Technological Solutions for Social Isolation Monitoring of the Elderly: A Survey of Selected Projects from Academia and Industry.

Social isolation is likely to be one of the most serious health outcomes for the elderly due to the COVID-19 pandemic, especially for seniors living alone at home. In fact, two approaches have been used to assess social isolation. The first is a self-reported survey designed for research purposes. The second approach is the use of monitoring technology. The objective of this paper is to provide some illustrative publications, works and examples of the current status and future prospects in the field of monitoring systems that focused on two main activities of daily living: meal-taking activity (shopping, cooking, eating and washing dishes) and mobility (inside the home and the act of going out). These two activities combined seem relevant to a potential risk of social isolation in the elderly. Although current research focuses on identifying only ADLs, we propose to use them as a first step to extract daily habits and risk level of social isolation. Moreover, since activity recognition is a recent field, we raise specific problems as well as needed contributions and we propose directions and research opportunities to accelerate advances in this field.

A Smart Shoe Insole to Monitor Frail Older Adults' Walking Speed: Results of Two Evaluation Phases Completed in a Living Lab and Through a 12-Week Pilot Study.

BACKGROUND: Recent World Health Organization reports propose wearable devices to collect information on activity and walking speed as innovative health indicators. However, mainstream consumer-grade tracking devices and smartphone apps are often inaccurate and require long-term acceptability assessment. OBJECTIVE: Our aim is to assess the user acceptability of an instrumented shoe insole in frail older adults. This device monitors participants' walking speed and differentiates active walking from shuffling after step length calibration. METHODS: A multiphase evaluation has been designed: 9 older adults were evaluated in a living lab for a day, 3 older adults were evaluated at home for a month, and a prospective randomized trial included 35 older adults at home for 3 months. A qualitative research design using face-to-face and phone semistructured interviews was performed. Our hypothesis was that this shoe insole was acceptable in monitoring long-term outdoor and indoor walking. The primary outcome was participants' acceptability, measured by a qualitative questionnaire and average time of insole wearing per day. The secondary outcome described physical frailty evolution in both groups. RESULTS: Living lab results confirmed the importance of a multiphase design study with participant involvement. Participants proposed insole modifications. Overall acceptability had mixed results: low scores for reliability (2.1 out of 6) and high scores for usability (4.3 out of 6) outcomes. The calibration phase raised no particular concern. During the field test, a majority of participants (mean age 79 years) were very (10/16) or quite satisfied (3/16) with the insole's comfort at the end of the follow-up. Participant insole acceptability evolved as follows: 63% (12/19) at 1 month, 50% (9/18) at 2 months, and 75% (12/16) at 3 months. A total of 9 participants in the intervention group discontinued the intervention because of technical issues. All participants equipped for more than a week reported wearing the insole every day at 1 month, 83% (15/18) at 2 months, and 94% (15/16) at 3 months for 5.8, 6.3, and 5.1 hours per day, respectively. Insole data confirmed that participants effectively wore the insole without significant decline during follow-up for an average of 13.5 days per 4 months and 5.6 hours per day. For secondary end points, the change in frailty parameters or quality of life did not differ for those randomly assigned to the intervention group compared to usual care. CONCLUSIONS: Our study reports acceptability data on an instrumented insole in indoor and outdoor walking with remote monitoring in frail older adults under real-life conditions. To date, there is limited data in this population set. This thin instrumentation, including a flexible battery, was a technical challenge and seems to provide an acceptable solution over time that is valued by participants. However, users still raised certain acceptability issues. Given the growing interest in wearable health care devices, these results will be useful for future developments. TRIAL REGISTRATION: ClinicalTrials.gov NCT02316600; https://clinicaltrials.gov/ct2/show/NCT02316600.

A Smart Insole to Promote Healthy Aging for Frail Elderly Individuals: Specifications, Design, and Preliminary Results.

BACKGROUND: Older individuals frequently experience reversible "frailty syndrome,", increasing incidence of disability. Although physical exercise interventions may delay functional decline, there are difficulties in implementing them and performing seamless follow-up at home. Very few technological solutions attempt to address this challenge and improve individual participation. OBJECTIVE: Our objectives are to (1) develop a technological solution designed to support active aging of frail older persons, (2) conduct a first laboratory evaluation of the device, and (3) design a multidimensional clinical trial to validate our solution. METHODS: We conducted a first phase of multidisciplinary meetings to identify real end users and health professional's unmet needs, and to produce specifications for the architecture of the solution. In a second phase, we performed laboratory tests of the first proposed prototype (a smart insole) with 3 healthy volunteers. We then designed an ongoing clinical trial to finalize the multidimensional evaluation and improvement of the solution. RESULTS: To respond to the needs expressed by the stakeholders (frailty monitoring and adherence improvement), we developed a prototype of smart shoe insole to monitor key parameters of frailty during daily life and promote walking. It is a noninvasive wireless insole, which automatically measures gait parameters and transmits information to a remote terminal via a secure Internet connection. To ensure the solution's autonomy and transparency, we developed an original energy harvesting system, which transforms mechanical energy produced by the user's walking movement into electrical energy. The first laboratory tests of this technological solution showed good reliability measures and also a good acceptability for the users. We have planned an original iterative medical research protocol to validate our solution in real life. CONCLUSIONS: Our smart insole could support preventive strategies against disability in primary care by empowering the older patients without increasing the busy health professional's workload. TRIAL REGISTRATION: Clinicaltrials.gov NCT02316600; https://clinicaltrials.gov/ct2/results?term=NCT02316600&Search=Search. Accessed: 2015-05-13 . (Archived by WebCite at http://www.webcitation.org/6YUTkObrQ).

