AI has the potential to substantially improve quality of life for the elderly, but not without nurses’ intervention
By Dana Dermody MACN
The use of technology in aged care is increasing for many reasons. The most significant factor relates to giving older adults a choice on where and how they want to age, but also includes a combination of factors including a shift in the ageing demographic, changes in consumer expectations, residential aged care concerns including staffing shortages, cost concerns and improving quality health outcomes.
Further, the current deliberations with the Royal Commission into the quality and safety of residents in aged care facilities has left providers and their families wondering if smart sensors and cameras could be solutions to facilitate the provision of quality nursing care to residents. In the newly emerging field referred to as Gerontechnology, researchers and developers focus on the design of an environment using technology to facilitate independent living and social participation of older persons in comfort and safety.
Ageing-in-place and technology
Many older people prefer to age where they are living to maintain social connectivity, but evidence points to potential risks associated with ageing-in-place such as accidents, slips and falls, and unnoticed exacerbations of chronic illnesses like congestive heart failure (Thoma-Lurkin et al., 2018). In addition, they may have limited access to a daily caregiver, family member or nurse to provide the health-support they need.
For older people who live in remote areas, clinical support through remote health monitoring may be a cost-effective alternative to residential aged care and supportive of their wish to age where they live.
Currently there are many ageing-in-place technologies which are readily available, such as wearables. However, to support ageing-in-place, smart homes – that cater to the health and safety of older adults – could be the real gamechanger.
‘Smart Home’ is a general term used to refer to in-home smart sensor technology, and a wide range of devices envisioned by research teams focusing on developing smart environments to assist with in-home delivery of health care. Products like Amazon’s Echo and Alexa®, Google Home® and Geeni® support both consumer comfort and a level of security with interconnected devices that can do a variety of things such as motion-activated lights, sounds and security cameras.
However, the emerging science to create smart home sensor technology to specifically support the health and safety of older adults, or persons with disabilities, has the potential to take ageing-in-place to new levels.
Nurse-monitored health-assistive smart homes
The idea of smart homes – which have been deployed across a variety of care settings such as private homes, assisted living and residential memory care – centers on the idea of a person’s daily routines being able to tell a story about their health. For example, if a person is not feeling well they may spend more time in bed or lying on the sofa or use the toilet more frequently or have less interest in food.
This type of health-assistive smart home can monitor a person’s health-related activities that are potential clues to changes in health. It uses unobtrusive sensor technology embedded in the home-environment (ceilings, walls).
Artificially intelligent (AI) algorithms are used to monitor daily behaviours and if it notes an abnormal behaviour pattern that may signal a change in health state, it is capable of alerting nurse-clinicians. For the AI agent to know how to make the right or expected decision, first AI has to be ‘trained.’ Machine learning achieves this training. To train the intelligent machine clinical nursing knowledge is critical, and why nurses play an important role in both the development and implementation of health-assistive smart homes (Dermody & Fritz, 2018).
Wearables in aged care
- Companies like Apple and Samsung are developing wearables that can send an emergency response through a smartphone to first responders, as well as connect to their smart home to adjust the living environment as needed.
- Coupled with the Garmin® wearables that can monitor heart rate to detect cardiac arrhythmias, is the Cardiogram Heart Health App that interprets the cardiac data.
- Companies like Bose and Hartman are developing hearing technology coupled with AI termed ‘hearables’. For example, Otican Opn™ that can connect to a person’s smart home and adjust itself based on the noisiness of the home.
- Verily is developing specialised contact lenses that can assist older adults suffering from age-related vision changes such as far-sightedness.
- Bluetooth enabled blood pressure cuffs, weight scales, glucose monitors, and pulse oximeters, etc., are part of telehealth technology that collect data, which when uploaded to the cloud can be readily accessed by a health care team remotely.
Remote Recognition of Changes in Health using Smart Home Sensor Data
The type of data a health-assistive smart home collects depends on the product and the needs of the resident. In general, it may monitor a person’s:
- activity level based on the total number of activated sensors
- time spent in each activity (cooking, personal hygiene, relaxing, etc.)
- the number of toileting episodes per 24 hours and bed-to-toilet transitions
- number of hours of sleep per day, including location of sleep and day and night sleep; walking speed, gait and balance.
This real-time data in easy-to-read graphs can uniquely tell the nurse whether or not a person is doing what they usually do, on a daily basis, and if deviations exist. It can provide clues to acute or gradual changes or declines over time that could go unnoticed.
For example, in adults with dementia, sleeping and eating can often become erratic resulting in altered mental well-being and nutritional deficiencies that can further compound the features of dementia. Direct area sensors coupled with wearables can collect sleep data and fridge and kitchen heat sensors can monitor eating habits.
Nurses can then follow established clinical practice guidelines and develop a plan of care. If the burner on a stove is accidently left on, and sensor movement in the stove area for a certain length of time is absent, actuators which are small devices can receive remote digital instructions and de-activate the stove that has been left on accidentally.
Similarly, motion sensors or infrared cameras can indicate a change in a person’s gait and balance, which impact function and the ability to be independent. Followed by an automatic alert sent to the health care team, it could help nurses to forecast a fall days or even weeks before it happens, allowing for early intervention.
Nurses play a key role in the management of a person’s health using the sensor collected data, as they need to recognise potential changes in health, and liaise with the interdisciplinary team to implement timely interventions.
Nurse-involvement in health-related technology applications
Although nurses have laid a historical claim to the space between technology and their patients, nurse representation in the development, research and translation of technologies in health care has been limited.
The expansion of technology use – such information management solutions, robotics, web-based apps, smart homes and AI – will impact patients and families, and ultimately how nursing care is delivered. Nurses are frequently the “end-user” of patient-related technology (think of the IV pump, or the fall alarm). Therefore, nurses should be involved in the development and integration of technologies into patient care, which requires increased nurse representation.
However, nursing representation and involvement in this field, and in particular working with AI, remains low. Reasons include limited exposure to technology beyond health care informatics, and myths such as technology might replace nurses, and subsequently the human touch. Unfortunately, this may leave nurses unprepared to consider their involvement, and may inhibit their involvement in development and implementation of these technologies (Fritz & Dermody, 2018).
It’s upon nurses to expand their skills to include using smart home technology dashboards to triage potential alerts and decision-making. They need to know that rather than replacing the human touch, technologies could enhance their patients’ health and well-being. Nurses have a unique holistic nursing knowledge base to understand the potential changes in health that could be taking place. To advocate for older adults, they must be at the design table of ageing in-place technologies, including AI and health assistive smart homes, and other wearables.
Dermody G, Fritz R. A conceptual framework for clinicians working with artificial intelligence and health-assistive Smart Homes. Nursing inquiry. 2018:e12267.
Fritz RL, Dermody G. A nurse-driven method for developing artificial intelligence in “smart” homes for aging-in-place. Nursing outlook. 2018.
Thoma-Lurken T, Bleijlevens MHC, Lexis MAS, de Witte LP, Hamers JPH. Facilitating aging in place: A qualitative study of practical problems preventing people with dementia from living at home. Geriatric nursing (New York, NY). 2018;39(1):29-38.