Eldercare Technology for Clinical Practitioners A M GING EDICINE RobertPignolo,MD,PhD;MaryAnnForciea,MD;JerryC.Johnson,MD, SeriesEditors Age-RelatedChangesoftheHumanEye,editedbyCarloA.CavallottiandLucianoCerrulli,2008 ClassicPapersinGeriatricMedicine,editedbyRobertPignolo,MaryAnneForciea,andMonica Crane,2008 EldercareTechnologyforClinicalPractitioners,editedbyRobinA.FelderandMajdAlwan,2008 HandbookofPainReliefinOlderAdults:AnEvidenceBasedApproach,editedbyMichaelF.Gloth, 2004 · Majd Alwan Robin A. Felder Editors Eldercare Technology for Clinical Practitioners Editors MajdAlwan RobinA.Felder CenterforAgingServices DepartmentofPathology Technologies(CAST) UniversityofVirginaHealth Washington,DC SciencesCenter Charlottesville,VA SeriesEditors RobertJ.Pignolo,MD,PhD JerryC.Johnson,MD AssistantProfessorofMedicine ProfessorofMedicine DepartmentofMedicine Chief,DivisionofGeriatricMedicine DivisionofGeriatricMedicine SeniorFellow,InstituteonAging UniversityofPennsylvaniaHealthSystem UniversityofPennsylvaniaHealthSystem MaryAnnForciea,MD ClinicalAssociateProfessorofMedicine DivisionofGeriatricMedicine UniversityofPennsylvaniaHealthSystem ISBN:978-1-58829-898-0 e-ISBN:978-1-59745-233-5 LibraryofCongressControlNumber:2007940426 (cid:2)c 2008HumanaPress,apartofSpringerScience+BusinessMedia,LLC Allrightsreserved.Thisworkmaynotbetranslatedorcopiedinwholeorinpartwithoutthewritten permissionofthepublisher(HumanaPress,999RiverviewDrive,Suite208,Totowa,NJ07512USA), exceptforbriefexcerptsinconnectionwithreviewsorscholarlyanalysis.Useinconnectionwithany form ofinformation storage and retrieval, electronic adaptation, computer software, or by similar or dissimilarmethodologynowknownorhereafterdevelopedisforbidden. Theuseinthispublicationoftradenames,trademarks,servicemarks,andsimilarterms,eveniftheyare notidentifiedassuch,isnottobetakenasanexpressionofopinionastowhetherornottheyaresubject toproprietaryrights. Whiletheadviceandinformationinthisbookarebelievedtobetrueandaccurateatthedateofgoing to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for anyerrorsoromissionsthatmaybemade.Thepublishermakesnowarranty,expressorimplied,with respecttothematerialcontainedherein. Printedonacid-freepaper. 9 8 7 6 5 4 3 2 1 springer.com Preface Background:The majority of our increasing elder adult population requires some degree of formal and/or informal care because of loss of function as a result of failing health. Accordingto the Centers for Disease Control (CDC), nearly three- quartersofelderadultssufferfromoneormorechronicdiseases.Examplesinclude arthritis,hypertension,anddiabetes,tonameafew.Thecostandburdenofcaring forelderadultsissteadilyincreasing. ChangesintheMedicaresystemledtoashiftintheresponsibilityforcarefrom institutions(nursinghomes,etc.)tothecommunity(individualsandfamilies).The roleofinformalcaregiversinprovidingcaretotheelderadultpopulationhasgreatly increasedinthepasttwodecades.Consequently,informalcaregivershavecometo beviewedasanunpaidextensionofprofessionalcaregivers,providingmostofthe caretoelderadultsrequiringlong-termcare.Infact,nationaldatabasesderivedfrom differentsourceshaveprovidedunequivocalevidencethatfamilyandfriendsarethe solecareprovidersforaboutthree-quartersofallcommunity-dwellingelderadults. Informal caregivers have experienced increased physical burdens and emotional strains because of this shift in long-term elder care responsibilities. Furthermore, healthcareprovidersarefacedwithashrinkingprofessionalcaregivingworkforce atthesametime. Onthecontrary,theproportionoftheworld’spopulationofindividualsoverthe ageof60yearsisexpectedtodoubleby2030to20%.IntheUSA,thenumberof elder adultsis expectedto growto 108millionoverthe next15 years, whichrep- resents45%oftheadultpopulation.Elderadultscurrentlyaccountfor60%ofthe overallhealthcarespendingintheUSA.Appropriatemanagementofchronicdisease inolderadultscanreducetheUShealthcarebillbyupto50%.Furthermore,92% oftheseelderadultslivealoneintheirownapartments,homes,independentliving facilities, or assisted living facilities, including about 50% of those 75 years and older.Such statistics demonstratean urgentneedfor innovativetelehealth/telecare tools that enable elder adults to live independentlyand maximize