Enno-Edzard Steen

Information and communication technologies for promoting and sustaining quality of life, health and self-sufficiency in ageing societies – outcomes of the Lower Saxony Research Network Design of Environments for Ageing (GAL)

Many societies across the world are confronted with demographic changes, usually related to increased life expectancy and, often, relatively low birth rates. Information and communication technologies (ICT) may contribute to adequately support senior citizens in aging societies with respect to quality of life and quality and efficiency of health care processes. For investigating and for providing answers on whether new information and communication technologies can contribute to keeping, or even improving quality of life, health and self-sufficiency in ageing societies through new ways of living and new forms of care, the Lower Saxony Research Network Design of Environments for Ageing (GAL) had been established as a five years research project, running from 2008 to 2013. Ambient-assisted living (AAL) technologies in personal and home environments were especially important. In this article we report on the GAL project, and present some of its major outcomes after five years of research. We report on major challenges and lessons learned in running and organizing such a large, inter- and multidisciplinary project and discuss GAL in the context of related research projects. With respect to research outcomes, we have, for example, learned new knowledge about multimodal and speech-based human–machine-interaction mechanisms for persons with functional restrictions, and identified new methods and developed new algorithms for identifying activities of daily life and detecting acute events, particularly falls. A total of 79 apartments of senior citizens had been equipped with specific “GAL technology”, providing new insights into the use of sensor data for smart homes. Major challenges we had to face were to deal constructively with GAL’s highly inter- and multidisciplinary aspects, with respect to research into GAL’s application scenarios, shifting from theory and lab experimentation to field tests, and the complexity of organizing and, in our view, successfully managing such a large project. Overall it can be stated that, from our point of view, the GAL research network has been run successfully and has achieved its major research objectives. Since we now know much more on how and where to use AAL technologies for new environments of living and new forms of care, a future focus for research can now be outlined for systematically planned studies, scientifically exploring the benefits of AAL technologies for senior citizens, in particular with respect to quality of life and the quality and efficiency of health care.

Modeling individual healthy behavior using home automation sensor data: Results from a field trial

A technical system for unobtrusive presence measurement and two novel models for describing user behavior in domestic environments are presented. Within the developed models user behavior is either described as the probability of being present at a certain location within an environment at a certain time on a day of the week or being present at a location for a certain number of times with a certain duration. The models are called timeslot-based and duration-based. Both models have been applied to presence information gathered by a technical system using home automation sensors. The system was installed into two flats of older people during a field trial for eight months. Results of the experiment show that the two models can be applied to describe individual user behavior. The influence of data structure and model quality on the detection of anomalies and the generation of alarms is discussed. On the long-term, the approach aims at detecting cutbacks in self-care ability and changes in health state by autonomously learning typical user behavior from presence information in a spatial model and by detecting untypical behavior, called anomalies, and generating alarms for caretakers. Such automatic assessment of self-care ability and health state is required in order to meet the increased challenges imposed to the decreasing number of care personal during the progress of the demographic change.

Multimodal activity monitoring for home rehabilitation of geriatric fracture patients--feasibility and acceptance of sensor systems in the GAL-NATARS study.

Background: Demographic change will lead to a diminishing care workforce faced with rising numbers of older persons in need of care, suggesting meaningful use of health-enabling technologies, and home monitoring in particular, to contribute to supporting both the carers and the persons in need. Objectives: We present and discuss the GAL-NATARS study design along with first results regarding technical feasibility of long-term home monitoring and acceptance of different sensor modalities. Methods: Fourteen geriatric participants with mobility-impairing fractures were recruited in three geriatric clinics. Following inpatient geriatric rehabilitation, their homes were equipped with ambient sensor components for three months. Additionally, a wearable accelerometer was employed. Technical feasibility was assessed by system and component downtimes, technology acceptance by face-to-face interviews. Results: The overall system downtime was 6%, effected by two single events, but not by software failures. Technology acceptance was rated very high by all participants at the end of the monitoring periods, and no interference with their social lives was reported. Discussion and conclusions: Home-monitoring technologies were well-accepted by our participants. The information content of the data still needs to be evaluated with regard to clinical outcome parameters as well as the effect on the quality of life before recommending large-scale implementations.

