In-home Monitoring Technologies Research Articles

Regular snoring is associated with uncontrolled hypertension

Snoring may be a risk factor for cardiovascular disease independent of other co-morbidities. However, most prior studies have relied on subjective, self-report, snoring evaluation. This study assessed snoring prevalence objectively over multiple months using in-home monitoring technology, and its association with hypertension prevalence. In this study, 12,287 participants were monitored nightly for approximately six months using under-the-mattress sensor technology to estimate the average percentage of sleep time spent snoring per night and the estimated apnea-hypopnea index (eAHI). Blood pressure cuff measurements from multiple daytime assessments were averaged to define uncontrolled hypertension based on mean systolic blood pressure≥140 mmHg and/or a mean diastolic blood pressure ≥90 mmHg. Associations between snoring and uncontrolled hypertension were examined using logistic regressions controlled for age, body mass index, sex, and eAHI. Participants were middle-aged (mean ± SD; 50 ± 12 y) and most were male (88%). There were 2467 cases (20%) with uncontrolled hypertension. Approximately 29, 14 and 7% of the study population snored for an average of >10, 20, and 30% per night, respectively. A higher proportion of time spent snoring (75th vs. 5th; 12% vs. 0.04%) was associated with a ~1.9-fold increase (OR [95%CI]; 1.87 [1.63, 2.15]) in uncontrolled hypertension independent of sleep apnea. Multi-night objective snoring assessments and repeat daytime blood pressure recordings in a large global consumer sample, indicate that snoring is common and positively associated with hypertension. These findings highlight the potential clinical utility of simple, objective, and noninvasive methods to detect snoring and its potential adverse health consequences.

ENGAGE UNDERREPRESENTED GROUPS IN TECHNOLOGY AND AGING RESEARCH: LIVED EXPERIENCE AT GEOGRAPHICALLY DIVERSE SITES

Abstract Minoritized and marginalized older adults face multifaceted barriers that could prevent them from participating in aging research, including but not limited to not having access to research opportunities, time and transportation constraints, lack of trust with health care providers and researchers, and language barriers. When the research projects involve technology, whether as a tool for engagement or recruitment, intervention delivery, or outcome monitoring and assessment, additional challenges exist in recruiting underrepresented groups. The technology adoption gap has been widely reported. Minoritized and marginalized older adults are less likely to have internet access or feel less confident in using technology compared to their more privileged counterparts. This symposium introduces the lived experience and lessons learned from engagement and recruitment of underrepresented populations at multiple Alzheimer’s Disease Research Centers. The first presentation presents outreach and recruitment efforts at the Oregon Outreach, Recruitment & Education Core. The authors will discuss strategies and benefits to engage people of underrepresented backgrounds in the research workforce. The following two presentations focus on recruitment efforts for installing an in-home monitoring technology platform for diverse older adult populations, including African Americans in Chicago, IL, and Hispanic/Latino immigrants in San Antonio, TX. The fourth presentation describes the response, retention, and enrollment rate of an online dementia research registry and the effort to adapt the registry and build capacity in recruiting Asian American immigrants with limited English proficiency. Sharing successes and lessons learned at multiple sites will contribute to developing more effective recruitment strategies for future aging research involving technology.

RECRUITMENT SUCCESSES AND CHALLENGES OF EMPLOYING IN-HOME SENSOR TECHNOLOGY WITH OLDER AFRICAN AMERICAN ADULTS

Abstract Older African Americans are under-represented in clinical research studies of aging. Many previous studies have shown results of in-home monitoring technologies to collect objective data for aging in place but few studies include minoritized populations. The CART platform uses home-based sensor technology to unobtrusively assess activity in the home and was embedded in homes of participants from the Minority Aging Research Study (MARS), an ongoing longitudinal study of cognitive decline in older African Americans. This presentation will highlight efforts to engage, recruit, and retain older African American participants in Chicago, with a particular focus on challenges and lessons learned. Recruitment consisted of presentations and mailings to potentially eligible MARS participants based on pre-specified inclusion criteria. Of 153 participants who met initial eligibility criteria, 36 refused before consent, 34 were ineligible after screening, and we enrolled 76 non-Hispanic African Americans participants (80% women; mean age = 80.4 (6.3) years); mean education = 16 (2.8) years; 78% without cognitive impairment). Enrolled participants were slightly younger, more likely to be female, and had higher education. There was no difference in cognitive impairment between those who enrolled compared to those who were ineligible after screening. Since enrollment, 11 have withdrawn and 7 are no longer active. The most common challenges include privacy concerns, broadband internet issues, emerging medical conditions, or changes in residency or resident occupancy. These results demonstrate that older African Americans participating in an ongoing longitudinal study can be recruited and retained in an ancillary study that involves home-based sensor technology.

