Jay Lundell

Unobtrusive In-Home Monitoring of Cognitive and Physical Health: Reactions and Perceptions of Older Adults

Although the potential benefits of unobtrusive in-home sensing technologies for maintaining health and independence of older adults have been highlighted in recent research, little is known about their views toward such technology. The aims of this project were to identify monitoring needs and expectations of community-residing elderly and their family members. Focus groups were presented with examples of in-home monitoring devices and data output; participants were asked to consider whether the data showed information that was meaningful to them, and how and to whom they would like to have such data disseminated. Content analysis of transcripts revealed four dominant themes: maintaining independence, detecting cognitive decline, sharing of information, and the trade-off between privacy and usefulness of monitoring. The acceptance by elderly of unobtrusive in-home monitoring was closely tied to perceived utility of data generated by such systems. Privacy concerns appeared to be less of an issue than anticipated in this sample.

New Perspectives on Ubiquitous Computing from Ethnographic Study of Elders with Cognitive Decline

A rapidly growing elder population is placing unprecedented demands on health care systems around the world. Cognitive decline is one of the most taxing health problems in terms of both its relation to elders’ overall functioning and the cost of care. The needs of elders with cognitive decline – for invisible, intuitive support and assessment – invite a reconsideration of the assumptions behind and specifications for ubiquitous computing solutions. This paper describes findings and implications of ethnographic research conducted with cognitively impaired individuals and their informal care networks in 45 households in 5 U.S. regions. Key themes regarding needs and barriers to successful aging are addressed through a set of design principles which apply across the stages of cognitive decline. To convey stage-specific findings and associated challenges for ubiquitous computing, case studies of four representative households and example concept solutions are presented. The design principles and technology challenges outlined in this paper may generalize to other contexts for ubiquitous computing.

A Study of Medication-Taking and Unobtrusive, Intelligent Reminding

Poor medication adherence is one of the major causes of illness and of treatment failure in the United States. The objective of this study was to conduct an initial evaluation of a context-aware reminder system, which generated reminders at an opportune time to take the medication. Ten participants aged 65 or older, living alone and managing their own medications, participated in the study. Participants took a low-dose vitamin C tablet twice daily at times that they specified. Participants were considered adherent if they took the vitamin within 90 minutes (before or after) of the prescribed time. Adherence and activity in the home was measured using a system of sensors, including an instrumented pillbox. There were three phases of the study: baseline, in which there was no prompting; time-based, in which there was prompting at the prescribed times for pill-taking; and context-aware, in which participants were only prompted if they forgot to take their pills and were likely able to take their pills. The context-based prompting resulted in significantly better adherence (92.3%) as compared to time-based (73.5%) or no prompting (68.1%) conditions (p < 0.0002, chi(2) = 17.0). In addition, subjects had better adherence in the morning than in the evening. We have shown in this study that a system that generates reminders at an opportune time to take the medication significantly improves adherence. This study indicates that context-aware prompting may provide improved adherence over standard time-based reminders.

Continuous Activity Monitoring and Intelligent Contextual Prompting to Improve Medication Adherence

Poor medication adherence is a serious medical problem, particularly in older adults. Various solutions have been developed to remind people to take their medications, but these systems are usually simple time-based alarm systems that are not particularly effective. We describe a system that is context aware, and that utilizes information about past patterns of behavior plus the current context to provide prompts at the appropriate time and place. A case study from our initial deployment of the system to eleven older adults illustrates the possibilities and advantages of context aware prompting systems.

Editorial: HCI and the older population

This paper describes a workshop on HCI and the older population, which will provide a forum for the presentation of current work and a platform for discussing key challenges in this area. HCI issues for older people are extremely important in the light of the rapidly ageing population in developed countries and the potential offered by computerised technology, a potential that can only be fulfilled if the technology can be used effectively by its target user group. In particular, the workshop will focus on questions of the identity of the older population and what makes this group distinct (or not) from the rest of the population. With the rise of approaches such as inclusive design that seek to design for as wide a group as possible, it is important to examine the place of designing specifically for the older population. This workshop aims to build up and support the community in this area, encouraging communication and addressing key issues together. 1. TOPIC The proportion of older people in developed countries is rapidly increasing [1]. At the same time the use of computerised technology in such countries is becoming more and more a part of everyday life. It is therefore increasingly important to consider how the design of such technology can meet the needs, wants and requirements of this important user group. What is more, many older people have substantial amounts of disposable income and are not particularly averse to using new technologies, if those technologies are appropriately designed and introduced (e.g., [2]). The older population therefore presents a sizeable market opportunity for the IT industry. In addition, the increasing proportion of older people will lead to a significant increase in the numbers needing support for daily activities and in those needing long term care. Technology presents one important avenue for providing such support. However, this technology is only going to be effective if it meets actual needs or desires in appropriate ways and can be used effectively. The development of such technology therefore needs to be carried out within the context of HCI and HCI issues. However, HCI for the older population faces some particular challenges. Compared with younger user groups, it is argued that older people often have different needs and wants when it comes to technology, requiring different types of applications and devices. Ageing is also often associated with changes in sight, hearing, mobility and other abilities, which could affect an older person’s technology use. In addition, older people often come from different backgrounds and experience than typical user groups, which may affect their expertise with and approach to items of technology. This workshop aims to build up and support the community in the area of HCI for older people, providing a forum for important issues to be discussed, promoting discussion of HCI for the older population on a wider level and drawing together an often scattered research community. It builds on previous popular workshops held at HCI 2002 and HCI 2004 [3,4]. 1.1 Specific Themes We will discuss some specific themes within HCI for older people, focusing on questions of the identity of the older population and what makes this group distinct (or not) from the rest of the population. Differences, such as those described above, may be less significant than similarities and it may be the case that simply designing well for the population as a whole will produce good designs for older people too. With the rise of such inclusive design approaches that seek to design for as wide a group as possible, it is important to examine the place of designing specifically for the older population. We need to address questions such as: Can we identify key characteristics of the older population that set it apart from other groups? What are they and how do they impact on design? Is designing for older people different from designing for the population as a whole? If so, how? Are there different methods that should be used, different methodology that should be followed or adaptations that should be made to existing methods? Do inclusive design approaches produce effective products for older people? How far can they go? Is there a point where a different approach is needed? If so, what should this approach be? How can older people’s needs be considered most effectively within an inclusive design framework? Can themes and ideas from inclusive design be incorporated effectively when designing for older people in particular?

