Shomir Chaudhuri

Framing the evidence for health smart homes and home-based consumer health technologies as a public health intervention for independent aging: a systematic review.

INTRODUCTION There is a critical need for public health interventions to support the independence of older adults as the worlds population ages. Health smart homes (HSH) and home-based consumer health (HCH) technologies may play a role in these interventions. METHODS We conducted a systematic review of HSH and HCH literature from indexed repositories for health care and technology disciplines (e.g., MEDLINE, CINAHL, and IEEE Xplore) and classified included studies according to an evidence-based public health (EBPH) typology. RESULTS One thousand, six hundred and thirty-nine candidate articles were identified. Thirty-one studies from the years 1998-2011 were included. Twenty-one included studies were classified as emerging, 10 as promising and 3 as effective (first tier). CONCLUSION The majority of included studies were published in the period beginning in the year 2005. All 3 effective (first tier) studies and 9 of 10 of promising studies were published during this period. Almost all studies included an activity sensing component and most of them used passive infrared motion sensors. The three effective (first tier) studies all used a multicomponent technology approach that included activity sensing, reminders and other technologies tailored to individual preferences. Future research should explore the use of technology for self-management of health by older adults; social support; and self-reported health measures incorporated into personal health records, electronic medical records, and community health registries.

Fall detection devices and their use with older adults: A systematic review

Background:Falls represent a significant threat to the health and independence of adults aged 65 years and older. As a wide variety and large number of passive monitoring systems are currently and increasingly available to detect when individuals have fallen, there is a need to analyze and synthesize the evidence regarding their ability to accurately detect falls to determine which systems are most effective. Objectives:The purpose of this literature review is to systematically assess the current state of design and implementation of fall-detection devices. This review also examines to what extent these devices have been tested in the real world as well as the acceptability of these devices to older adults. Data Sources:A systematic literature review was conducted in PubMed, CINAHL, EMBASE, and PsycINFO from their respective inception dates to June 25, 2013. Study Eligibility Criteria and Interventions:Articles were included if they discussed a project or multiple projects involving a system with the purpose of detecting a fall in adults. It was not a requirement for inclusion in this review that the system targets persons older than 65 years. Articles were excluded if they were not written in English or if they looked at fall risk, fall detection in children, fall prevention, or a personal emergency response device. Study Appraisal and Synthesis Methods:Studies were initially divided into those using sensitivity, specificity, or accuracy in their evaluation methods and those using other methods to evaluate their devices. Studies were further classified into wearable devices and nonwearable devices. Studies were appraised for inclusion of older adults in sample and if evaluation included real-world settings. Results:This review identified 57 projects that used wearable systems and 35 projects using nonwearable systems, regardless of evaluation technique. Nonwearable systems included cameras, motion sensors, microphones, and floor sensors. Of the projects examining wearable systems, only 7.1% reported monitoring older adults in a real-world setting. There were no studies of nonwearable devices that used older adults as subjects in either a laboratory or a real-world setting. In general, older adults appear to be interested in using such devices although they express concerns over privacy and understanding exactly what the device is doing at specific times. Limitations:This systematic review was limited to articles written in English and did not include gray literature. Manual paper screening and review processes may have been subject to interpretive bias. Conclusions and Implications of Key Findings:There exists a large body of work describing various fall-detection devices. The challenge in this area is to create highly accurate unobtrusive devices. From this review it appears that the technology is becoming more able to accomplish such a task. There is a need now for more real-world tests as well as standardization of the evaluation of these devices.

Examining health information-seeking behaviors of older adults.

This study aims to examine which resources older adults utilize for their health information needs, how trustworthy and reliable they find these resources, and the difficulties they face in obtaining health-related information. A 41-item survey designed to understand the information-seeking characteristics of older adults was developed and distributed to retirement communities. Some items were taken from the Health Information National Trends Survey. Of 1520 surveys, 403 were returned completed (26.6%). Respondents’ mean age was 77.65 years. Average scores indicated respondents trusted particular sources of health information in the following order (highest to lowest): health care providers, pharmacists, friends and relatives, retirement community staff, newspapers, the Internet, television, and the radio. In conclusion, older adults have a greater amount of trust in a person with whom they are able to actively discuss their health as opposed to a nonliving source, which they have to access or manipulate, such as the Internet. Efforts must be made to help older adults better navigate and utilize the Internet and recognize dependable online sources so that they may increase their trust in its use, thereby increasing satisfaction with their own ability to seek and use sources of health information.

