Alma’s Technology: Monitoring Activities of Daily Living

Messages from Majd | May 12, 2013

CAST’s new video, High-Tech Aging: Improving Lives Today, follows 83-year-old Alma Jones on her journey from home to hospital, to a rehabilitation center, and back home. In this 5th installment of our 12-part series on “Alma’s Technology,” CAST Executive Director Majd Alwan explores activity monitoring solutions that give health care providers and family members vital information about the functional abilities, health and wellbeing of older adults.

We received Alma’s records and activated a care plan for her. It monitors and reports her progress to everyone in the network. The physical therapy regimen will have her home soon. Once she’s there, her care plan consists of (1) telehealth: Alma’s doctors will be able to monitor her remotely; and (2) in-home sensors to detect if she’s declining or needs assistance. This really is the future of aging.

When Alma Jones has a stroke, she’s rushed to the hospital, where she receives life-saving treatment. Alma makes great progress toward recovery during her hospital stay. But the road to recovery doesn’t end with Alma’s hospital discharge. Neither does the work of Alma’s health care team.

Alma is a fictional 83-year-old great-grandmother and the central character in CAST’s new High-Tech Aging video. The video shows how Alma stays connected with her health care providers after she returns home from the hospital. That connection is made possible by new technology that continually monitors Alma as she carries out activities of daily living (ADL).

I’ll be exploring remote monitoring solutions in this 5th installment of our 12-part series on the technologies that appear in the High-Tech Aging video. These technologies give health care providers and family members vital information about the health and wellbeing of older adults like Alma. 

Caregivers use this information to detect small changes in the older adult’s behavior. By detecting these subtle changes, health care providers can address a minor health setback before it becomes a serious health issue requiring an expensive and disruptive hospitalization or hospital readmission.

Using Information about ADLs to Prevent Decline and Disability

Health care professionals and informal caregivers can help prevent decline in an older adult when they identify changes in behavior or functional abilities early and intervene in a timely fashion, according a recent Report to Congress on aging services technologies written by CAST and NORC at the University of Chicago. 

For example, the ability of an older adult to carry out ADLs—like eating, walking, dressing and bathing—can tell caregivers a great deal about that person’s level of wellbeing. So can the older adult’s ability to perform instrumental activities of daily living (IADLs) like cooking and housekeeping.

The trouble is that formal and informal caregivers aren’t always aware of the older person’s current level of function—or subtle changes in functional abilities that could signal a developing health issue. Monitoring technologies help to bridge that information gap.

Using Technology to Monitor ADLs

Monitoring technologies fall into several broad categories:

  • Passive monitoring systems use sensors embedded in the living environment to collect information about an individual’s activities or movements. These systems then transmit that information to health providers. For example, this kind of monitoring system could track an older adult’s overall activity levels. It could also offer more detailed information on the use of the kitchen by detecting whether and how often the person opens and closes the refrigerator, uses the stove or moves around the sink. Most of these systems provide safety monitoring and alerting capabilities. 
  • Interactive communication technologies present an older adult with a series of daily wellness questions. These questions might explore how the person is feeling or the quality of that person’s sleep. They might ask about the person’s mood or his/her ability perform ADLs. Such information may prompt caregivers to call and check, provide care, arrange for supportive services, help the older adult hone his/her self-management skills, or determine if the individual needs to see a health care provider. 
  • Sensor-based monitoring technologies that assess walking balance and gait are now in development. These technologies include a pressure-sensitive shoe insole that identifies balance problems; insoles that increase balance by delivering stimulating vibrations to the foot; wearable accelerometer-based wireless devices that analyze step patterns and foot positioning; portable pressure gait mats that record each footfall and look for evidence of gait abnormalities; and an under-development instrumented walker that assesses walking ability and balance. 
  • Narrow-beam infrared sensors, also in development, detect walking speed when arranged in a linear array on walls or ceilings. 
  • Ambient intelligence technologies, under development, combine monitoring data from the home with physiologic data from the user to adjust the user’s environment or respond to emergencies. A kitchen stove equipped with this technology would sound an alarm when left unattended. An unanswered doorbell might trigger an emergency call if the person is at home. 

Selection Tips

The most important points in selecting these types of technology are:

  • The issues the older adult is experiencing, his/her capabilities, and what caregivers need to know: Are you interested in monitoring overall activity levels and wellness? Do you want the system to be capable of inferring activities of daily living in order to facilitate delivering supportive services? Are you interested in using information about activities like sleep, walking, balance or other fine motor function to gain more insights into health and enable prevention? These questions are also closely related to who will see the monitoring data and how they will use that data. (Please see below.)
  • The older adult’s willingness to wear or use the technology: If the person is physically and cognitively able and willing to use an interactive communication or a wearable technology, that’s great. If, on the other hand, they’re unable or unwilling to use or wear the technology, you should consider passive monitoring that embeds sensing in the environment and everyday objects with which the older adult would normally interact. 
  • Who will be responsible for reviewing the data and acting upon it? Some monitoring technologies are aimed at family caregivers. Others are only marketed through aging services providers. The latter are usually bundled with monitoring and, in some cases, proactive, preventive and supportive care services. 

For More Information

I recommend watching the full-version of the Alma video, and I would encourage you to check the wellness monitoring section of CAST’s report on the State of Technology in Aging Services to find out relevant information and technologies.