A telemetry system embedded in clothes for indoor localization and elderly health monitoring.

This paper presents a telemetry system used in a combined trilateration method for the precise indoor localization of the elderly who need health monitoring. The system is based on the association of two wireless technologies: ultrasonic and 802.15.4. The use of the 802.15.4 RF signal gives the reference starting time of the ultrasonic emission (time difference of arrival method). A time of flight measurement of the ultrasonic pulses provides the distances between the mobile node and three anchor points. These distance measurements are then used to locate the mobile node using the trilateration method with an accuracy of a few centimetres. The originality of our work lies in embedding the mobile node in clothes. The system is embedded in clothes in two ways: on a shoe in order to form a "smart" shoe and in a hat in order to form a "smart" hat. Both accessories allow movements, gait speed and distance covered to be monitored for health applications. Experiments in a test room are presented to show the effectiveness of our system.

Smart wearable systems: current status and future challenges.

OBJECTIVE: Extensive efforts have been made in both academia and industry in the research and development of smart wearable systems (SWS) for health monitoring (HM). Primarily influenced by skyrocketing healthcare costs and supported by recent technological advances in micro- and nanotechnologies, miniaturisation of sensors, and smart fabrics, the continuous advances in SWS will progressively change the landscape of healthcare by allowing individual management and continuous monitoring of a patient's health status. Consisting of various components and devices, ranging from sensors and actuators to multimedia devices, these systems support complex healthcare applications and enable low-cost wearable, non-invasive alternatives for continuous 24-h monitoring of health, activity, mobility, and mental status, both indoors and outdoors. Our objective has been to examine the current research in wearable to serve as references for researchers and provide perspectives for future research. METHODS: Herein, we review the current research and development of and the challenges facing SWS for HM, focusing on multi-parameter physiological sensor systems and activity and mobility measurement system designs that reliably measure mobility or vital signs and integrate real-time decision support processing for disease prevention, symptom detection, and diagnosis. For this literature review, we have chosen specific selection criteria to include papers in which wearable systems or devices are covered. RESULTS: We describe the state of the art in SWS and provide a survey of recent implementations of wearable health-care systems. We describe current issues, challenges, and prospects of SWS. CONCLUSION: We conclude by identifying the future challenges facing SWS for HM.

Behaviour monitoring of the elderly by trajectories analysis.

This paper presents a way to keep the elderly autonomous in their daily activities. The principle is to monitor their behaviour and more specifically their trajectories of movement in the living area. Two methods have been developed and compared: supervised and unsupervised classification. Some results from data collected in a long-stay setting are shown. They highlight the possibility of determining normal trajectory classes, and by comparison with the usual situation, to trigger alarms when the trajectories are unusual.

Smart homes - current features and future perspectives.

In an ageing world, maintaining good health and independence for as long as possible is essential. Instead of hospitalization or institutionalization, the elderly and disabled can be assisted in their own environment 24h a day with numerous 'smart' devices. The concept of the smart home is a promising and cost-effective way of improving home care for the elderly and the disabled in a non-obtrusive way, allowing greater independence, maintaining good health and preventing social isolation. Smart homes are equipped with sensors, actuators, and/or biomedical monitors. The devices operate in a network connected to a remote centre for data collection and processing. The remote centre diagnoses the ongoing situation and initiates assistance procedures as required. The technology can be extended to wearable and in vivo implantable devices to monitor people 24h a day both inside and outside the house. This review describes a selection of projects in developed countries on smart homes examining the various technologies available. Advantages and disadvantages, as well as the impact on modern society, are discussed. Finally, future perspectives on smart homes as part of a home-based health care network are presented.

PROSAFE-extended, a telemedicine platform to contribute to medical diagnosis.

