy is increasing dramatically throughout
the world. The health problems associated with wealthy and aged populations has been an issue of great concern to a broad
and expanding number of people. Appropriate healthcare ITC-based technologies and services have to cope with this situa-
tion. Some specic challenges related to senior-centred care as well as impediments to acceptance of health-related digital
approaches by elderly persons are underlined in this paper. The assistive technologies play a major role in increasing, main-
taining, or improving the functional capabilities of seniors as well as in creating the opportunities for ageing in place. This
paper aims to illustrate how an ongoing eHealth solution can be further upgraded by integrating some of the latest assistive
technologies devices. A brief presentation of some representative devices (such as wearable sensors, mHealth apps and in-
home monitoring system) highlights their benets for the senior healthcare delivery. The current phase of the “Conceptual
Model for a Platform of Integrated Services based on Cloud for Home Monitoring of Seniors affected by Dementia (MSI-
MDD)” project is put in. A proposed extended architecture of MSI-MDD platform is provided emphasizing the benets of the
integration of the most appropriate assistive technologies for an improved remote senior-centered healthcare service delivery.
Keywords: Senior-centred care, Health-assistive technologies, Wearable technology, mHealth, In-home monitoring.
One of the most important issue and concern in
this respect is to identify and implement the most
appropriate healthcare services and technology
which are adapted to the degenerative disorders
of the seniors, but also to the demands and needs
of so called “tech-savvy” new generations of
elderly people that are accustomed and willing
to use the digital technology.
A 2017 report from Ericsson ConsumerLab
representing the results of two surveys carried
out in Germany, Japan, South Korea, the UK
and the USA revealed that over 60 percent of
surveyed consumers are prepared to include
assistive technology as a preventive means
for health management. Assistive technology
can provide the medical specialists with the
opportunities to have access and process the
clinically-relevant, real-time health information
and data. “As improved healthcare helps people
live longer, healthcare systems come under
increasing pressure as older patients need
more care.
The progressive evolution of age-related
disorders have also a negative impact on the
seniors’ quality of life and independence.
The resulting resource shortage is forcing the
industry to become more and more dependent
https://doi.org/10.24846/v26i3y201710

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344
on automation, remote treatment and articial
intelligence (AI)” [10]. See Figure 1.
Chapter 2 introduces the holistic approach of
senior-centred care that focuses on enhancing the
dimensions of senior’s health and well-being. Some
specic challenges and the main constraints related
to the acceptance and use of consumer-oriented
health digital technologies are further detailed.
In Chapter 3, the assistive technologies and
healthcare associated applications for seniors’ use
are presented, with emphasis on wearable sensors,
mHealth apps and in-home monitoring systems.
Chapter 4 presents a case study and provides details
regarding the modules included in the “Conceptual
Model for a Platform of Integrated Services based
on Cloud for Home Monitoring of Seniors affected
by Dementia (MSI-MDD)” project.
Chapter 5 discusses the proposed future functions
to be included in the previously mentioned project
and the new associated proposed architecture.
These are in line with the assistive technologies
and applications presented in Chapter 3.
2.
Issues related to senior-centred care
Senior people are more likely to be subject of age-
related health impairments, which can uctuate in
many directions ranging from cognitive decline
or mobility dysfunctions to chronic diseases.
Therefore the need of expenditure, facilities and
access to appropriate and personalised healthcare
services is signicant and is gaining importance in
the context of world ageing population.
Senior-centred care focuses on the elderly’ s
health management, taking into consideration any
support or health service delivery that might be
necessary for ensuring and facilitating a proper
life and health condition of the senior.
Specific challenges have to be taken into
consideration in order to provide senior-
centred care that can facilitate them a dignied,
independent and active life:
- Providing an increased, adapted and
affordable assistance with their activities of
daily living.
- Training a greater number of better specialised
health carer able to respond to the particular
necessities of the elderly.
- Endorsing the shift from reactive care to
preventive care.
- Sustaining the implementation of new and
emerging supporting technologies that aim
Adriana Alexandru, Marilena Ianculescu
Figure 1. Cross-industry decision makers’ perception of key applications that positively
impact healthcare [10]

345
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to create a familiar and safe environment
and to avoid as much as possible the
institutionalisation of the seniors.