caregivers’effi- cacybyprovidingtimelyhealthinformationanddeliveringmoreeffectivecare.This change in the demographics and its potential economic impact on industrialized nationshaspromptedactiveresearchinautomatedsystemsforfunctionalandhealth statusmonitoringandassistance,enabledbyrecenttechnologicaladvancement. v vi Preface Inthemeantime,advancesinsensor,communication,andinformationtechnolo- gies have created opportunities to develop novel tools enabling remote manage- ment and monitoring of chronic diseases, emergencyconditions, and the delivery ofhealthcare.In-homehealthassessmentandmonitoringhastheaddedbenefitof measuringindividualizedhealthstatusandreportingittotheprimarycareprovider andcaregiversalike,allowingtimelierandtargetedpreventiveinterventions.Health monitoringinhomeenvironmentscanbeaccomplishedbya)ambulatorymonitors that utilize wearable sensors and devices to record physiological signals; b) sen- sors embedded in the home environmentand furnishings to unobtrusively collect behavioralandphysiologicaldata;orc)acombinationofthetwo. Aim and scope: This book addresses technologies targeted at the assessment, earlydetection,andthemitigationofcommongeriatricconditionsincludingdecline infunctionalabilities,gait,mobility,sleepdisturbance,visionimpairment,hearing loss, falls, and cognitive decline. This book not only describes the state of both embedded and wearable technologies, including technologies under research and onthebrinkoftranslationintoproducts,butalso focusesonresearchshowingthe potentialutilityofthesetechnologiesinthefield. Chapter 1 presents an introductionand reviews the statistics that make a com- pelling case for developmentand utilization of technologiesfor the geriatric care. Chapter 2 presents a comprehensive review of functional assessment instruments andpromisingtechnologiesusedinfunctionalassessmentofelders.Chapter3cov- ersmobilityandgaitassessmenttechnologies,whereasChapter4reviewsmobility aidtechnologiesfortheelderly.InChapter5,wereviewsleepdisordersinolderage andsleepassessmenttechnologies,withemphasisonin-homeassessmenttechnolo- gies. Chapter 6 presents a comprehensivereview of age-related changes in vision andcorrectivetechnologies,whereasChapter7addressesthemanagementofhear- inglossinolderage.Chapter8isdedicatedtofalls,falldetection,andfallpreven- tiontechnologies.Finally,Chapter9addressesemergingcomputer-basedcognitive assessmenttechnologies. Webelieve,andhope,thatthisworkwillfillagapintheknowledgeandwillbe invaluabletoEldercarepractitioners,aswellasmedicalstudentstudyingGeriatrics and interested in gerotechnology, social studies, students studying gerontology and interested in gerontechnology, and nursing students interested in Geriatric Nursing, in addition to engineeringstudents interested in Eldercare Technologies, andresearchersfroma broadspectrumofdisciplines,particularlythose interested in field experience and the end-user’s perspective. This volume comes at a time when interest in Eldercare Technology and the need for effective and appropriate technologiesespeciallyarepeaking. Washington,DistrictofColumbia MajdAlwan Charlottesville,Virginia RobinA.Felder Contents Preface........................................................... v Contributors...................................................... ix ListofAcronymsandAbbreviations................................. xi 1 Introduction................................................... 1 RichardLindsay 2 FunctionalAssessmentTechnologies.............................. 5 Marilyn Rantz, Marjorie Skubic, Kathryn Burks, Jie Yu, George Demiris, Brian K. Hensel, Gregory L. Alexander, Zhihai He, Harry W. Tyrer, Marc Hamilton, Jia Lee, andMarybethBrown 3 MobilityandGaitAssessmentTechnologies ....................... 33 PatrickO.Riley,KateW.Paylo,andD.CaseyKerrigan 4 IntelligentMobilityAidsfortheElderly .......................... 53 GlennWasson,PradipSheth,CunjunHuang,andMajdAlwan 5 SleepandSleepAssessmentTechnologies ......................... 