A Novel Indoor Localization Approach Using Dynamic Changes in Ultrasonic Echoes

In this paper a novel approach to continuous and unobtrusive localization of a person inside his or her domestic environment based on ultrasonic sensors is presented. The approach uses half rings with ultrasonic sensors mounted on the ceiling of the environment. The person’s position is computed by analyzing the detected echoes of the available sensors. After distinguishing between echoes caused by the static environment and echoes caused by the person, only the last-mentioned echoes are utilized to determine the position. This position can then be used for further analyses such as mo-bility assessments or for providing location dependent services.

A technical platform for environments for ageing--lessons learned from three field studies.

The Lower Saxony Research Network “Design of Environments for Ageing” (GAL) studied possible applications of assistive technology for enabling older adults to live longer and independent in their own home. As part of this work, a technical platform was developed as a common technical basis for all assistive systems in the project. This article presents an overview of the architecture and core functionality of the technical platform, which in the first generation was developed for use in a laboratory setting, and in a second generation was extended for use in the project’s field studies, i.e. prototype installations in end-users homes. The field studies’ primary objective was the evaluation of the assistive technologies, that were developed within the overall project. However, these studies also confirmed that the fundamental concept of the technical platform is valid, and the prototypes continuously worked 24 h a day for several months. However, there were some problems related to lack of infrastructure in the older adults’ homes and human factors such as inadvertent placement of objects across sensors’ field of view, acceptance problems due to aesthetical reasons or simply communication problems, which show that making complex technologies work for users with little technical experience is well possible, but requires a careful consideration of the complete service chain and related “soft factors”.

Performing gait analysis within the timed up & go assessment test: comparison of aTUG to a marker-based tracking system

Results from a technical validation of the aTUG (ambient Timed Up & Go) system are presented. The approach’s gait analysis capabilities were compared to a gold standard: SIMI Motion, a marker-based motion tracking system. Seven people participated and computation of step length and step duration happened with a median error of 3 cm (IQR 3 cm) respectively 0.08 s (IQR 0.07 s). These results show that aTUG has a measurement precision which is sufficient for use in clinical gait analysis and enables the use of the device without a gold standard, i.e. in hospitals outside laboratories or in the homes of patients. aTUG is an approach and system that utilizes only ambient sensor technologies to support the execution of geriatric mobility assessment tests and to perform a gait analysis simultaneously. Such capabilities are strongly demanded in order to support physicians in executing the geriatric assessment tests frequently and objectively in professional and domestic environments. The latter may enable more early prevention and more sustainable rehabilitation.

Working with a domestic assessment system to estimate the need of support and care of elderly and disabled persons: results from field studies

This article describes the results of field studies performed over a period between five months and 24 months. The objectives of these studies were to collect long-term real-life data to evaluate how these data can be mapped to items on standardized assessment tests and which presentation method is most suitable to inform caregivers about critical situations and changes in health or care needs. A Home-monitoring system which uses modern sensor technologies was developed for and used in these field studies. It was installed in living environments of seven people (three who were not in need of care, two in need of care, and two with mental disabilities). The data were generated by sensor data acquisition and questionnaire reporting. Four types of data analysis and representation were evaluated to support caregivers. Results show that sensor data can be used to determine information directly or indirectly, which can be mapped to relevant assessment items and presented with different degrees of granularity. It is also feasible to determine and present additional information of potential interest which cannot be directly mapped to any assessment item. Sensor data can also be displayed in a live view. This live data representation led to a decrease in the caregivers’ workload when assessed according to the German version of the Perceived Stress Questionnaire.

Inferring Multi-person Presence in Home Sensor Networks

We present an evaluation of two approaches to the problem of inferring the presence of multiple persons in networks of binary sensors. This problem is critical for many applications of Ambient Assisted Living that benefit from knowledge of single- and multi-person presence where data is collected using ambient sensors. Both approaches make use of a graph representing sensors and their spatial relations. One approach uses a simple statistical method to derive a minimum number of people present, the other precisely tracks people through the sensor network. Both approaches are evaluated in a low and higher resolution setting on data of two persons inhabiting a laboratory equipped with motion sensors and contact sensors. Although the latter approach performs well tracking multiple persons, its inability to distinguish inactivity and absence make the former approach more suitable for this task, independent of resolution.