- Working out a holistic approach of the
degenerative diseases, their associated co-
morbidities and of the diversity of digital
technology in order to provide an improved
health management.
-
Anticipating the demands of the new
generations of seniors which are supposed to be
more accustomed and receptive to healthcare
supported by digital technology because they
already have the appropriate level of health and
information technology literacy.
Digital healthcare technology proved undoubtedly
to have the potential to support the provision of
an integrated senior-centred care across the whole
healthcare and social systems and to tackle the
challenges of ageing.
Main constraints for a broader acceptance of
health digital technology by the seniors:
- Lack of confidence regarding their own
capacity to gain knowledge and skills about
how to use it.
- Unconvinced position regarding the
opportunities and benets of the involvement
of digital technology in the personal
health management.
- Physical age-related disabilities that
might hinder a proper use of health digital
technology.
- Cognitive disorders that limit the total or
partial access to the functions provided by
the health digital technology.
- Fear about the unauthorised use of the
personal data and information.
- Insufcient age-friendly features of the health
digital technology.
- Unaffordable cost of some digital devices.
Taking into consideration the fact that the number
of the seniors is increasing, their health condition
or needs are continuously changing, that they
have becoming more empowered and motivated
to remain independent, engaged in activities inside
the family or community and more determined
to age-in-place instead of living in nursing
homes, it is imperative that innovations and new
technological solutions to be deployed.
Assistive technology for seniors represents a
reliable support designed to replace, supplement
or recover the diminished or lost physical or
cognitive functions and skills of the elderly,
helping them to avoid many degradations related
to the quality of life.
3. Some representative health-
assistive technologies focusing on
a better senior-centred care
The role of assistive technologies is to:
-
Provide support in gaining enhanced
accessibility and improved aids for people
with physical or cognitive disorders
and disabilities.
- Enable seniors to continue their lives in a
secure and familiar habitat.
- Reduce negative feelings like insecurity,
vulnerability, loneliness, and depression.
- Enable social activity and even working
process [1].
- Prevent injuries or accelerated deterioration
of health conditions.
“Assistive technology is an umbrella term
referring to specialized technology used by
people to adapt how specic tasks are performed.
Ambient assisted living (AAL) technology is the
result of a progression from individual devices
assisting with one task or activity of daily living
to ambient systems in which the assistance or
support completely encompasses the living area
and the person”. [6] Assistive technology has
evolved with and emerged from information
technology, passing from detecting and reporting
problems, to preventing them (see Figure 2).
Figure 2. Three Generations of Ambient Assisted
Living (AAL) [6]
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The most representative assistive technologies
focusing on the seniors are presented in Table 1.
3.1 Wearable technologies
Wearable technologies or wearables aim to monitor,
prevent or assist the treatment and daily activities of
a person; they can be attached in a diverse way to
the person or to a currently used item or equipment.
Wearables that are focused on seniors have the
potential to monitor the vital signs, location or safety
of the elderly, to prevent and trigger alerts in case
of an emergency situation like a fall or hypertension
crisis, to maximize the independence of the seniors
and also to support a remote healthcare management.
The actual capabilities of the wearables comprise
physiological and biochemical sensing and also
motion sensing [7].
In order to decrease the possible restraints of the
seniors related to the acceptance of the wearables,
many of them can be unobtrusively integrated into
“smart” fabrics.
“Currently, smartwatch, smartphone and smart
clothing are the mainstream products embedded
wearable technologies with care functions. All
of them have attractive advantages for delivering
health information.” [23].
“Smart wearables are becoming increasingly
pervasive driven by the continuous miniaturisation
of electronics; advances in sensor technology,
computing power and connectivity; and, an
ever stronger capability to embed intelligence
in electronic (and photonic) components and
systems, ultimately coupled by a reduction in the
price of components.” [11]. See Figure 3.
Figure 3. Wearables’ evolution [11]
Here are examples of some of the latest wearables
appropriate for seniors:
- Thread-based diagnostic platform -
Considered to be an active substrate for the
newest implantable diagnostic devices and
smart wearables, the platform is composed
of nano-scale sensors, electronics and
microuidics comprised into threads that
can be sutured via many layers of tissues
(see Figure 4). The health data is gathered
wirelessly in real time and it determines a
diagnostic like status of healing wound [19].
