Gregory L. Alexander

A smart home application to eldercare: Current status and lessons learned

To address an aging population, we have been investigating sensor networks for monitoring older adults in their homes. In this paper, we report ongoing work in which passive sensor networks have been installed in 17 apartments in an aging in place eldercare facility. The network under development includes simple motion sensors, video sensors, and a bed sensor that captures sleep restlessness and pulse and respiration levels. Data collection has been ongoing for over two years in some apartments. This longevity in sensor data collection is allowing us to study the data and develop algorithms for identifying alert conditions such as falls, as well as extracting typical daily activity patterns for an individual. The goal is to capture patterns representing physical and cognitive health conditions and then recognize when activity patterns begin to deviate from the norm. In doing so, we strive to provide early detection of potential problems which may lead to serious health events if left unattended. We describe the components of the network and show examples of logged sensor data with correlated references to health events. A summary is also included on the challenges encountered and the lessons learned as a result of our experiences in monitoring aging adults in their homes.

Automated Technology to Speed Recognition of Signs of Illness in Older Adults

Our team has developed a technological innovation that detects changes in health status that indicate impending acute illness or exacerbation of chronic illness before usual assessment methods or self-reports of illness. We successfully used this information in a 1-year prospective study to alert health care providers so they could readily assess the situation and initiate early treatment to improve functional independence. Intervention participants showed significant improvements (as compared with the control group) for the Short Physical Performance Battery gait speed score at Quarter 3 (p = 0.03), hand grip-left at Quarter 2 (p = 0.02), hand grip-right at Quarter 4 (p = 0.05), and the GAITRite functional ambulation profile score at Quarter 2 (p = 0.05). Technological methods such as these could be widely adopted in older adult housing, long-term care settings, and in private homes where older adults wish to remain independent for as long as possible.

TigerPlace, A State-Academic-Private Project to Revolutionize Traditional Long-Term Care

ABSTRACT The Aging in Place Project at the University of Missouri (MU) required legislation in 1999 and 2001 to be fully realized. An innovative home health agency was initiated by the Sinclair School of Nursing specifically to help older adults age in place in the environment of their choice. In 2004, an innovative independent living environment was built and is operated by a private long term care company, as a special facility where residents can truly age in place and never fear being moved to a traditional nursing home unless they choose to do so. With care provided by the home care agency with registered nurse care coordination services, residents receive preventative and early illness recognition assistance that have markedly improved their lives. Evaluation of aging in place reveal registered nurse care coordination improves outcomes of cognition, depression, activities of daily living, incontinence, pain, and shortness of breath as well as delaying or preventing nursing home placement. Links with MU students, faculty, and nearly every school or college on campus enrich the lives of the students and residents of the housing environment. Research projects are encouraged and residents who choose to participate are enjoying helping with developing cutting technology to help other seniors age in place.

Clinical information systems in nursing homes: an evaluation of initial implementation strategies.

This article presents qualitative results collected 6 months after implementation of a clinical information system in four nursing homes in the Midwestern USA. Researchers explored initial implementation strategies, discussed employee experiences and analyzed employee satisfaction. Transcript-based analysis and axial coding were completed to illustrate recurring phenomena. Common attributes were identified by two gerontological nurse experts and a researcher with human factors expertise. Common themes emerging from 22 focus groups and direct observation of more than 120 nursing home staff were perception and cognition, change, workable systems, competence, and connectedness. Implementation strategies associated with lower satisfaction were availability of equipment, training resources, and the presence of information technology professionals. Initial clinical information system implementation strategies and employee satisfaction could be enhanced by the inclusion of a system life cycle charter plan, emphasizing change management procedures, improving start-up projections, hiring adequately trained information technology staff, and providing a system support plan. Findings will be useful to administrators and policy makers who are contemplating implementation of a clinical information system.

Effects of a computerized decision support system on pressure ulcers and malnutrition in nursing homes for the elderly.

BACKGROUND Computerized decision support systems (CDSSs) have been shown to help health care professionals to avoid errors and improve clinical practice and efficiency in health care. Little is known about its influence on nursing practice and outcomes for residents in nursing homes. AIM The aim of this study was to evaluate the effects on the risk for and prevalence of pressure ulcers (PUs) and malnutrition of implementing a CDSS to improve prevention and care of PUs and also to improve nutrition in the elderly in nursing homes. DESIGN SETTING AND PARTICIPANTS The study used a quasi-experimental design with two intervention groups and one control group. A convenience sample of residents from 46 units in 15 nursing homes in rural areas in Norway was included. A total of 491 residents participated at baseline in 2007 and 480 residents at follow-up in 2009. METHODS The intervention included educational sessions in prevention of PUs and malnutrition for registered nurses (RNs) and nursing aides (NAs) in the two intervention groups. In addition, one intervention group (intervention group 1) had a CDSS integrated into the electronic healthcare record (EHR) based on two research-based risk assessment instruments: the Risk Assessment Pressure Scale (RAPS) for PU risk screening and the Mini Nutritional Assessment (MNA(®)) scale for screening nutritional status. In each participating nursing home trained RNs and NAs examined all residents who consented to participate on the RAPS and the MNA(®) scale. This examination included a skin assessment and details about PUs were collected. RESULTS The proportion of malnourished residents decreased significantly in intervention group 1 between the two data collection periods (2007 and 2009). No other significant effects of the CDSS on resident outcomes based on the RAPS and MNA(®) scores were found. CONCLUSION CDSSs used by RNs and NAs in nursing homes are still largely unexplored. A CDSS can be incorporated into the EHR to increase the meaningful use of these computerized systems in nursing home care. The effects of CDSS on healthcare provider workflow, clinical decision making and communication about preventive measures in nursing home practice still need further exploration. Based on results from our study, recommendations would be to increase both sample size and the number of RNs and NAs who participate in CDSS education programs.