Technologies for monitoring activities of daily living in older adults: a systematic review

Purpose As the older adult population rise globally, technologies to monitoring activities of daily living (ADL) may have a role in supporting aging in place for older adults. The objective of this systematic literature review was to study the scope, diversity and readiness of technologies developed to monitor ADL in older adults. Methods We systematically searched two scientific databases (CINAHL and IEEE), following Preferred Reporting Items for Systematic reviews and Meta Analyses (PRISMA) guidelines. We included studies on technologies used to monitor older adults’ ADL in the home but excluded studies focused on communication technologies (phone calls, text messages) or monitoring postures alone. The JBI checklist for case series was used for quality assessment. Extracted details included population characteristics, ADL assessment outcomes, types of monitoring technology, and technology readiness and usability. Results The search found 147 papers, with 16 papers included in the final analysis. The literature described 48 types of technologies. Of moderate quality studies, five studies used wearables at technology readiness level 4–6 to monitor basic ADL (walking, transfers and walking up stairs) and one used ambient sensors to detect urinary incontinence. Conclusions Monitoring technologies remain at development stages. More research is needed to strengthen technologies that monitor activities of daily living. Implications for rehabilitation Monitoring activities of daily living at home remains focused on using wearables to assess in-home functional mobility to support rehabilitation. Technologies remain a 4–6 readiness level and there is a lack of evidence to recommend in-home monitoring technologies.

Supportive oncology care at home after discharge for patients with advanced cancer.

295 Background: Patients with advanced cancer often experience frequent and prolonged hospitalizations, and the transition from hospital to home represents a critical period for these individuals, as they prefer to maximize time at home and avoid readmissions. We sought to demonstrate the feasibility and acceptability of a Supportive Oncology Care at Home intervention to address the post-discharge needs of recently hospitalized patients with advanced cancer. Methods: We conducted a single-arm pilot trial at Massachusetts General Hospital (MGH). We enrolled English-speaking adults with advanced solid tumors experiencing their second or later unplanned hospitalization, who were being discharged home without hospice services and residing within a 50 mile radius of MGH. The three-week intervention consisted of: 1) hospital in the home care model for proactive symptom assessment and management, including clinician visits to assess patients, draw labs, administer intravenous medications and hydration, and ensure optimal symptom management; 2) remote monitoring of daily patient-reported symptoms, vital signs, and body weight; and 3) structured communication with the oncology team. The primary endpoint of the study was feasibility, defined as ≥60% of approached and eligible patients enrolling and ≥60% of participants completing daily symptom assessments. After intervention completion, patients rated the helpfulness and convenience of the intervention and symptom monitoring technology. Results: From 12/2021-6/2022, we enrolled 40 out of 66 approached patients (60.6% enrollment rate). Enrolled patients (median age = 58.5 years, 50% female, 75% white, 68% married, 50% gastrointestinal cancers) completed 93.8% of daily symptom assessments. 12 patients (30%) did not complete the intervention due to withdrawal (5), hospice transfer (4), or death (3). Among enrolled patients, 20.0% were enrolled in hospice and 15.4% died at 30 days after hospital discharge. In exit interviews, 100% and 75% rated the intervention and symptom monitoring as helpful, respectively. 83% of patients found the in-home monitoring technology convenient. Conclusions: We found that a three-week Supportive Oncology Care at Home intervention is a feasible approach to providing post-discharge care for high acuity, seriously ill hospitalized patients with advanced cancer. These patients also found the intervention highly acceptable. Future studies will test the efficacy of the intervention for reducing hospital readmissions, improving symptom management and quality of life, and increasing days spent at home near the end of life. Clinical trial information: NCT04637035.

In-Home Monitoring Technology for Aging in Place: Scoping Review.