Table 1. The Most Representative Assistive Technologies for Aged Care [3]
Category Most Signicant Assistive Technologies
New medical
devices and sensor
technologies
Non-invasive medical devices.
Wrist watch for personalised monitoring of signs like breathing and pulse, as well as
pathology.
Data visualisation and imaging.
Regenerative
Medicine
Nano-based therapies that cross blood-brain barrier.
Stem cells and induced pluripotent stem cells (iPS) technologies.
Biomimetics or the use of smart materials and design inspired by nature.
Smart homes and
intelligent materials
Implantable monitoring devices.
Smart fabrics and intelligent materials
Assistive devices designed for low dexterity.
Data monitoring - client controlled.
Smart grids able to withstand power interruptions.
Sources of renewable energy.
Integrated health
and social support
services
Integrated Healthcare - streamline care, sharing of documentation.
Smart homes - voice and face activated.
Uptake enablers such as funding, development, design, resources and program
support, and education for carers, individual and professionals.
Bio-mechanical
technologies,
robotics and neuro-
prostheses
Neuro-prosthesis - Brain signals have an impact on sensors.
Robots - integrated information systems enabling monitoring, and social
engagement.
Biomechanics - e.g. walking-aid shoes; exoskeletons that help movement.
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347
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- Smart contact lens - Smart contact lens are
designed as a self-powered biosensor for
diverse health signs monitoring and wireless
biomedical sensing, able to detect in real time
the pathogen, bacteria, glucose, and infectious
keratitis present in tear uid [5]. See Figure 5.
Figure 4. The structure of the thread-based
diagnostic platform [19]
Figure 5. Schematics of smart contact lens [5]
- Human stress monitoring patch - It integrates
three sensors that are designed to detect
the human physiological signals: skin
temperature, skin conductance, and pulse
wave in the size of stamp. The skin contact
area is minimized through the invention
of an integrated multi-layer structure and
the associated microfabrication process.
The stress is measured by multimodal
physiological data analysis [25]. See Figure 6.
Figure 6. Human stress monitoring patch [25]
- Graphene smart patch for monitoring diabetes
- The graphene made patch senses glucose in
sweat. A connected portable electrochemical
analyser receives data by wires. When
blood sugar is too high, it releases the drug
metformin through microneedles to lower it
[24]. See Figure 7.
Figure 7. Graphene smart patch for monitoring
diabetes [24]
3.2 mHealth
In actual aging society, the healthcare system
is transformed by mHealth (healthcare using
mobile wireless technologies, also called mobile
health technologies) that provides new access
opportunities to health services and medical
care. The advancement in mobile devices
(powerful on board computing capability, pre-
built with health sensors, large memories and
screens, open operating systems [8] has led to
signicant growth in the mHealth industry. The
latest generation of smartphones makes easier for
users to track their health, having a. tremendous
potential in assisting seniors and people with
chronic conditions to live independently.
Four types of solutions have been identied [9]:
1) Self-healthcare management - focused on the
autonomy, implication and self-sufciency of
aging people, without the need for involvement
of an external carer in the delivery of the mHealth
service. These solutions usually consist of:
- A body sensor network (BSN) - a network of
low cost, miniaturized and wireless wearable
or implantable interconnected biosensors and
actuators that acquire the patient’s biosignals
and contextual parameters (i.e. ECG, EEG,
heart and respiration rates, blood pressure,
body temperature, glucose level, spatial
location, etc.) [9].
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- A mobile-based unit (MBU) - in most cases
a smartphone that receives the transmitted
wirelessly data (through Wi-Fi or short-
ranged protocols) from sensors and acts as
a local storage, processing and analysis unit
providing feedback ready for visualization by
doctor and patient, through a user-friendly and
interactive graphical or audio interface.
An example of an mHealth blood pressure
application is presented in Figure 8.
Figure 8. iBP Blood Pressure [15]
2) Assisted healthcare - involves not only the
elder in self measurements of health parameters,
but an external carer in the process of sharing
these data. In case of an emergency, an alarm
condition is generated when health parameters
exceeded a preset threshold. By using xed
terminals or mobile devices, the carers are
warned about undesirable or worrying situations
through SMS, voice calls, e-mails, and audio
alarms. The data from a certain range are
forwarded to the caregiver, including the GPS
position of the patient.