Information technology sophistication in nursing homes.

OBJECTIVE There is growing recognition that a more sophisticated information technology (IT) infrastructure is needed to improve the quality of nursing home care in the United States. The purpose of this study was to explore the concept of IT sophistication in nursing homes considering the level of technological diversity, maturity and level of integration in resident care, clinical support, and administration. METHODS Twelve IT stakeholders were interviewed from 4 nursing homes considered to have high IT sophistication using focus groups and key informant interviews. Common themes were derived using qualitative analytics and axial coding from field notes collected during interviews and focus groups. RESULTS Respondents echoed the diversity of the innovative IT systems being implemented; these included resident alerting mechanisms for clinical decision support, enhanced reporting capabilities of patient-provider interactions, remote monitoring, and networking among affiliated providers. DISCUSSION Nursing home IT is in its early stages of adoption; early adopters are beginning to realize benefits across clinical domains including resident care, clinical support, and administrative activities. The most important thread emerging from these discussions was the need for further interface development between IT systems to enhance integrity and connectivity. CONCLUSION The study shows that some early adopters of sophisticated IT systems in nursing homes are beginning to achieve added benefit for resident care, clinical support, and administrative activities.

Using sensor networks to detect urinary tract infections in older adults

Integrated sensor networks have been installed in apartments of volunteer residents at TigerPlace, an aging in place retirement community that allows residents to remain in their apartments even if their health deteriorates. The sensor networks supplement registered nurse (RN) care coordination provided by Sinclair Home Care by alerting the RN care coordinator about changes in the normal sensor patterns. In several cases, the alerts have prompted the care coordinator to have the resident tested for urinary tract infections. Importantly, the sensor network detected signs of illness earlier than traditional health care assessment.

Information technology from novice to expert: implementation implications.

AIMS This paper explores how the Novice-to-Expert Nursing Practice framework can illuminate the challenges of and opportunities in implementing information technology (IT), such as clinical decision support systems (CDSS), in nursing practice. BACKGROUND IT implementation in health care is increasing; however, substantial costs and risks remain associated with these projects. EVALUATION The theoretical framework of Novice-to-Expert Nursing Practice was applied to current design and implementation literature for CDSS. KEY ISSUES Organizational policies and CDSS design affect implementation and user adoption. CONCLUSIONS Nursing CDSS can improve the overall quality of care when designed for the appropriate end-user group and based on a knowledge base reflecting nursing expertise. IMPLICATIONS FOR NURSING MANAGEMENT Nurse administrators can positively influence CDSS function and end-user acceptance by participating in and facilitating staff nurse involvement in IT design, planning and implementation. Specific steps for nurse administrators and managers are included in this paper.

Linguistic summarization of sensor data for eldercare

Ubiquitous passive, as well as active, monitoring of elders is a growing field of research and development with the goal of allowing seniors to live safe active independent lives with minimal intrusion. Much useful information, fall detection, fall risk assessment, activity recognition, early illness detection, etc. can be inferred from the mountain of data. Healthcare must be human centric and human friendly, and so, methods to consolidate the data into linguistic summaries for enhanced communication and problem detection with elders, family and healthcare providers is essential. Long term trends can be most easily identified using summarized information. This paper explores the soft computing methodology of protoforms to produce linguistic summaries of one dimensional data, motion and restlessness. The technique is demonstrated on a 15 month sensor collection for an elder participant.

Passive sensor technology interface to assess elder activity in independent living.

Background:The effectiveness of clinical information systems to improve nursing and patient outcomes depends on human factors, including system usability, organizational workflow, and user satisfaction. Objective:The aim of this study was to examine to what extent residents, family members, and clinicians find a sensor data interface used to monitor elder activity levels usable and useful in an independent living setting. Methods:Three independent expert reviewers conducted an initial heuristic evaluation. Subsequently, 20 end users (5 residents, 5 family members, 5 registered nurses, and 5 physicians) participated in the evaluation. During the evaluation, each participant was asked to complete three scenarios taken from three residents. Morae recorder software was used to capture data during the user interactions. Results:The heuristic evaluation resulted in 26 recommendations for interface improvement; these were classified under the headings content, aesthetic appeal, navigation, and architecture, which were derived from heuristic results. Total time for elderly residents to complete scenarios was much greater than for other users. Family members spent more time than clinicians but less time than residents did to complete scenarios. Elder residents and family members had difficulty interpreting clinical data and graphs, experienced information overload, and did not understand terminology. All users found the sensor data interface useful for identifying changing resident activities. Discussion:Older adult users have special needs that should be addressed when designing clinical interfaces for them, especially information as important as health information. Evaluating human factors during user interactions with clinical information systems should be a requirement before implementation.