BackgroundFor successful aging-in-place strategy development, in-home monitoring technology is necessary as a new home modification strategy. Monitoring an older adult’s daily physical activity at home can positively impact their health and well-being by providing valuable information about functional, cognitive, and social health status. However, it is questionable how these in-home monitoring technologies have changed the traditional residential environment. A comprehensive review of existing research findings should be utilized to characterize recent relative technologies and to inform design considerations.ObjectiveThe main purpose of this study was to classify recent smart home technologies that monitor older adults’ health and to architecturally describe these technologies as they are used in older adults’ homes.MethodsThe scoping review method was employed to identify key characteristics of in-home monitoring technologies for older adults. In June 2021, four databases, including Web of Science, IEEE Xplore, ACM Digital Library, and Scopus, were searched for peer-reviewed articles pertaining to smart home technologies used to monitor older adults’ health in their homes. We used two search strings to retrieve articles: types of technology and types of users. For the title, abstract, and full-text screening, the inclusion criteria were original and peer-reviewed research written in English, and research on monitoring, detecting, recognizing, analyzing, or tracking human physical, emotional, and social behavior. The exclusion criteria included theoretical, conceptual, or review papers; studies on wearable systems; and qualitative research.ResultsThis scoping review identified 30 studies published between June 2016 and 2021 providing overviews of in-home monitoring technologies, including (1) features of smart home technologies and (2) sensor locations and sensor data. First, we found six functions of in-home monitoring technology among the reviewed papers: daily activities, abnormal behaviors, cognitive impairment, falls, indoor person positioning, and sleep quality. Most of the research (n=27 articles) focused on functional monitoring and analysis, such as activities of daily living, instrumental activities of daily living, or falls among older adults; a few studies (n=3) covered social interaction monitoring. Second, this scoping review also found 16 types of sensor technologies. The most common data types encountered were passive infrared motion sensors (n=21) and contact sensors (n=19), which were used to monitor human behaviors such as bodily presence and time spent on activities. Specific locations for each sensor were also identified.ConclusionsThis wide-ranging synthesis demonstrates that in-home monitoring technologies within older adults’ homes play an essential role in aging in place, in that the technology monitors older adults’ daily activities and identifies various health-related issues. This research provides a key summarization of in-home monitoring technologies that can be applied in senior housing for successful aging in place. These findings will be significant when developing home modification strategies or new senior housing.

Association Between Mild Cognitive Impairment and Seasonal Rest-Activity Patterns of Older Adults.

Seasonal variation in rest-activity patterns has been observed in healthy adult populations. This study examined seasonal variation in total time spent overnight in the bedroom by cognitively intact older adults and older adults with mild cognitive impairment (MCI). We hypothesize that seasonal variation in rest-activity patterns is observed in the cognitively intact group and that this variation is disturbed in those with MCI. Study participants were 128 older adults; mean age 85.2 years. Ninety-eight were cognitively intact, and 30 had been diagnosed with MCI. All were enrolled in an ongoing longitudinal study using in-home passive monitoring technology. Infrared presence sensors were placed throughout each participant's home to monitor movement and presence in each room of the home. Activity data was collected from the sensors over a period of up to 527 days. Overnight time in bedroom was found to vary seasonally for the cognitively intact group, with longer times spent overnight in the bedroom during the winter months. This seasonal variation was not observed for those with non-amnestic MCI. MCI is associated with an attenuation of seasonal variation in total time spent in the bedroom at night. Detection of changes in infradian sleep patterns may be an early marker of cognitive decline. Which key determinants are driving these disturbed rhythms, such as features intrinsic to changes in the brain or to environmental factors or external cues, remains an important question for ongoing and future studies.

Voices of Caregivers: Key Demands Towards AI-driven Home Monitoring in Community-based Dementia Care

While most people with dementia prefer to live at home for as long as possible, this also puts more pressure on both their informal and formal care network. To provide support in home-based dementia care, there is growing interest in technology that allows caregivers to remotely monitor health and safety of people with dementia. Novel generations of these technologies are using non-wearable, pervasive sensors coupled with algorithms to continuously collect and model meaningful in-home information. However, while these self-learning monitoring systems develop rapidly, their target users’ views and demands are still insufficiently mapped out. To identify possible barriers to acceptance and ways to overcome these, we conducted a scenario-based study, including semi-structured interviews with informal caregivers (n=19) and focus groups with home care professionals (n=16) of community-dwelling people with dementia. Inductive qualitative content analysis revealed that both groups of caregivers were concerned about the informational privacy of their care recipient with dementia, information overload, and ethical issues related to dehumanizing care. Identified demands mainly centered around how to overcome these barriers. We identified several demands related to specific functionalities, user experience factors, services surrounding the technology, and integration into the existing work context. Most notably, caregivers highlighted the importance of introducing AI-driven in-home monitoring technologies in a way it prevents them from feeling undervalued. In conclusion, our findings can help to inform the development of more acceptable and unobtrusive in-home monitoring technologies to support home-based dementia care.