3) Supervised healthcare – the data ow between
the patient and the caregivers includes all the
patient’s biosignals, as well as the abnormal
data collected in case of an emergency. This
data are stored remotely and can be accessed by
doctors and families. A monitoring system is also
included, involving a remote database where the
collected physiological data are periodically sent
and stored, allowing doctors, family and friends
to manage the patient conditions or to congure
the BSN sensors remotely. The carers can
remotely access and supervise both current and
past physiological data of the senior, evaluate his
condition, share and discuss these records with
other doctors, set thresholds for sensors and give
advice remotely [18].
4) Continuous monitoring - offers a fully
automatic analysis of real-time vital biosignals
of the patient using a reasoning engine, which
proactively uses data mining techniques to correlate
data from multiple sensors, assess risk levels and
generate preventive actions. Reports are available
to both patients and carers. Thus, through the
automated healthcare intelligence and a continuous
and ubiquitous double sense information ow, not
only appropriate actions in response to abnormal
situations, but also preventive personalized
recommendations are available for supporting both
patients and health providers.
Some trends that will reshape the mobile health
industry are presented bellow [17]. In 2013, a
Research2Guidance report [20] predicted that
“2017 would be a signicant year for mHealth
apps as the market will reach $26 billion, with
medical apps being integrated into medical
professionals’ treatment plans”.
For syncing all this data into one place it would
be necessary:
- Wider IoT connection - The next generation
of mHealth technologies will be standalone
and will use their own SIM card slots to
connect to the internet with high-speed
connectivity. Thus, mHealth devices will be
able “to connect with other internet-based
technologies (smart homes, smart cars, etc.)
and create a healthy tech-powered ecosystem
for consumers” [17].
-
Advanced mHealth technologies – provision of
advanced health-assisting features for specic
patients, such as in-depth health analysis.
- mHealth business models will be expanded.
Some identied challenges for the mHealth Area are:
- Battery with limited lifetime - Batteries
currently cannot withstand a full work day
without a recharge [13].
- Multiplatform development - iOS, Windows
Phone, and Android being the most
common choices.
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- Delays in data transmission and their
consequences for patient [21].
- Effort to implement the applications in
real environments [12].
3.3 In-home monitoring systems
functioning without disrupting the
resident seniors
For living alone seniors, it can become dangerous
as they age when their medical conditions and
mobility issues can turn into emergency situations.
For making day-to-day life easier and have health
monitoring at a click distance without giving up
their independence and safety, in our increasingly
technology clever society, the most useful
products to aid elderly and caregivers are based
on innovative technologies.
The remote monitoring systems for the seniors
help family members and other caregivers to
stay connected to a senior (even from a distance),
locate him if he has wandered away or call for
help in emergency situations, such as falls.
For improving the monitoring of elderly in their
own homes by making it faster and more effective
than ever, the healthcare providers and carers are
looking for devices increasingly integrated with
wireless mobile devices (i.e. wearable sensors that
collect real-time health data and are a discreet and
comfortable way to collect vital biosignals) and
cloud-based data storage that can be accessed by
physicians at any time. Medical alert bracelets
and systems communicate with a monitoring
station, so if a senior is in trouble, he can call
for help. They combine both sensor technology
and personal emergency response to help promote
senior’s independent life. See Figure 9.
Figure 9. Examples of medical monitoring and alert
systems [16]
The devices are designed to identify problems
before they become emergencies by observing
daily activity patterns and alerting caregivers if
any abnormalities are noticed. Alerts to caregivers
are provided by the devices without disrupting
residents and can be either phone calls, text
messages, and/or emails letting the caregiver
know when events happen.
In the age of advancing technologies, seniors can
be monitored remotely by family and caregivers
from any computer, tablet or smartphone. See
Figure 10.
Figure 10. An example interface of a senior’s remote
monitoring [14]
The 24/7 remote monitoring facilities are
combined in one simple unit integrating the best
features of a tablet, computer, digital picture
frame, mobile phone. Touch-screen monitor
systems with easy to use interface for the seniors
that offer a simple way to video chat, message,
send photos, view scheduled appointments are
well appreciated by seniors.
