Technologies for Improving the Independence of Older Adults and Individuals with Disabilities

Background
 
In March 2013, a group led by the National Institutes of Health’s (NIH) Heart, Lung, and Blood Institute (NHLBI) formed a working group to investigate innovative in-home monitoring technologies to enhance health while aging in place.  Aging in place refers to a person living in his or her private home or community for as long as possible as the person ages while receiving support and services to help them do that safely.  Effective home management of chronic diseases such as dementia, heart failure, hypertension, chronic obstructive airway disease (COPD), and asthma would reduce hospitalizations and other healthcare costs and improve quality of life.  In a healthcare environment where decision-making is increasingly evidence-based, the lack of published, quantitative information on the effectiveness of in-home technologies can dramatically inhibit adoption among providers and patients.  Technologies have been used with the goal to  improve the quality of life by monitoring health status, assisting with independent living, helping rehabilitation, promoting social interaction, and sharing medical data with care providers. However, critical gaps exist in the validation and deployment of these technologies in larger scale. This Workshop gathered interdisciplinary expertise from healthcare professionals, health researchers, computer scientists, engineers, and economists, to discuss ways to expedite the development and application of technology in home settings for older adults, people with disabilities, and people with chronic diseases.  

Workshop Discussions

Workshop members first reviewed the present state of the science and technologies related to in-home care and recognized the following challenges in developing technologies to be used for older adults, their caregivers at home, and people with disabilities. The discussion centered on four main challenges: designing for the population, sensing innovations required to enhance health, using technology to identify and support transitions in health, and utilizing the new non-health technologies to support health in smart homes. The panels highlighted the challenges of talking across disciplines and the need to develop standard metrics that allow better collaborations among diverse disciplines. More specifically, the findings included the need for the following:

• Developing opportunities for collaboration with experts in the relevant disciplines (e.g., computer scientists, health researchers, clinicians, and engineers) to transform aging in place from health care outside the home to health care in the home environment that support healthy aging and reduce disease burden.
• Creating more personalized technology to serve the diverse populations of older adults and people with disabilities. Diversity may be due to differences in age, ethnicity/culture, education, income, literacy level, and health status, as well as variability within function over time. Participants noted that to achieve personalization, there is a need for the creation of evidence-based, generalizable solutions from which to adapt.  
• Changing the current mind-set so that technology in the home is an alternative to care and not just an add-on to care. Also, change the limiting disciplinary lens that describes technology researchers as technicians and researchers as clinicians.
• Recognizing that multiple research approaches are needed to address different needs of people who are the sickest, managing the health of those with chronic diseases and sustaining health and wellness.
• Creating customized yet adaptable solutions with the principles of ‘future’ proofing.  The next generation of older adults may face different sets of technologies and similar difficulties of adaptation.
• Designing technologies/tools to empower patients, caregivers, and providers with timely and actionable information, not overwhelm them with technologies.
• Developing standards to enhance interoperability between devices and networks.
• Ensuring technology does not create a ‘digital’ divide or disadvantages among groups of people by including research in the varied settings in which older adults and people with disabilities live, including low income/low resource communities.
• Developing ‘test beds’ in the community to efficiently, economically, and systematically explore the use of these technologies and involve the community in the research process and spur discovery science.
• Creating new robust methods of analysis and sensor-driven decision analysis to create predictive, personalized models of health.
• Thinking about the application of technologies more broadly, including integrating technology into other healthcare services and embedding health tools and data collection into the “internet of things” used in the home.
• Validating the effectiveness and reliability of technologies that are changing rapidly. This includes developing methods that rapidly generate evidence (unbiased estimators of effect).

Recommendations

The following recommendations were suggested to advance the development of technologies for in-home monitoring:

Leverage existing resources to assess the effectiveness of in-home technologies for improving the health and quality of life for older adults and people with disabilities by: a) validating technologies by including them in existing clinical trials; b) developing ancillary clinical trials to utilize established patients or health control cohorts who are older adults; c) collaborating with all stakeholders, including government agencies (FDA, NIH, VA, and CMS), non-government institutes, and industries to share research resources and data; and d) exploring the opportunities to create new models of evaluation techniques that increase efficiencies for evaluating and creating evidence for rapidly developing technologies that also take advantage of existing population cohorts while deploying these technologies that would allow for both basic and applied research.

• Bring together technology design, health literacy, and form factor expertise to develop and design technologies to meet the needs of an aging population, including the needs of specific subgroups, such as people with a particular chronic disease.  
• Develop the analytics necessary to develop technologies that provide timely, personalized, actionable information, with reliable interfaces and systems to support evidence-based decision-making.
• Understand the needs, preference, and context (home environment) of the target users in order to design and adapt technologies that take advantage of the strengths of the target populations and meet the necessary requirements to facilitate healthy independence.
• Use the technologies to collect large amounts of longitudinal data on health and aging to enable discovery science that will transform health and aging research.
• Engage the users, caregivers, clinicians, and regulatory agencies to identify factors and outcome markers for success/effectiveness measurement of a technology.
• Develop a generalized matrix for cost analysis of technologies, for example using the “Saved Caregiver’s Time” as a standard to measure the cost-saving of a technology.
• Design technologies to motivate user engagement in social interactions, healthy behaviors, and becoming more aware and responsible for their own health.
• Establish frequent dialogues between innovators, research funding agencies, and government regulatory agencies to discuss study designs and identify potential collaborations.

Publication Plans
A summary of the workshop proceedings and recommendations is being prepared for publication in a peer-reviewed scientific journal.

NHLBI Contact
Erin Iturriaga, RN, BS
NHLBI, NIH, DHHS
Email:  iturriae@mail.nih.gov
Telephone: 301-435-0403

Participating Institutes/Agencies

The agenda and roster of Workshop participants are posted on the Computing Community Consortium (CCC) website.

National Institutes of Health

• National Heart, Lung, and Blood Institute
• National Institutes of Aging
• National Institute of Biomedical Imaging and Bioengineering
• Office of Behavioral and Social Sciences Research
• National Cancer Institute
• National Institute of Child Health and Human Development
• National Center for Medical Rehabilitation Research
• National Institute of Neurological Disorders and Stroke

National Science Foundation

• Computer and Information Science and Engineering Directorate
• Computing Community Consortium of the Computing Research Association

Department of Education/National Institute on Disability and Rehabilitation Research
Department of Veterans Affairs
U.S. Department of Housing and Urban Development
Food and Drug Administration/Center for Device and Radiological Health
Administration on Community Living
National Academies of Sciences
Institute of Medicine
Centers for Medicaid and Medicare Services

Workshop Organizing Committee Members

• Alice Borelli, Intel
• Sara Czaja, Professor, Psychiatry and Behavioral Sciences & Industrial Engineering, University of Miami
• Ann Drobnis, Director, Computing Community Consortium
• Erin Iturriaga, National Institutes of Health, National Heart, Lung and Blood Institute
• Jeff Kaye, Professor of Neurology and Biomedical Engineering, OHSU, Director of the Oregon Center for Aging and Technology (ORCATECH)
• Elizabeth Mynatt, Professor of Interactive Computing, Georgia Tech, CCC Liaison
• Wendy Nilsen, National Institutes of Health, Office of Behavioral and Social Sciences Research, National Science Foundation, Smart and Connected Health
• Dan Siewiorek , Buhl University Professor of ECE and Computer Science, CMU, Director, Quality of Life Technology Center (NSF ERC), CMU
• John Stankovic, BP America Professor of CS and Co-Director of the Wireless Health Center, Professor, Computer Science, University of Virginia

Complete Workshop participant list can be found here.