Factors Influencing Implementation of eHealth Technologies to Support Informal Dementia Care: An Umbrella Review

The increase of People with Dementia (PwD) living at home underscores the need for innovative eHealth technologies that support both patients and informal caregivers (IC). Sustainable implementation of eHealth technologies within this target group can, however, be difficult. Our study aims at providing an overview of (1) technologies employed in the context of informal dementia care (IDC) and (2) factors influencing the implementation of these technologies. Five databases were searched for (systematic) reviews. 21 reviews were included. A combination of deductive and inductive thematic analysis was performed, using the NASSS Framework to organize the findings. We identified technologies used “by IC”, “by PwD” and “with PwD”. Most represented technologies included: (i) devices for in-home monitoring (ii) technologies for supporting memory, orientation, and day structure, and (iii) communication technologies. Most factors influencing implementation related to the condition of dementia, characteristics of the technology, the expected/perceived value by users, and the characteristics of the IC. Considerably less has been reported on factors related to the implementing organization, the technology supplier, the wider institutional and sociocultural context of policy and regulations, and the adaptation of technology over time. Our study 1) created a comprehensive overview of eHealth technologies employed in the context of IDC and contributes to a better understanding of factors influencing their implementation, and 2) uncovered a knowledge gap regarding success factors for implementation related to the wider context. Although future research is needed, these findings can help researchers improving the development and implementation of eHealth technologies to support IDC.

Requirements for Unobtrusive Monitoring to Support Home-Based Dementia Care: Qualitative Study Among Formal and Informal Caregivers.

BackgroundDue to a growing shortage in residential care, people with dementia will increasingly be encouraged to live at home for longer. Although people with dementia prefer extended independent living, this also puts more pressure on both their informal and formal care networks. To support (in)formal caregivers of people with dementia, there is growing interest in unobtrusive contactless in-home monitoring technologies that allow caregivers to remotely monitor the lifestyle, health, and safety of their care recipients. Despite their potential, these solutions will only be viable if they meet the expectations and needs of formal and informal caregivers of people with dementia.ObjectiveThe objective of this study was to explore the expected benefits, barriers, needs, and requirements toward unobtrusive in-home monitoring from the perspective of formal and informal caregivers of community-dwelling people with dementia.MethodsA combination of semistructured interviews and focus groups was used to collect data among informal (n=19) and formal (n=16) caregivers of people with dementia. Both sets of participants were presented with examples of unobtrusive in-home monitoring followed by questions addressing expected benefits, barriers, and needs. Relevant in-home monitoring goals were identified using a previously developed topic list. Interviews and focus groups were transcribed and inductively analyzed. Requirements for unobtrusive in-home monitoring were elicited based on the procedure of van Velsen and Bergvall-Kåreborn.ResultsFormal and informal caregivers saw unobtrusive in-home monitoring as a support tool that should particularly be used to monitor (the risk of) falls, day and night rhythm, personal hygiene, nocturnal restlessness, and eating and drinking behavior. Generally, (in)formal caregivers reported cross-checking self-care information, extended independent living, objective communication, prevention and proactive measures, emotional reassurance, and personalized and optimized care as the key benefits of unobtrusive in-home monitoring. Main concerns centered around privacy, information overload, and ethical concerns related to dehumanizing care. Furthermore, 16 requirements for unobtrusive in-home monitoring were generated that specified desired functions, how the technology should communicate with the user, which services surrounding the technology were seen as needed, and how the technology should be integrated into the existing work context.ConclusionsDespite the presence of barriers, formal and informal caregivers of people with dementia generally saw value in unobtrusive in-home monitoring, and felt that these systems could contribute to a shift from reactive to more proactive and less obtrusive care. However, the full potential of unobtrusive in-home monitoring can only unfold if relevant concerns are considered. Our requirements can inform the development of more acceptable and goal-directed in-home monitoring technologies to support home-based dementia care.

A survey on the attitudes of parents with young children on in-home monitoring technologies and study designs for infant research.

