Assistive Technologies Research: Independent Living for Elderly Persons

An intelligent emergency response system: preliminary development and testing of automated fall detection.

Lee T, Mihailidis A. Intelligent Assistive Technology and Systems Laboratory, Department of Occupational Therapy, University of Toronto, Canada. J Telemed Telecare. 2005;11(4):194-8.

We have designed an intelligent emergency response system to detect falls in the home. It uses image-based sensors. A pilot study was conducted using 21 subjects to evaluate the efficacy and performance of the fall-detection component of the system. Trials were conducted in a mock-up bedroom setting, with a bed, a chair and other typical bedroom furnishings. A small digital videocamera was installed in the ceiling at a height of approximately 2.6 m. The digital camera covered an area of approximately 5.0 m x 3.8 m. The subjects were asked to assume a series of postures, namely walking/standing, sitting/lying down in an inactive zone, stooping, lying down in a ‘stretched’ position, and lying down in a ‘tucked’ position. These five scenarios were repeated three times by each subject in a random order. These test positions totalled 315 tasks with 126 fall-simulated tasks and 189 non-fall-simulated tasks. The system detected a fall on 77% of occasions and missed a fall on 23%. False alarms occurred on only 5% of occasions. The results encourage the potential use of a vision-based system to provide safety and security in the homes of the elderly.


Does assistive technology substitute for personal assistance among the disabled elderly?

Hoenig H, Taylor DH Jr, Sloan FA.  Department of Medicine/Geriatrics, Duke University Medical Center, Durham, NC, USA.  Am J Public Health. 2003 Feb;93(2):330-7.

OBJECTIVES: This study examined whether use of equipment (technological assistance) to cope with disability was associated with use of fewer hours of help from another person (personal assistance).

METHODS: In a cross-sectional study of 2368 community dwellers older than 65 years with 1 or more limitations in basic activities of daily living (ADLs) from the 1994 National Long Term Care Survey, the relation between technological assistance and personal assistance was examined.

RESULTS: Among people with ADL limitations, multivariate models showed a strong and consistent relation between technological assistance and personal assistance, whereby use of equipment was associated with fewer hours of help.

CONCLUSIONS: Among people with disability, use of assistive technology was associated with use of fewer hours of personal assistance.


Managing activity difficulties at home: a survey of Medicare beneficiaries.

Dudgeon BJ, Hoffman JM, Ciol MA, Shumway-Cook A, Yorkston KM, Chan L.

Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195-6490, USA. dudgeonb@u.washington.eduArch Phys Med Rehabil. 2008 Jul;89(7):1256-61. Epub 2008 Jun 13.

OBJECTIVE: To describe assistance from helpers and use of assistive technology and environmental modification by community-dwelling people with difficulties in activities of daily living (ADLs) and instrumental activities of daily living (IADLs).

DESIGN: Cross-sectional study using the 2004 Medicare Current Beneficiary Survey. SETTING: Community.

PARTICIPANTS: Nationally representative sample of 14,500 Medicare beneficiaries (mean age, 71.5 y; 55% female; 49% currently married; 68% living with others; 84% white).

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Self-reported difficulty with ADLs and IADLs; uses of help, assistive technology, and/or environmental modification.

RESULTS: Difficulties were reported most frequently for heavy housework, walking, and shopping; money management, shopping, and light housework were reported as activities most often needing a helper. Walking, bathing, and toileting were activities most often needing uses of assistive technology. Bathroom modifications were the most commonly reported environmental modification. Results from a logistic regression showed that advancing age was the primary factor associated with increasing use of helpers and assistive technology or both for difficult activities.

CONCLUSIONS: Uses of helpers, assistive technology, and environmental modification are common but vary by type of ADL and/or IADL and age. Focused studies regarding uses of help and access to assistive technology and environmental modification appear needed to support community living. Public education about methods and types of accommodations appears needed and may substitute for or augment guidance from care providers.


Reconsidering substitution in long-term care: when does assistive technology take the place of personal care?

Agree EM, Freedman VA, Cornman JC, Wolf DA, Marcotte JE.  Department of Population and Family Health Sciences, 615 North Wolfe Street, Room E4646, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.  J Gerontol B Psychol Sci Soc Sci. 2005 Sep;60(5):S272-80.

OBJECTIVE: Assistive technology (AT) may improve quality of life and reduce dependence for older persons with disabilities. In this article, we examine tradeoffs between the use of AT and reliance on personal care, with attention to factors that may influence those relationships.

METHODS: We jointly modeled hours of formal and informal care with use of AT in order to address the interdependence of these outcomes in ways not taken into account in previous studies. We analyzed a national sample of older persons with difficulty in activities of daily living drawn from Phase 2 of the 1994-1995 National Health Interview Survey (NHIS) Disability Supplement.

RESULTS: Our findings show that the use of AT was associated with reductions in informal care hours, especially for those who were unmarried, better educated, or had better cognitive abilities, but appeared to supplement formal care services for these groups. Individuals with cognitive impairment were less likely than others to substitute AT with either type of personal care.

DISCUSSION: These models raise the possibility that reductions of informal care hours may be accomplished with a combination of formal care and assistive devices, rather than from either alternative alone.


Trends in the use of assistive technology and personal care for late-life disability, 1992-2001.

Freedman VA, Agree EM, Martin LG, Cornman JC.  Department Health Systems and Policy, School of Public Health, University of Medicine and Dentistry of New Jersey, 335 George Street, Suite 2200, New Brunswick, NJ 08903, USA.  Gerontologist. 2006 Feb;46(1):124-7.

We describe national trends during the 1990s in late-life difficulty and assistance with self-care activities. Among older Americans living in the community and experiencing difficulty with self-care activities, assistive-technology use increased substantially whereas use of personal care declined. Using a decomposition technique, we demonstrate that these shifts in assistance toward technology account for half the decline in the number of people dependent on personal care.