- As a result of demographic change and increasing life expectancy, challenges in providing care for elderly people is expected. Furthermore, older people seek to remain in their own living environment as long as possible in order to retain a certain quality of life. Due to chronic conditions, multi-morbidity and social isolation our care system has to face challenges in order to accomplish the above mentioned. Active and assisted living (AAL) technologies try to meet these challenges but only a few technologies have been effective so far. This study measures the usability and acceptability of existing AAL-technologies which are bundled in a package for older people in home care or assisted living. Possible impacts of using AAL-technologies on the quality of life and the independence in older age are monitored between 07/2017 and 09/2018 in a two-armed randomized controlled trial (N=240).
INTRODUCTION
Many older people wish to remain in their own environment enjoying the highest possible quality of life for as long as possible. This is also an aim which is echoed in many official bodies and organizations, such as the WHO, OECD and EU. However, the ageing process is typically associated with an increase in, and worsening of, chronic conditions, both physical and mental, including diabetes, high blood pressure and depression. This multi-morbidity among older people is often accompanied by social isolation and associated with real or perceived need for help and assistance. Thus, in order to be able to remain living at home, the need for external support – in terms of personal care or social needs – has been rising.
Active and assisted living (AAL) as well as innovative ICT
technologies supporting older people have been developed and
tested on a small-scale within research projects. However, as
evaluated by the European AAL program (about 13 examples
mentioned [
RegionAAL is an AAL-test region project focused on the urban centres of Graz, Deutschlandsberg and Leibnitz. Its aim is to support older people in being able to reside for longer in their own surroundings. In order to achieve this goal information and communication technologies (ICT) which are be accepted by elderly people shall be used.
Besides research on the acceptance and use of these technologies, information regarding possibilities of these new systems and services shall be widespread in media and the region’s population in order to foster the uptake of AAL technologies in the future.
The benefit program aims to make AAL technologies available, to get some kind of evidence on the efficacy and usability of the technologies and to bring information about these developments into our society on different levels. Similar to other AAL-test regions in Austria – there are already six – some elements comprise this project to underpin these major aims of the benefit program. These elements are: identifying the technologies and services to be used implementing and integrating a prototype of the package to be used in the test households preparing a study design which allows evaluation of the chosen technical approach implementing the prototype package in each test household running the system and services in a larger number of test households over the defined test period evaluation of the acceptance of the solutions and the efficacy of the introduced interventions disseminating results and information about the test region
II.
The benefit programme (Austria’s pendant to the European
AAL programme) has included AAL test regions within its
calls since 2012 whereas three regions (i.e. Modulaar,
WestAAL and ZentrAAL) within this framework, even started
before the RegionAAL project.
The aim of Modulaar (2012-2014, [
West-AAL (2014-2016, [
ZentrAAL (2015-2017, [
In several workshops with those three regions, lessons learned were identified and taken into account in the various work packages of RegionAAL. Findings concerned very different aspects:
Technologies (availability of internet; even widespread commercial products such as tablets, offer lots of technical and not reproducible problems, e.g. WLAN in half of devices was deactivated after reboot) Recruiting (difficulties in recruiting members of the control group and how to reach them best) Test phase (little use of hotlines in the test phase due to inhibitions of participants; still few social interactions but not due to technical difficulties, but rather due to non-existing contacts in many cases; Other stakeholders like general practitioners did not make use of possibilities as these kinds of services are not billable; performing surveys very often requires assistance through caregivers)
Besides the common aspects among the various AAL test regions in Austria, there are differences between all those projects according to their definition, their evaluation approaches etc.
III.
Instead of having a fully defined set of technologies as part
of the project proposal, the first phase of the RegionAAL
project was dedicated to an intense analysis on the evidence of
AAL technologies (see [
Based on the findings of the analysis, a potential test
household was planned. Furthermore, a scientific enquiry was
initiated in order to find already available technologies (e.g. in
[
After finalizing the actual set of interventions and technologies, two activities were started: defining / preparing the evaluation processes and implementing / adapting products and software for the use in test households. The implementation and adaptions happened in close cooperation with the care organizations represented in the RegionAAL project group. Developments and adaptions were discussed with caregivers in regular meetings to get continuous feedback about details for the technical work.
The test of technologies in households took place in two phases. The first phase was performed with eight friendly users. They tested the mobile technologies (tablet and smart watch) for two weeks. On the one hand, this created information on the instruction process and on the other hand, feedback on the use of the technologies could be collected. After the friendly user tests had taken place, the large field trial has started as the second phase. The households were recruited by the care organizations and randomized to achieve an intervention and a control group with similar size.