A combination of in-home monitoring technology,
simple medical devices and a helpful human
element will provide the balance between service
usefulness and protection of senior’s dignity.
Smart homes could reduce the challenges
associated with aged care while affording safety
and wellbeing for seniors and families.
4. Case study: MSI-MDD project
The “Conceptual Model for a Platform of
Integrated Services based on Cloud for Home
Monitoring of Seniors affected by Dementia
(MSI-MDD)” project proposed a conceptual
model of an integrated platform for cloud-
based services that were designed to create a
safe familiar environment and an appropriate
personalised health management for the seniors
suffering from dementia. Additional services for
sustaining improvements of specic healthcare
provided by physicians or carers were integrated
with the senior-centred ones that enable a
real time monitoring of the patient, with a
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350
strong emphasis on crisis prevention and delay
progressive deterioration of health.
MSI-MDD platform is structured into ve main
components presented in the application layer
(see Figure 11).
Figure 11. Current architecture of the MSI-MDD Platform
-Help: it provides support to daily activities -
such as locating a lost object - by activating
an online function that triggers a sensor beep.
Requesting help or the presence of acarer/
family member in case of an unexpected
event is another example of comprised
service.
-
Monitoring: it enables the collecting of
data and information regarding the senior’s
health condition by using medical devices
and sensors. Data is stored in a patient-
centred database and it can be used both for
the personal health management, and for
developing predictive models. The identied
dysfunctions and the abnormal values of some
measured parameters initiate a procedure
whereby the carer and the attending physician
are warned in real time.
-
Alarm: senior’s carers are warned
both locally and remotely in case of a
malfunction of appliances or of parts of the
space environment.
- Predictive Models: they are developed based
on the data and information provided by the
Monitoring component. Predictive models
aim to allow a preventive and proactive health
management for a personalized senior care.
Adriana Alexandru, Marilena Ianculescu
Figure 12. New proposed architecture

351
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- Support for Carers: it contains modules with
updated and practical information for carers to
improve and better understand their duties in
taking care of seniors affected by dementia. In
order to enhance the efciency of the training
process, the used eLearning system has to be
adaptive and personalised on the specic
prole of the students, namely senior`s carers
[2], [4].
5. A proposed upgraded architecture
for MSI-MDD platform
The solution provided by MSI-MDD project and
designed for the seniors affected by dementia can
be extended and adapted to different categories
of elderly persons.
In this respect and taking into consideration
the opportunities brought by the new assisted
technology, the MSI-MDD platform can be
further upgraded with new functionalities. The
proposed new architecture is shown in Figure 12.
Some of the envisioned functions are presented
as it follows:
Firstly, taking into consideration the associated co-
morbidities, the vital signs monitoring that is based
on the newest wearable technologies (like smart
contact lens or graphene smart patch), together
with the use of predictive models (allowing a
preventive and proactive disease management
for a personalized care of the patient) can be of
interest for all categories of seniors (as illustrated
in Data Acquisition Layer in Figure 12).
Secondly, the access by mobile phones to
healthcare data and to the management of age
associated diseases is valuable not only for seniors,
but also for a coordinated healthcare delivery
among every person directly involved in the life of
the elderly. The Data Acquisition and Application
Service Layers from Figure 12 illustrate how a
mHealth solution can add up the previous assisted
healthcare services of MSI-MDD.
Thirdly, MSI-MDD platform can be extended with
another functionality regarding the localization
of wandering senior patients inside hospitals
or nursing homes by using radio-frequency
identication (RFID) sensors or outside the house
by using GPS facilities for increasing elderly’s
safety and assuring the possibility of his/her free
movement. (as illustrated in Application Service
Layer in Figure 12).
In conclusion, MSI-MDD platform can be further
deployed in order to become an efcient support
to other categories of seniors and to provide
improved remote senior-centred healthcare
services. A progressively enlarged range of
assistive technologies integrated in the familiar
environment can better address the specic needs
of the elderly.
Acknowledgements
“Conceptual Model for a Platform of Integrated
Services based on Cloud for Home Monitoring of
Seniors affected by Dementia” (MSI-MDD) project
was funded by Ministry of Research and innovation
(2014-2015). The authors gratefully acknowledge
the contribution of the Romanian ministry.
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