Exploring the Role of Active Assisted Living in the Continuum of Care for Older Adults: Thematic Analysis.

BACKGROUND: Active assisted living (AAL) refers to systems designed to improve the quality of life, aid in independence, and create healthier lifestyles for those who need assistance at any stage of their lives. As the population of older adults in Canada grows, there is a pressing need for nonintrusive, continuous, adaptable, and reliable health monitoring tools to support aging in place and reduce health care costs. AAL has great potential to support these efforts with the wide variety of solutions currently available; however, additional work is required to address the concerns of care recipients and their care providers with regard to the integration of AAL into care. OBJECTIVE: This study aims to work closely with stakeholders to ensure that the recommendations for system-service integrations for AAL aligned with the needs and capacity of health care and allied health systems. To this end, an exploratory study was conducted to understand the perceptions of, and concerns with, AAL technology use. METHODS: A total of 18 semistructured group interviews were conducted with stakeholders, with each group comprising several participants from the same organization. These participant groups were categorized into care organizations, technology development organizations, technology integration organizations, and potential care recipient or patient advocacy groups. The results of the interviews were coded using a thematic analysis to identify future steps and opportunities regarding AAL. RESULTS: The participants discussed how the use of AAL systems may lead to improved support for care recipients through more comprehensive monitoring and alerting, greater confidence in aging in place, and increased care recipient empowerment and access to care. However, they also raised concerns regarding the management and monetization of data emerging from AAL systems as well as general accountability and liability. Finally, the participants discussed potential barriers to the use and implementation of AAL systems, especially addressing the question of whether AAL systems are even worth it considering the investment required and encroachment on privacy. Other barriers raised included issues with the institutional decision-making process and equity. CONCLUSIONS: Better definition of roles is needed in terms of who can access the data and who is responsible for acting on the gathered data. It is important for stakeholders to understand the trade-off between using AAL technologies in care settings and the costs of AAL technologies, including the loss of patient privacy and control. Finally, further work is needed to address the gaps, explore the equity in AAL access, and develop a data governance framework for AAL in the continuum of care.

Exploring the Use of Pictograms in Privacy Agreements to Facilitate Communication Between Users and Data Collecting Entities: Randomized Controlled Trial.

BACKGROUND: Privacy agreements can foster trust between users and data collecting entities by reducing the fear of data sharing. Users typically identify concerns with their data privacy settings, but due to the complexity and length of privacy agreements, users opt to quickly consent and agree to the terms without fully understanding them. OBJECTIVE: This study explores the use of pictograms as potential elements to assist in improving the transparency and explanation of privacy agreements. METHODS: During the development of the pictograms, the Double Diamond design process was applied for 3 instances of user interactions and 3 iterations of pictograms. The testing was done by performing a comparative study between a control group, which received no pictograms, and an experimental group, which received pictograms. The pictograms were individually tested to assess their efficacy by using an estimated comprehension of information symbols test. RESULTS: A total of 57 participants were recruited for the pictogram evaluation phase. With the addition of pictograms, the overall understanding improved by 13% (P=.001), and the average time spent answering the questions decreased by 57.33 seconds. A 9% decrease in perceived user frustration was also reported by users, but the difference was not significant (χ24=4.80; P=.31). Additionally, none of the pictograms passed the estimated comprehension of information symbols test, with 7 being discarded immediately and 5 requiring further testing to assess their efficacy. CONCLUSIONS: The addition of pictograms appeared to improve users' understanding of the privacy agreements, despite the pictograms needing further changes to be more understandable. This proves that with the aid of pictographic images, it is possible to make privacy agreements more accessible, thereby allowing trust and open communication to be fostered between users and data collecting entities. TRIAL REGISTRATION: ClinicalTrials.gov NCT05631210; https://clinicaltrials.gov/ct2/show/NCT05631210.

A Blockchain-Based Consent Platform for Active Assisted Living: Modeling Study and Conceptual Framework.

BACKGROUND: Recent advancements in active assisted living (AAL) technologies allow older adults to age well in place. However, sensing technologies increase the complexity of data collection points, making it difficult for users to consent to data collection. One possible solution for improving transparency in the consent management process is the use of blockchain, an immutable and timestamped ledger. OBJECTIVE: This study aims to provide a conceptual framework based on technology aimed at mitigating trust issues in the consent management process. METHODS: The consent management process was modeled using established methodologies to obtain a mapping of trust issues. This mapping was then used to develop a conceptual framework based on previous monitoring and surveillance architectures for connected devices. RESULTS: In this paper, we present a model that maps trust issues in the informed consent process; a conceptual framework capable of providing all the necessary underlining technologies, components, and functionalities required to develop applications capable of managing the process of informed consent for AAL, powered by blockchain technology to ensure transparency; and a diagram showing an instantiation of the framework with entities comprising the participants in the blockchain network, suggesting possible technologies that can be used. CONCLUSIONS: Our conceptual framework provides all the components and technologies that are required to enhance the informed consent process. Blockchain technology can help overcome several privacy challenges and mitigate trust issues that are currently present in the consent management process of data collection involving AAL technologies.

The Influence of Exposure to Natural Disasters on Depression and PTSD Symptoms among Firefighters.

Introduction Firefighters represent an important population for understanding the consequences of exposure to potentially traumatic stressors. Hypothesis/Problem The researchers were interested in the effects of pre-employment disaster exposure on firefighter recruits' depression and posttraumatic stress disorder (PTSD) symptoms during the first three years of fire service and hypothesized that: (1) disaster-exposed firefighters would have greater depression and PTSD symptoms than non-exposed overall; and (2) depression and PTSD symptoms would worsen over years in fire service in exposed firefighters, but not in their unexposed counterparts. METHODS: In a baseline interview, 35 male firefighter recruits from seven US cities reported lifetime exposure to natural disaster. These disaster-exposed male firefighter recruits were matched on age, city, and education with non-exposed recruits. RESULTS: A generalized linear mixed model revealed a significant exposure×time interaction (e coef =1.04; P<.001), such that depression symptoms increased with time for those with pre-employment disaster exposure only. This pattern persisted after controlling for social support from colleagues (e coefficient=1.05; P<.001), social support from families (e coefficient=1.04; P=.001), and on-the-job trauma exposure (coefficient=0.06; e coefficient=1.11; P<.001). Posttraumatic stress disorder symptoms did not vary significantly between exposure groups at baseline (P=.61). CONCLUSION: Depression symptoms increased with time for those with pre-employment disaster exposure only, even after controlling for social support. Posttraumatic stress disorder symptoms did not vary between exposure groups. Pennington ML , Carpenter TP , Synett SJ , Torres VA , Teague J , Morissette SB , Knight J , Kamholz BW , Keane TM , Zimering RT , Gulliver SB . The influence of exposure to natural disasters on depression and PTSD symptoms among firefighters. Prehosp Disaster Med. 2018;33(1):102-108.