Older adults’ acceptance of a community-based telehealth wellness system

The development of ongoing assessment tools to monitor older adult health and wellness can support improved quality of life and independence. These technologies have often been employed within private residences. Our work describes a telehealth kiosk system implemented within a community setting, which reduces the costs of installing and maintaining individual systems. Though user acceptance of telehealth systems has been studied within the context of home residences, this has yet to be addressed for community-based systems. Older adults in a retirement community were recruited to use a telehealth system including assessment of vital signs and cognitive performance. With a series of focus groups (N = 12, average age 79.3 years), we examined user perceptions of the telehealth kiosk, addressing issues of usability, effectiveness and privacy. Older adults were favorable towards the collection of health monitoring information, recognizing the utility of these data sources. There were issues of usability, especially regarding ergonomics of the telehealth kiosk. We found no concerns over privacy, with some participants expressing increased preference for the social interactions afforded through the community setting. Understanding the social, technical and human factors involved with a community-based telehealth system can inform the design of cost-effective health monitoring systems.

Integrating Patient-Reported Outcomes into Spine Surgical Care through Visual Dashboards: Lessons Learned from Human-Centered Design.

Introduction: The collection of patient-reported outcomes (PROs) draws attention to issues of importance to patients—physical function and quality of life. The integration of PRO data into clinical decisions and discussions with patients requires thoughtful design of user-friendly interfaces that consider user experience and present data in personalized ways to enhance patient care. Whereas most prior work on PROs focuses on capturing data from patients, little research details how to design effective user interfaces that facilitate use of this data in clinical practice. We share lessons learned from engaging health care professionals to inform design of visual dashboards, an emerging type of health information technology (HIT). Methods: We employed human-centered design (HCD) methods to create visual displays of PROs to support patient care and quality improvement. HCD aims to optimize the design of interactive systems through iterative input from representative users who are likely to use the system in the future. Through three major steps, we engaged health care professionals in targeted, iterative design activities to inform the development of a PRO Dashboard that visually displays patient-reported pain and disability outcomes following spine surgery. Findings: Design activities to engage health care administrators, providers, and staff guided our work from design concept to specifications for dashboard implementation. Stakeholder feedback from these health care professionals shaped user interface design features, including predefined overviews that illustrate at-a-glance trends and quarterly snapshots, granular data filters that enable users to dive into detailed PRO analytics, and user-defined views to share and reuse. Feedback also revealed important considerations for quality indicators and privacy-preserving sharing and use of PROs. Conclusion: Our work illustrates a range of engagement methods guided by human-centered principles and design recommendations for optimizing PRO Dashboards for patient care and quality improvement. Engaging health care professionals as stakeholders is a critical step toward the design of user-friendly HIT that is accepted, usable, and has the potential to enhance quality of care and patient outcomes.

Older Adults' Perceptions of Fall Detection Devices.

A third of adults over the age of 65 are estimated to fall at least once a year. Perhaps as dangerous as the fall itself is the time spent after a fall if the person is unable to move. Although there are many devices available to detect when a person has fallen, little is known about the opinions of older adults regarding these fall detection devices (FDDs). We conducted five focus groups with 27 older adults. Transcripts from sessions were coded to generate themes that captured participants’ perceptions. Themes were identified that related to two topics of interest: (a) personal influences on the participants’ desire to have a FDD, including perceived need, participant values, and cost, and (b) participant recommendations regarding specific features and functionalities of these devices such as automation, wearable versus non-wearable devices, and device customization. Together, these themes suggest ways in which FDDs may be improved so that they are suitable for their intended population.

Older adults’ attitudes and preferences regarding a multifunctional wellness tool: A pilot study

Objective: To examine older adults’ attitudes toward multifunctional technology tools and specific preferences and expectations that would maximize their utility and usability. Methods: We held three focus group sessions for this pilot study to determine perceptions of older adults toward multifunctional wellness tools, including usefulness and barriers to use. Areas discussed included features that would be wanted or unwanted, form factor and context of use. Recordings were transcribed and qualitative content analysis was performed. Results: Fourteen older adults participated in the focus group sessions. Participants viewed potential uses for wellness tools with regard to their health and health information positively, as they felt currently available tools were lacking. In addition, participants felt that a single-user, smaller, portable device would be more useful than a non-portable multi-user device. Concerns were expressed toward technologies that were difficult to use with aging-related changes, privacy and perceptions of technology. Conclusions: Participants felt generally positively toward a multifunctional wellness tool and would be willing to use one if it were portable, intuitive and had reliable health-related information on the device.