A single elderly, dependent subject was monitored for a period of three months. Data were collected from 12 sensors in his apartment. We investigated new criteria for diagnosing abnormal events with more reliability. Initial results suggested that six diagnostic functions could be achieved using only presence sensors. These were: immobility detection; the level of agitation; the speed of motion in chosen areas; the distance covered; the time spent in given areas of the apartment; and the activities of getting up, going to bed and going to the toilet. The analysis was based on calculation of thresholds from past behaviour of the user for automatically defined temporal bands. Any variation in these criteria may represent a change in the subject's physical abilities and may thus allow the remote identification of potential risk.

A review of smart homes- present state and future challenges.

In the era of information technology, the elderly and disabled can be monitored with numerous intelligent devices. Sensors can be implanted into their home for continuous mobility assistance and non-obtrusive disease prevention. Modern sensor-embedded houses, or smart houses, cannot only assist people with reduced physical functions but help resolve the social isolation they face. They are capable of providing assistance without limiting or disturbing the resident's daily routine, giving him or her greater comfort, pleasure, and well-being. This article presents an international selection of leading smart home projects, as well as the associated technologies of wearable/implantable monitoring systems and assistive robotics. The latter are often designed as components of the larger smart home environment. The paper will conclude by discussing future challenges of the domain.

Wireless fall sensor with GPS location for monitoring the elderly.

Falls of the elderly has become a major public health problem in our modern society. It is both the first cause of accidental death, but also the beginning of the loss of autonomy from these people. In this context, the paper describes a solution based on an energy-efficient embedded device capable of detecting the fall, to send a warning to a control and monitoring processing station and to locate the person in a close external environment. Fall detection, location, processing and signal analysis, and data transmission are provided by an accelerometer, a GPS receiver, a microcontroller and a Zigbee technology transceiver.

An extended PROSAFE platform for elderly monitoring at home.

In 1995, the first principles of a monitoring system based on a study of behavioural differences compared to normal living habits were put forward. These gave rise to the launch of a PROSAFE programme involving the use of distributed presence sensors and diagnostic components based on movement criteria. The approach was validated in a hospital and institutional environment, in a room being monitored at night. Here the authors discuss the possibility of extending the concept to a "wired-up" apartment monitored day and night and a multifunctional platform (agitation, fall, wandering, location, videoconference, monitoring of medical parameters). Initial experimental results show that noise increased, which meant that data had to be split in geographical and time terms to achieve an acceptable level of security and a system modelling had to be developed to cope with the complexity of designing and using multifunctional systems.

Assessment of activity of elderly people using a home monitoring system.

A multisensor home monitoring system has been developed within a telecare project to help elderly people by observing mobility changes indicative of abnormal events. This paper assesses the motor activity and the relationships between activity measures using the system. The motor activity data (in bed, getting up, getting out, visiting the toilets) are analysed from a statistical perspective to assess changes in occurrence, time and duration. Changes in activity data and correlations between in-bed restlessness and getting up variables show interesting trends in the behavior of elderly people and can be used by the system as a predictive tool in abnormal situations. The objective of the telecare project is to build an abnormal event diagnosis system to help elderly people living alone.

Validation of a remote monitoring system for the elderly: application to mobility measurements.

The aim of this paper is to introduce a smart tool for the assessment of the mobility of patient with motor disorders and to evaluate its performance through some initial experiments. These experiments are based on a system which is composed of sensors connected to a Personal Computer (PC) using data acquisition cards and a communication network. The PC includes a data acquisition and processing software. This system has been installed in a patient's housing (a bedroom and a washroom) in a long-stay setting. Pre-established travel and activity (going to bed, getting up, visiting the washroom em leader ) patterns of patient in the housing including their duration have been defined by physicians for the experiments. A volunteer participated in the experiments and the results of his mobility obtained by the data processing software were compared with his real mobility. An agreement was found between the proposed assessment system and the experiments, thereby validating functioning of the whole system. Then, the system has been used to monitor a patient over a period of 39 nights. Again there is a good agreement between the characteristics derived from the system and the findings of the caring staff in charge of the patient's routine night monitoring. Data collected during 24 consecutive hours have been used to identify and characterise the patient's whole day mobility. This study paves the way for a new assessment system of the mobility of patient thus allowing the follow up of patients suffering from dementia and to study their significant mobility changes over time by introducing an indicator of mobility which can be used to assess their motor behavioural disorders.

Assessment of elderly mobility using a remote multisensor monitoring system.

This study was designed to estimate the changes of different activities (going to bed, getting up, visiting washroom) of elderly as an index of mobility. The different values in time and number of the different activities were obtained from 16 elderly suffering from Alzheimer's disease in a hospital for short period observation adding up 4 months of observation data. Significant agreement in different activities (going to bed, getting up, visiting washroom, wandering) among the two measurements by multisensor system and by nursing staff notation was found. As interesting results, the follow up of a patient is shown for 13 consecutive nights. These studies show the potential usefulness of assessment of night activities as an index of mobility, mirror of motor behaviour. Due to minor error, the precise mobility index could not be observed, motor behaviour could simply be evaluated.