Exploring the nuances of Murphy's Law---long-term deployments of pervasive technology into the homes of older adults

and academia on developing technology to allow older people to remain in their homes for as long as possible [1,6]. One approach involves “pervasive technology”—the deployment of various sensors, computers, and output devices embedded in the home environment to track behavior and interactions with household objects (Figure 1). Behind the technology sits software that measures, for example, activities of daily living (ADLs), accumulates this information, and uses it to notify relatives or medical people of the status of an older person living alone [5]. Additionally, this software could provide direct assistance to the older person, such as activity-appropriate prompts and reminders [2]. Since 2002 a group of researchers at Intel’s Digital Health Group have been observing and interviewing senior citizens in studies to better understand them, how this “ubiquitous” sensing might help them, and determine design issues to address. Our philosophy has been to develop emerging-technology solutions and place them into “real” homes as soon as possible, rather than use an on-campus simulated home. This approach provides more valid data on the “livability” of our solutions. Initially, we conducted extensive ethnographic interviews of the home environment and the challenges faced by older adults [4]. Next, we deployed sensors in the homes of six senior citizens and the homes of their primary caregivers to better understand their social activities and how feedback might help improve their social contact [3]. Our next project has involved sensing daily activities and medication compliance to deliver “context sensitive” medication reminders. We have enrolled 11 older adults in a long-term study that is just now being completed. Here, we summarize many of the practical considerations in deploying this type of technology and working with older adults in the design of in-home technology.

Tales, Tours, Tools, and Troupes: A Tiered Research Method to Inform Ubiquitous Designs for the Elderly

As the elder population continues to increase throughout the world, there is a tremendous need for technologies that will keep elders healthy and self-sufficient in their homes. Ubiquitous, smart home technologies can fulfill this role, but a thorough understanding of elders’ routines, lifestyles, and home environments is required in order to develop effective aids. This paper describes our research approach, which evolved from stories related in household interviews (‘tales’), ethnographic observation of elders’ routines and environments (‘tours’), analysis of artefacts (‘tools’) and finally interactive performances (‘troupes’) to convey and elicit feedback about the capabilities of future home technologies for the elderly. This combination of methods revealed a range of user values, behaviours, coping styles, and requirements for ubiquitous technology that would otherwise have been difficult to gather in this domain of ubiquitous, ‘invisible’ computing.

Understanding User Experience Journeys for a Smart Watch Device

Although a great deal of work has been done in assessing User Experience, relatively little has been done in analyzing the course of User Experience over time. In a longitudinal study of the Apple Watch*, we tracked 90 people who had pre-purchased the watch for over four months of use. In this study, we identify three categories of user journeys for a smart watch, and describe users’ most memorable episodes. We discuss how these user journeys and the memory of specific episodes relate to the overall assessment of the Apple Watch, and why some individuals stopped using their watch.

Fostering Social Engagement and Self-Efficacy in Later Life: Studies with Ubiquitous Computing

This chapter describes a multiyear project with a team of social scientists and engineers at Intel focused on emerging technologies and successful aging. Theories of behavioral change are linked to the capabilities of emerging technologies for capturing and reflecting variability in activity and health status. The technologies described in this chapter reflect an attempt to integrate psychological theory and ethnographic research with ubiquitous computing. Ethnographic research that we conducted at the outset of this project consistently underscored the value of social engagement for successful aging. It also pointed out the significant social barriers encountered by many older adults. These barriers – which include changes in lifestyle, mobility, and cognitive functioning – are compounded by a perceived inability to change isolating circumstances. To address these social needs and barriers, we developed a set of prototypes involving sensor networks and feedback displays. This chapter describes the social health technologies that we developed, reactions of the older adults and family caregivers who participated in in-home trials, and implications for future development. We also describe the need for tools to encourage self-awareness and self-efficacy for a broad range of health concerns.

Lessons learned from designing a displayless consumer wearable tech

This paper discusses challenges and lessons learned from designing and launching consumer-facing wearable technologies that Intel developed with other companies. The lessons are drawn from the perspective of a user experience team working in a traditionally hardware company.