A novel approach for discovering human behavior patterns using unsupervised methods

BackgroundAs is well known, elderly people gradually lose the ability of self-care. The decline can be reflected in changes in their daily life behavior. A solution to assess their health status is to design sensor-enhanced living environments to observe their behavior, in which unobtrusive sensors are usually used. With respect to information extraction from the dataset collected by means of these kinds of sensors, unsupervised methods have to be relied on for practical application. Under the assumption that human lifestyle is associated with health status, this study intends to propose a novel approach to discover behavior patterns using unsupervised methods.MethodsTo evaluate the feasibility of this approach it was applied to datasets collected in the GAL-NATARS study. The study is part of the Lower Saxony research network Design of Environments for Aging (GAL) and conducted in subjects’ home environments. The subjects recruited in GAL-NATARS study are older people (age ≥ 70 years), who are discharged from hospital to live alone again at their homes after treatment of a femoral fracture.ResultsThe change of lifestyle regularity is measured. By analyzing the correlation between the extracted information and medical assessment results of four subjects, two of them exhibited impressive association and the other two showed less association.ConclusionsThe approach may provide complementary information for health assessment; however, the dominant relationship between the change of behavior patterns and the health status has to be shown and datasets from more subjects must be collected in future studies.LimitationsMerely environmental data were used and no wearable sensor for activity detection or vital parameter measurement is taken into account. Therefore, this cannot comprehensively reflect reality.ZusammenfassungHintergrundDass ältere Menschen allmählich Selbstsorgekompetenzen verlieren, ist weithin bekannt. Der allmähliche Verlust kann sich in Veränderungen des Verhaltens im Alltagsleben widerspiegeln. Eine Möglichkeit zur Überprüfung ihres gesundheitlichen Zustands ist die Entwicklung sensorgestützter Lebensumfelder, um ihr Verhalten zu beobachten. Dabei werden in der Regel unauffällige Sensoren verwendet. Im Hinblick auf die Extrahierung von Informationen aus den so gesammelten Datensätzen verlässt man sich für die praktische Anwendung auf nichtsupervidierte Methoden. Ausgehend von der Annahme, dass Lifestyle und Gesundheitszustand miteinander zusammenhängen, zielt diese Studie auf einen innovativen Ansatz, Verhaltensmuster mit nichtsupervidierten Methoden zu detektieren.MethodenUm die Machbarkeit dieses Ansatzes zu evaluieren wurde er auf die in der GAL-NATARS-Studie generierten Datensätze angewendet; vom niedersächsischen Forschungsnetzwerk Design of Environments for Aging (GAL) wird diese Studie im Wohnumfeld der Probanden durchgeführt. Die allein lebenden Probanden der GAL-NATARS-Studie waren ≥ 70 Jahre alt und nach stationärer Behandlung einer Femurfraktur wieder in ihr häusliches Umfeld entlassen worden.ErgebnisseGemessen wurden die Veränderungen in der Regelmäßigkeit des Lebensstils. Bei 4 Probanden wurden die extrahierten Informationen und die Ergebnissen des medizinischen Assessments miteinander korreliert: Bei 2 von ihnen zeigte sich ein eindrucksvoller Zusammenhang, bei den anderen beiden fand sich weniger Assoziation.SchlussfolgerungenZwar kann der untersuchte Ansatz zusätzliche Informationen für das medizinische Assessment liefern, doch die dominante Beziehung zwischen den Änderungen in Verhaltensmustern und dem Gesundheitszustand ist noch darzustellen. In künftigen Studien müssen noch mehr Patientendatensätze gesammelt werden.EinschränkungenVerwendet werden lediglich Umweltdaten, keine Daten von tragbaren Sensoren zur Registrierung von Aktivität bzw. Vitalparametern. Daher können die Ergebnisse die Wirklichkeit nicht umfassend wiedergeben.

Einbettung assistierender Technologien in Gesundheitsnetzwerke – von der Wohnung zum Arzt

Die Bedeutung Informationstechnik(IT)-gestutzter Dienstleistungen fur die Sicherstellung bzw. Verbesserung von Qualitat und Effizienz der Gesundheitsversorgung ist langst weltweit erkannt. In ihrer eHealth-Resolution mahnt die World Health Organization bereits 2005 ihre Mitgliedsstaaten, entsprechende Programme systematisch umzusetzen (WHO Executive Board 2005). In reicheren Landern mit gut umfassender Versorgungsstruktur liegt das Potenzial in der Uberwindung okonomischer, wissenschaftlicher und, sozialer und operativer Barrieren. Im Fokus steht dabei die Unterstutzung eines „citizen-preventioneducation-home based“ (Healy 2007) Versorgungsparadigmas.