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Providing for Older Adults Using Smart Environment Technologies

By Diane J. Cook

The number of individuals who live with cognitive or physical impairments is rising significantly due to the aging of the population and better medical care. In 1985, 5.5 million disabled elderly were living at home. By 2030, 70 million Americans will be 65+ [1] and over 10.1 million of these elderly will be living at home with functional disabilities [2]. Surveys indicate that older adults want to remain in their homes as they age despite disabilities that may compromise safety. Maintaining older individuals in their homes is also financially preferable ó 40 percent of elder adults cannot even afford to live in an assisted care facility.

Placing the burden on caregivers alone is not an effective solution. Family members in the United States provide approximately $197 billion/year of ďfreeĒ care. However, many of these caregivers themselves have disabilities, and this level of care degrades their own health as well as forces many caregivers to sacrifice jobs and social lives.

Can the technology sector help older adults live independently at home? A solution may be found in health-assistive technologies. Convergence of technologies in pervasive computing, artificial intelligence, and sensor networks is now making smart environments a reality, and this technology can tremendously impact and facilitate the desire of adults to age in place. We define a smart environment as an intelligent agent that is able to acquire and apply knowledge about the environment and its residents in order to improve their quality of life in that environment [3]. Physical implementations of these smart environments can be found in projects such as MavHome, the Gator Tech Smart House, the iDorm, the Georgia Tech Award Home, the Adaptive Home, and the Home Depot Smart Home.

With the maturing of supporting technologies, at-home automated assistance can allow people with mental and physical challenges to lead independent lives in their own homes [4]. Some of these technologies focus on assurance, or making sure our friends and loved ones are safe and healthy at home. In particular, software that supports smart environments can use collected sensor data to recognize tasks that residents are performing. This is beneficial for recognizing whether adults are completing essential ADLs (Activities for Daily Living). By tagging food packages, medicine dispensers, and key pieces of furniture with RFID tags, smart environments can also monitor the residentís diet, medication and exercise routines. Once a model of daily activities is learned, the smart environment can detect long-term changes or trends, and identify sudden changes or anomalies that may pose a health concern. If a health-critical situation is encountered the smart environment can contact the caregiver and intervene with automated assistance (e.g., turn off the bathwater).

The next category of health technologies targets the goal of providing support to individuals with cognitive or physical impairments. Using the learned model of planned or regular daily activities, the smart environment can remind residents of their normal tasks or the sequence of steps that comprise these tasks (such as hand washing [5]). Devices such as the activity compass [6] can remind users of the route that will get them back to a safe location if they have wandered off. For those with physical limitations, automation of their home and work environment can allow them to control their physical environments without requesting assistance from caregivers.

Smart environment technologies can also be used to assess the cognitive and physical limitations of individuals. Researchers have performed this type of assessment based on the ability of individuals to complete kitchen tasks or play a variety of computer games.

Finally, smart environments can be used to enhance the quality of life for individuals who would otherwise lead solitary lives at home. Intel has created the Proactive Health Group, which performs research and development of technologies that can increase older adults' quality of life. One important contributor to the wellbeing of older adults is their social network. Using wireless sensors, smart environments can monitor social interaction of older adults, report the level of social interaction to caregivers, and offer advice on how to improve that aspect of a personís life.

While bringing health care to homes is an exciting development, hospitals are still needed for a variety of reasons. The concentration of costly equipment and specialized professionals is valuable in many situations. Applications of smart environment technologies in hospitals can vary from enhancing safety for patients and professionals to following the evolution of patients after surgical intervention. At some hospitals, long-term patients can specify their preferences and the settings are noted using the patientís RFID-encoded card. The hospital is then aware of the patientís presence at the unit and can tailor lighting and wall/ceiling projections to calm anxiety and to guide the patient. A child who needs to hold his breath during an examination can view a figure in the projection doing the same. Understanding the procedure he is about to undertake can alleviate some of his fear.

Computers can link hospital care with smart environment technology. At the Ulster Community Hospitals Trust of Northern Ireland, the PathFinder project equipped 3,000 homes in the community with sensors. A combination of computer software and hospital staff can thus monitor the well-being of patients with chronic conditions that may be detrimental to their lifestyle.

Finally, smart environment technologies can improve care in the context of assisted care facilities. Consumer Reports [7] laments the status of assisted care facilities in the United States and the need in most for additional staffing. Smart environment capabilities can monitor resident activities and health status and thereby reduce the burden on staff nurses in assisted care facilities, as well as make them aware more quickly of residentsí needs as they arise. By monitoring activities of staff members, they can be more easily located when they are urgently needed.

As society and technology advance, there is a growing interest in adding intelligence to our everyday environments. The impact of this assistance is perhaps most greatly felt in the area of health assistance. Advances in the fields of artificial intelligence, pervasive and mobile computing, robotics, middleware, sensor networks, and multimedia computing have prompted a sudden interest in smart environment projects. These technologies have demonstrated their value in providing accessible and low-cost health assistance in an individualís own home or any other setting. Much continued research is needed to make these technologies robust and ready for widespread adoption. Investigating these issues is imperative if we want to adequately care for our aging population and provide the best possible quality of life for them and, ultimately, for ourselves.


  1. S. Lanspery, J.J. Callahan Jr., J.R. Miller, and J. Hyde. Introduction: Staying put. In S. Lanspery and J. Hyde, editors, Staying Put: Adapting the Places Instead of the People, pages 1-22, Baywood Publishing Company, 1997.

  2. R. Elliott. Assistive technology for the frail elderly: An overview. U.S. Department of Health and Human Services, aspe.hhs.gov, 1991.

  3. D. Cook and S. Das, editors. Smart Environments: Technologies, Protocols, and Applications, Wiley, 2004.

  4. M.E. Pollack. Intelligent technology for an aging population: The use of AI to assist elders with cognitive impairment. AI Magazine, 26(2):9-24, 2005.

  5. A. Mihailidis, J.C. Barbenel, and G. Fernie. The efficacy of an intelligent cognitive orthosis to facilitate handwashing by persons with moderate-to-severe dementia. Neuropsychological Rehabilitation, 14(1/2):135-171, 2004.

  6. H. Kautz, L. Arnstein, G. Borriello, O. Etzioni, and D. Fox. An overview of the assisted cognition project. Proceedings of the AAAI Workshop on Automation as Caregiver: The Role of Intelligent Technology in Elder Care, pages 60-65, 2002.

  7. Consumer Reports. Profits vs. patients: CR investigates nursing homes, August 2006.


Diane J. Cook is the Huie-Rogers Chair Professor at Washington State University's School of Electrical Engineering and Computer Science. Comments may be submitted to todaysengineer@ieee.org.

Copyright © 2008 IEEE

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