Remote in-home infant monitoring technologies hold great promise for increasing the scalability and safety of infant research (including in regard to the current Covid-19 pandemic), but remain rarely employed. These technologies hold a number of fundamental challenges and ethical concerns that need addressing to aid the success of this fast-growing field. In particular, the responsible development of such technologies requires caregiver input. We conducted a survey of the opinions of 410 caregivers on the viability, privacy and data access of remote in-home monitoring technologies and study designs. Infant-friendly wearable devices (such as sensing body suits) were viewed favourably. Caregivers were marginally more likely to accept video and audio recording in the home if data was anonymised (through automated processing) at point of collection, particularly when observations were lengthy. Caregivers were more open to international data sharing for anonymous data. Caregivers were interested in viewing all types of data, but were particularly keen to access video and audio recordings for censoring purposes (i.e., to delete data segments). Taken together, our results indicate generally positive attitudes to remote in-home monitoring technologies and studies for infant research but highlight specific considerations such as safety, privacy and family practicalities (e.g. multiple caregivers, visitors and varying schedules) that must be taken into account when developing future studies.

Application of In-Home Monitoring Data to Transition Decisions in Continuing Care Retirement Communities: Usability Study.

BackgroundContinuous in-home monitoring of older adults can provide rich and sensitive data capturing subtle behavioral and cognitive changes. Our previous work has identified multiple metrics that describe meaningful trends in daily activities over time. The continuous, multidomain nature of this technology may also serve to inform caregivers of the need for higher levels of care to maintain the health and safety of at-risk older adults. Accordingly, care decisions can be based on objective, systematically assessed real-time data.ObjectiveThis study deployed a suite of in-home monitoring technologies to detect changing levels of care needs in residents of independent living units in 7 retirement communities and to assess the efficacy of computer-based tools in informing decisions regarding care transitions.MethodsContinuous activity data were presented via an interactive, web-based tool to the staff identified in each facility who were involved in decisions regarding transitions in care among residents. Comparisons were planned between outcomes for residents whose data were shared and those whose data were not made available to the staff. Staff use of the data dashboard was monitored throughout the study, and exit interviews with the staff were conducted to explicate staff interaction with the data platform. Residents were sent weekly self-report questionnaires to document any health- or care-related changes.ResultsDuring the study period, 30 of the 95 residents (32%) reported at least one incidence of new or increased provision of care; 6 residents made a permanent move to a higher level of care within their communities. Despite initial enthusiasm and an iterative process of refinement of measures and modes of data presentation based on staff input, actual inspection and therefore the use of resident data were well below expectation. In total, 11 of the 25 staff participants (44%) logged in to the activity dashboard throughout the study. Survey data and in-depth interviews provided insight into the mismatch between intended and actual use.ConclusionsMost continuous in-home monitoring technology acceptance models focus on perceived usefulness and ease of use and equate the intent to use technology with actual use. Our experience suggests otherwise. We found that multiple intervening variables exist between perceived usefulness, intent to use, and actual use. Ethical, institutional, and social factors are considered in their roles as determinants of use.

Support, Health, Activities, Resources, & Education (SHARE): New Program Innovations for Early-Stage Families

Persons living with a recent diagnosis of dementia experience great uncertainty and stress as they and their families try to adjust to the new reality of their lives and futures. One fruitful strategy for intervening with these families is to include both the person living with dementia and their family care partner in the program. Although dyadic approaches are rare among early-stage programs, promising examples exist. The SHARE Program (Support, Health, Activities, Resources, and Education) is one exception where dyadic materials address: 1) current and long- term needs of care partners, and 2) how the family can develop a realistic plan of care based on their care values and preferences. This symposium describes the development and positive outcomes of the original SHARE intervention and the promising adaptations that expand how and to whom the intervention is delivered. Presentations explore: 1) the original SHARE for Dementia program and strategies for expanding its reach into chronic conditions populations (Orsulic-Jeras & Whitlatch), 2) a group version translated into Spanish (“EPIC: Early-stage Partners in Care,” Dr. Coon), and 3) the development of a remote needs assessment and unobtrusive in-home monitoring technology platform that guides care planning and helps to maintain independence (“SHARE-sense,” Dr. Miller). Discussion will focus on the challenges, unique solutions, and positive outcomes when adapting SHARE to different settings and populations (Dr. Zarit).

51 Interactive Home Monitoring of ED Patients with Suspected or Confirmed COVID-19

Remote in-home monitoring technology has become an increasingly important means to conserve hospital and emergency department (ED) capacity while providing observation and care for high-risk patients with milder symptoms during the COVID-19 pandemic. We aimed to evaluate the safety of introducing an Interactive Home Monitoring program (IHM) for high-risk patients discharged from the emergency department (ED) with suspected or confirmed COVID-19 who without remote monitoring would have required admission to the hospital.