Real-world accuracy and use of a wearable fall detection device by older adults

To the Editor: A significant danger with falling is the inability to get up afterward, which is reported to occur in as many as 30% of falls. Individuals have been shown to have better chances of survival the sooner they are discovered after a fall. Thus, several devices have been designed to detect a fall. A pilot study was conducted to investigate the real-world use and accuracy of a wearable fall detection (FD) device with community-dwelling older adults. The device had the ability to detect falls automatically using a combination of accelerometer, magnetometer, and gyroscope. It also had audio feedback and global positioning system capabilities. The company reported testing their device in a laboratory setting with subjects performing prescribed falls, activities of daily living, and stumbles. The system was subsequently tested on an independent dataset and yielded results of sensitivity range from 94.1% to 94.4% and specificity from 92.1% to 94.6%. Of 18 participants, eight completed the 4-month study; of the 10 who partially completed the study, nine voluntarily left the study, and one was unable to complete because of an injurious fall. Participants had the device for an average of 80.7 days (range 8–124); 84 alarms indicating a fall were recorded, of which 83 were false alarms. The largest percentage of false alarms (42.2%) was during normal device use. Another 16.9% of false alarms occurred when the participant dropped the device. Device misuse and putting the device down each constituted 10.8% of false alarms; 19.3% of false alarms occurred for unknown reasons. Table 1 shows the binary classification measurements for the study. Those who completed the study had 58 false alarms over 812 days (7.1%), and those who partially completed had 25 false alarms over 263 days (9.5%) (P = .31). Only one true positive was recorded, when a participant fell backward and hit her head. Participants reported three additional falls while wearing the device, although the device did not identify them as such. In one situation, a participant reported “a light fall into a person’s lap.” The other two falls occurred from a seated position. Eight falls were reported that occurred while participants were not wearing their devices. Half of these occurred with the device in the charger, in the early morning or at night. Device adherence was a binary measurement; if the participant removed the device from its charger for at least 20 minutes, they were recorded as having used the device on that day. Those who partially completed the study had significantly less adherence (P = .003), although those who completed had a drop in adherence similar to that of partial completers approximately halfway through the trial. To examine the influence of false alarms on adherence, a paired t-test was used to compare adherence 5 days before and after a false alarm (P = .67). Use of the device 5 days before a fall was also compared with use after the fall (P = .63). These findings suggest that the device is inaccurate in real-world settings given the low sensitivity observed. The manufacturer reported testing their device using 59 volunteers. Based on this testing, the company reported sensitivity ranging from 94.1% to 94.4% and specificity ranging from 92.1% to 94.6%. Although the specificities match fairly closely between the laboratory and real-world settings, the difference in sensitivities is stark. Although it is difficult to compare the two studies given the difference in sample size and fall data, such a comparison would appear to match previous evidence suggesting that real-world falls are more difficult to detect accurately. This finding points to necessary improvements in the accuracy of the device and a need for real-world testing before deployment. The similar decrease in adherence between the two groups near the halfway point of device usage might indicate that participants grew weary of using the device or forgot to use it as the study continued regardless of their willingness to participate in the study. There is a need for more research to better understand what motivates older adults to use these devices so as to encourage greater use. Even with limitations of a single device and a short observation period (4 months), this study demonstrates the critical need for real-world testing of fall detection devices by older adults, as well as the need to gather data regarding the actual usage of these devices by their intended audience. Clinicians working with older adults need to assess for the availability (and accuracy) of real-world testing of any fall detection devices before recommending them to patients.

The use of think-aloud and instant data analysis in evaluation research

While health information technologies have become increasingly popular, many have not been formally tested to ascertain their usability. Traditional rigorous methods take significant amounts of time and manpower to evaluate the usability of a system. In this paper, we evaluate the use of instant data analysis (IDA) as developed by Kjeldskov et al. to perform usability testing on a tool designed for older adults and caregivers. The IDA method is attractive because it takes significantly less time and manpower than the traditional usability testing methods. In this paper we demonstrate how IDA was used to evaluate usability of a multifunctional wellness tool, discuss study results and lessons learned while using this method. We also present findings from an extension of the method which allows the grouping of similar usability problems in an efficient manner. We found that the IDA method is a quick, relatively easy approach to identifying and ranking usability issues among health information technologies.

Trust in Health Information Sources Differs Between Young/Middle and Oldest Old

Purpose. Examine differences in trust of health information sources between the oldest old and young/middle old. Design. Cross-sectional survey using convenience sampling. Setting. Eleven retirement communities. Subjects. Older adults ≥ 65 years (N = 353). Measures. Self rated trust in health information sources. Analysis. Mann-Whitney U-test or Fisher exact test to compare trust between age groups; multinomial ordered logistic regression analyses to model trust in Internet information sources. Results. The overall survey response rate was 26.6%. Differences in trust were identified between oldest old (n = 108) and young/middle old (n = 245) for pharmacist (p < .05), Internet (p < .001), television (p < .05), radio (p < .001), and newspaper (p < .05) sources. In the oldest old, we found associations between levels of trust in Internet sources and frequency of Internet use (β = 4.13, p < .001). Conclusion. Understanding where differences in trust arise can inform the design of resources to support the information-seeking process. When planning widespread distribution of health information to these distinct groups, program developers need to consider these differences.