Gerald Kolb

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.

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.

Five years of interdisciplinary research on ageing and technology: Outcomes of the Lower Saxony Research Network Design of Environments for Ageing (GAL) - An introduction to this Special Issue on Ageing and Technology

This Special Issue of Informatics for Health and Social Care is presenting outcomes of the Lower Saxony Research Network Design of Environments for Ageing (abbreviated as GAL), probably one of the largest inter- and multidisciplinary research projects on aging and technology. In order to investigate and provide 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, GAL had been established as a five-year research project, running from 2008 to 2013. Ambient-assisted living technologies in personal and home environments were especially important. During the five years of research in GAL, more than seventy researchers from computer science, economics, engineering, geriatrics, gerontology, informatics, medicine, nursing science and rehabilitation pedagogy intensively collaborated in finding answers.

Anemia in the aged is not ageing related: position paper on anemia in the aged by the “working group anemia” of the German Geriatric Society (DGG)

Anemia in the aged is a frequent but still under-estimated problem in geriatric patients. However, in recent years increasing research on anemia in the aged has improved awareness and interest in this clinically relevant problem. Guidelines for diagnostic and therapeutic steps are now required to improve the treatment of anemic aged patients. For encouraging the development of diagnostic and therapeutic recommendations, the “working group anemia” of the German Geriatric Society (DGG) has issued a position paper on anemia in the aged, based on the current literature. The statements are (1) that anemia has to be considered a highly prevalent but not a physiologic finding in aged persons; (2) that reference values for hemoglobin concentration are independent of age, indicating that WHO reference values for anemia definition are valid for aged persons; (3) that anemia in the aged is associated with functional and cognitive impairment based on comprehensive geriatric assessment (CGA), requiring diagnosis and treatment.

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.

Grundsätze der Therapiestrategie und Risikostratifikation

ZusammenfassungOnkologische Funktionsscores erfassen zwar die akuten Einschränkungen des funktionellen Status durch eine Tumorerkrankung. Aber gerade bei älteren Patienten mit Malignomen werden alltagsrelevante, vorbestehende Einschränkungen nur unzureichend abgebildet. Hierfür sind die geriatrischen Funktionsscores wesentlich sensitiver. Grundsätzlich sollte deshalb bei Patienten im Alter von über 70 Jahren ein geriatrisches Basisassessment durchgeführt werden. Ist dafür keine Zeit, sollte zumindest ein „Minimalprogramm“ zur groben Orientierung erfolgen.