Innovative Assisted Living Tools, Remote Monitoring Technologies, Artificial Intelligence-Driven Solutions, and Robotic Systems for Aging Societies: Systematic Review.

BackgroundThe increase in life expectancy and recent advancements in technology and medical science have changed the way we deliver health services to the aging societies. Evidence suggests that home telemonitoring can significantly decrease the number of readmissions, and continuous monitoring of older adults’ daily activities and health-related issues might prevent medical emergencies.ObjectiveThe primary objective of this review was to identify advances in assistive technology devices for seniors and aging-in-place technology and to determine the level of evidence for research on remote patient monitoring, smart homes, telecare, and artificially intelligent monitoring systems.MethodsA literature review was conducted using Cumulative Index to Nursing and Allied Health Literature Plus, MEDLINE, EMBASE, Institute of Electrical and Electronics Engineers Xplore, ProQuest Central, Scopus, and Science Direct. Publications related to older people’s care, independent living, and novel assistive technologies were included in the study.ResultsA total of 91 publications met the inclusion criteria. In total, four themes emerged from the data: technology acceptance and readiness, novel patient monitoring and smart home technologies, intelligent algorithm and software engineering, and robotics technologies. The results revealed that most studies had poor reference standards without an explicit critical appraisal.ConclusionsThe use of ubiquitous in-home monitoring and smart technologies for aged people’s care will increase their independence and the health care services available to them as well as improve frail elderly people’s health care outcomes. This review identified four different themes that require different conceptual approaches to solution development. Although the engineering teams were focused on prototype and algorithm development, the medical science teams were concentrated on outcome research. We also identified the need to develop custom technology solutions for different aging societies. The convergence of medicine and informatics could lead to the development of new interdisciplinary research models and new assistive products for the care of older adults.

In-home monitoring evaluation by home-dwelling older adults, caregivers and healthcare providers

Abstract Background In Europe, population ageing is increasing the healthcare needs and costs. Both frailty and chronic diseases affecting older people reduce their ability to live independently. However, most older people prefer to age in their own homes. New development of in-home monitoring can play a role in staying independent, active and healthy. Our objective was to evaluate a new in-home monitoring system among home-dwelling older adults (OA), their family caregivers (FC), and their healthcare providers (HCP) for the support of home care. Methods The system continuously monitored OA’s daily activities (e.g., mobility, sleep habits, fridge visits, door events) at home by ambient sensor system (DomoCare®) and health-related events by wearable sensors (Fitbit®, ECG). In case of deviations in daily activities (e.g., changes in mobility), alerts were transmitted to HCP via email. Using specific questionnaires, the opinion of 13 OA, 13 FC, and 20 HCP were collected at the end of 12-month of follow-up focusing on their user experience and the impact of in-home monitoring on home care services. Results These preliminary results underlined that the majority of OA, FC, and HCP consider that in-home sensors can help staying at home, improving home care, reducing family stress, and preventing domestic accidents. The opinion tended to be more favourable toward ambient sensors (80%) than toward Fitbit® (67%) and ECG (64%). On average, OA (80%) and FC (73%) tended to be more enthusiast than HCP (63%). Some barriers reported by HCP were a fear of weakening of the relationship with OA and an excessive surveillance. Conclusions Overall, the opinion of OA, FC and HCP were positive related to in-home sensors, with HCP being more mixed about their use in clinical practice. Key messages In-home monitoring technologies seem to be generally well accepted. In-home monitoring technologies could be help facilitating home care of older people.

PATTERNS OF HOME COMPUTER USE DIFFER OVER TIME BETWEEN OLDER ADULTS DESTINED TO DEVELOP MILD COGNITIVE IMPAIRMENT AND THOSE WHO REMAIN COGNITIVELY INTACT