77 StevenM.Koenig,DavidMack,andMajdAlwan 6 VisionImpairmentAssessmentandAssistiveTechnologies ..........121 StanleyWoo 7 ManagingHearingLossinOlderAdults:Assessment,Intervention, andTechnologiesforIndependenceandWellBeing .................143 Matthew H. Bakke, Claire M. Bernstein, Scott J. Bally, andJanetL.Pray 8 Falls,FallPrevention,andFallDetectionTechnologies..............187 Prabhu Rajendran, Amy Corcoran, Bruce Kinosian, andMajdAlwan vii viii Contents 9 ComputerizedMethodsforCognitiveTesting......................203 VeredAharonsonandAmosD.Korczyn Index ............................................................217 Contributors VeredAharonson,Ph.D.,Department KathrynBurks,R.N.,Ph.D., ofSoftwareEngineering,TelAviv SchoolofNursing,Universityof Academic College of Engineering, Missouri,Columbia,MO Afeka,Israel AmyCorcoran,M.D.,Geriatric GregoryL.Alexander,Ph.D.,R.N., Fellow,DepartmentofMedicine, AssistantProfessor,SinclairSchoolof DivisionofGeriatrics,Universityof Nursing,Columbia,MO Pennsylvania,Philadelphia,PA MajdAlwan,Ph.D.,Director,Center GeorgeDemiris,Ph.D.,Associate forAgingServicesTechnologies Professor,Biobehavioral (CAST),Washington,DC NursingandHealthSystems,Schoolof MatthewH.Bakke,Ph.D.,Associate Nursing&Biomedicaland Professor,GallaudetUniversity, HealthInformatics,SchoolofMedicine, DepartmentofHearing,Speechand UniversityofWashington,Seattle,WA LanguageSciences,Director, RehabilitationEngineeringResearch MarcHamilton,Ph.D.,Associate Center(RERC)onHearing Professor,Biomedical Enhancement,Washington,DC Sciences,DaltonCardiovascular ResearchInvestigator&Collegeof ScottJ.Bally,Ph.D.,Associate VeterinaryMedicine,Universityof Professor,GallaudetUniversity, Missouri,Columbia,MO DepartmentofHearing,Speechand LanguageSciences,Washington,DC ZhihaiHe,Ph.D.,AssistantProfessor, DepartmentofElectricalandComputer ClaireM.Bernstein,Ph.D.,Research Engineering,UniversityofMissouri, Audiologist,GallaudetUniversity, Columbia,MO DepartmentofHearing,Speechand LanguageSciences,Washington,DC Brian K. Hensel, Ph.D., M.S.P.H., MarybethBrown,Ph.D.,Professor, Post-DoctoralFellowin PhysicalTherapy,SchoolofHealth Health Informatics, University of Professions,Columbia,MO Missouri-Columbia,Columbia,MO ix x Contributors CunjunHuang,Ph.D.,Departmentof PrabhuRajendran,M.S.,Graduate MechanicalandAerospace ResearchAssistant,Medical Engineering,Universityof Virginia, AutomationResearchCenter, Charlottesville,VA UniversityofVirginia, Charlottesville,VA D.CaseyKerrigan,M.D.,M.S., UniversityofVirginia,Schoolof MarilynRantz,R.N.,Ph.D.,F.A.A.N., Medicine,DepartmentofPhysical Professor,SinclairSchoolofNursing MedicineandRehabilitation, andFamilyandCommunityMedicine, Charlottesville,VA S406SinclairSchoolofNursing, BruceKinosian,M.D.,Associate UniversityofMissouri-Columbia, Professor,DivisionsofGeneralInternal Columbia,MO MedicineandGeriatrics,University ofPennsylvania,SchoolofMedicine, PatrickO.Riley,Ph.D.,Research Philadelphia,PA AssociateProfessor,Universityof Virginia,SchoolofMedicine, StevenM.Koenig,M.D.,FCCP, DepartmentofPhysical ProfessorofInternalMedicine, MedicineandRehabilitation, UniversityofVirginiaHealthSystem, Charlottesville,VA TheDepartmentofInternalMedicine, DivisionofPulmonary&CriticalCare, PradipSheth,Ph.D.,Department Charlottesville,VA ofMechanicalandAerospace AmosD.Korczyn,M.D.,B.Sc., Engineering,UniversityofVirginia, Professor,SieratzkiChairofNeurology, Charlottesville,VA Tel-AvivUniversityMedicalSchool, MarjorieSkubic,Ph.D.,Associate Ramat-Aviv,Israel Professor,Electricaland JiaLee,Ph.D.,R.N.,Assistant ComputerEngineeringDepartment, Professor,SinclairSchoolofNursing, Columbia,MO Columbia,MO HarryW.Tyrer,Ph.D.,Professor, RichardLindsay,M.D.,Former DepartmentofElectrical ChairofGeriatricMedicine,School andComputerEngineering,University ofMedicine,UniversityofVirginia, ofMissouri,Columbia,MO Charlottesville,VA DavidMack,M.S.,Ph.D.,Graduate GlennWasson,Ph.D.,Departmentof ResearchAssistant,Medical ComputerScience,Universityof AutomationResearchCenter, Virginia,Charlottesville,VA UniversityofVerginia, Charlottesville,VA StanleyWoo,Ph.D.,Clinical AssociateProfessor,Chief,LowVision KateW.Paylo,D.O.,University RehabilitationServices,Director, ofVirginia,SchoolofMedicine, CenterforSightEnhancement, DepartmentofPhysicalMedicineand UniversityofHoustonCollegeof Rehabilitation,Charlottesville,VA Optometry,Houston,TX JanetL.Pray,Ph.D., Professor,GallaudetUniversity, JieYu,B.S.N.,R.N.,DoctoralStudent, DepartmentofSocialWork, SinclairSchoolofNursing, Washington,DC Columbia,MO