In addition, a baseline, a 6-months intermediate and a
12months follow up questioning are also part of the study. The
participants are interviewed on their health status, quality of
life, autonomy and their experience according to electronic
devices. The participants of the intervention group are asked to
rate the usability of the AAL-technologies on a scale from 1 to
5 in the 6-months intermediate and 12-months follow up and
are also questioned on their satisfaction and usability of the
devices used in the study. The caregivers are interviewed on
the care situation as well as on their satisfaction and usability
potentially useful for and acceptable to this group was
identified. Existing technologies were adapted, extended and
integrated - with parallels to Smart City. The one year scientific
evaluation includes 219 test households (intervention group =
110; control group = 109) and assesses the effectiveness of ICT
in meeting stated aims. [
Preliminary results from the literature review indicate that
safety, support in Instrumental Activities of Daily Living
(IADL) and Activities of Daily Living (ADL) and social
interaction are important factors regarding the quality of life.
The results of the workshops with caregivers show similarities:
Technologies should assist in safety, fall prevention, ADLs,
prevention and training. [
The evaluation was defined as a randomized controlled trial (RCT) with the aim to include 240 participants for a period of one year. An appropriate protocol with accompanying documents (questionnaires, participants’ information, informed consent etc.) were prepared and proposed to the ethics committee.
The following inclusion and exclusion criteria have to be
met: The participants are over 60 years old, have a care level
between 0 and 4 (max. of 160 hours of care needed per month)
and do not have any kind of cognitive impairment or
procuration. [
The participants were recruited by the three care
organizations of the RegionAAL project group from March
2017 until September 2017. Already existing clients of their
assisted living facilities, day care centres and mobile services
were asked to participate. Furthermore, announcements in local
newspapers were made. Through senior clubs and presentations
on exhibitions further participants were recruited. The older
people stated their interest via telephone, were screened
according to the inclusion and exclusion criteria and got first
information about the one-year-intervention. Afterwards, the
more detailed information materials and the informed consent
were sent to them. If required personal information was given
by project staff. [
In the meantime, training programs on the applications and devices used took place for projects’ staff.
After signing the informed consent, appointments with participants from the intervention group were made in order to install the technical devices and to get the intervention started. The installation was realized by the technical partner in the project. At the same time, instructions on the applications and on the different devices were conducted by the project staff.
IV.
PRELIMINARY RESULTS
The aim of the study should be achieved through the implementation of those ICT elements (fig. 1) that are likely to be accepted and used by end users. Evidence of ICT that is
Thus, a set of core functionalities was fixed preparing a
prototype of a technical setting which is used in the test
households of the intervention group. Due to these intermediate
findings, the AAL-technologies which are going to be tested in
the one-year-study, are divided into the following four fields of
application: health and wellbeing-related technologies, safety,
information and communication, and entertainment. The main
functions available contain: [
Health and wellbeing vital data at a glance various reminder (e.g. medication) training videos and fitness trackers to stay fit o o o o o o o o o safety Information electric stove shutdown wireless doorbell fall detection emergency call individual light assistance calendar and daily agenda communication and entertainment o
events and meetings o o o video phone calls photos from relatives games and entertainment
The main functions (fig. 1) are implemented on a number of technologies which are already available on the market, such as a Samsung Tab A 2016 tablet, a Finow X3 Smartwatch, asina platform for mobile devices, diverse apps from the PlayStore (games, video player/conferencing, for configuring the tablet etc.), an electric stove shutdown from Hager or Bedlight as part of the light assistance.
The intervention group, which is testing the technologies mentioned above, is accompanied by monthly meetings in small groups discussing and answering questions according the handling of the applications and technologies. Furthermore, a hotline was installed that is available from 8 a.m. to 3 p.m. on weekdays. Besides that, a 24/7 hotline exists for urgent matters according the stove shutdown and lightning.
V.
DISCUSSION
Lessons learned that were made so far concern the recruiting process, technical installation and instruction but also practical matters like purchasing and rollout of a larger number of equipment. Especially the recruitment claimed all forces within the project team and extended the project time by several months. Local connection and various media announcements in approved newspapers were needed. However, the sample size of 240 participants was nearly met. Furthermore, the participants have very diverse knowledge on technological devices. Therefore, the planned instruction process and instruction material did not fit everyone. Individual adaptations had to be made.
The main success factors until now are that the used technologies can be installed in every existing household, that there are regular meetings to answer questions and a telephone hotline, as well as individual support for participants.
The final results will be available in January 2019 after the one year trial took place and all data are analysed.
The project RegionAAL is partially funded under the program benefit by the Austrian Research Promotion Agency (FFG) and the Austrian Ministry for Transport, Innovation and Technology (bmvit). The authors of this paper want to thank all other partners in the RegionAAL consortium for their cooperation in the described study.