Identification of pre-symptomatic changes in healthy older adults that signal future cognitive decline and transition to MCI and AD is an important goal for early detection and intervention. Subtle changes in behavior associated with less efficient or effective performance in routine daily activities may signal incidental MCI. These changes have been correlated with cognitive tests and medial temporal lobe brain structures often affected in early AD. In this study, we examined whether patterns of responding to an in-home weekly online health questionnaire differed between older adults who remained cognitively intact and those who were destined to transition to MCI over a study period of four years. Participants were 110 community dwelling older adults enrolled in a longitudinal study of in-home monitoring technologies. At baseline in 2011, all participants were non-depressed (GDS<5) and cognitively intact (mean age = 84.8 years; 77% female). Of these individuals, 29 (26%) were classified as MCI based on neuropsychological criteria (mean age=86.0; 79% female) at an annual clinical follow-up visit (mean follow-up = 2.1 years). During the study period, a short online health questionnaire was distributed weekly through the Internet on Monday mornings at 5 am on participants’ home computers. Longitudinal generalized linear mixed effects models were generated with three online questionnaire response variables: completion time, in seconds; start time in the day, in seconds from 5am; and whether staff assistance was needed (yes/no), as unique outcomes. Models were adjusted for age, education and number of items endorsed. On average, individuals destined to develop MCI completed their questionnaires 1.4 hours later in the day than cognitively stable participants (p=.029), after adjusting for covariates. Over time, more participants needed assistance to complete the online questionnaires and this increase was significantly steeper in those destined to convert to MCI (p=0.032). The longitudinal trajectories of ambiently assessed measures of weekly home computer use differed between those who remained cognitively stable and those who were destined to transition to MCI. Remote, high frequency assessment of routine activities is a promising approach for detecting the earliest changes associated with future cognitive decline in older adults.

Embedded Online Questionnaire Measures Are Sensitive to Identifying Mild Cognitive Impairment.

Early changes in cognitively demanding daily activities occur between normal cognition and the development of mild cognitive impairment (MCI). These real-world functional changes as early signals of cognitive change form a prime target for meaningful early detection of dementia. We examined whether passive aspects of responding to a remotely monitored weekly online questionnaire discriminated between older adults with and without MCI. Participants were 83 independent, community-dwelling older adults enrolled in a longitudinal study of in-home monitoring technologies, which included completion of a short weekly online questionnaire of health and life events. In longitudinal analyses, time to complete the online questionnaire decreased over 1 year in both MCI and cognitively intact participants (P<0.01). MCI and intact participants did not differ in the time of day they submitted their questionnaires initially; however, over the course of 1 year MCI participants began to submit their questionnaires progressively later in the day and they needed greater assistance from staff as compared with intact participants (P<0.05). The online questionnaire performance measures were significantly correlated to conventional cognitive test scores (P<0.05) across the spectrum of normal cognition to MCI. Ambiently assessed, passive performance measures embedded within an online questionnaire are able to discriminate between normal cognition and MCI. Remote monitoring of cognitively demanding routine daily activities is a promising approach for ecologically valid real-world cognitive assessment.

Older Adults' and Caregivers' Perspectives on In-Home Monitoring Technology.

In the past decade, there has been an increase in the application and investigation of in-home monitoring systems to support older adults with dementia and their caregivers. The current study focused on a monitoring system that included the use of motion sensors and Internet connections with one-way communication capabilities. Only a limited number of studies have explored and compared older adults' and caregivers' perspectives on such monitoring systems. The purpose of the current study was to explore older adults' and caregivers' perspectives on in-home monitoring systems using photo elicitation techniques. Three overarching themes emerged: (a) feeling cared for (which included two sub-themes), (b) feeling cared about (which included three sub-themes), and (c) suggestions for change (which included four sub-themes). These results revealed the duality of care when using in-home monitoring. Clinical and other future implications are discussed. [Journal of Gerontological Nursing, 42(6), 43-50.].

Computer mouse movement patterns: A potential marker of mild cognitive impairment

IntroductionSubtle changes in cognitively demanding activities occur in mild cognitive impairment (MCI) but are difficult to assess with conventional methods. In an exploratory study, we examined whether patterns of computer mouse movements obtained from routine home computer use discriminated between older adults with and without MCI. MethodsParticipants were 42 cognitively intact and 20 older adults with MCI enrolled in a longitudinal study of in-home monitoring technologies. Mouse pointer movement variables were computed during one week of routine home computer use using algorithms that identified and characterized mouse movements within each computer use session. ResultsMCI was associated with making significantly fewer total mouse moves (P < .01) and making mouse movements that were more variable, less efficient, and with longer pauses between movements (P < .05). Mouse movement measures were significantly associated with several cognitive domains (P values <.01–.05). DiscussionRemotely monitored computer mouse movement patterns are a potential early marker of real-world cognitive changes in MCI.