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Effects of Currently Effects of Currently Available Smart Available Smart

Home Technology on Home Technology on Frail EldersFrail Elders

Machiko R. Tomita, Machiko R. Tomita, Ph.D.Ph.D.

Department of Rehabilitation Department of Rehabilitation ScienceScience

University at BuffaloUniversity at BuffaloPresented at

NYSOTA ConferenceBuffalo, NY, September 27-

29, 2007

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Rationale for the StudyRationale for the Study

• Elders with disabilities are likely to Elders with disabilities are likely to experience functional limitations, experience functional limitations, dependence on caregivers, and dependence on caregivers, and depression, which could lead to depression, which could lead to institutionalization.institutionalization.

• Smart Home utilizing a computer may Smart Home utilizing a computer may improve safety to prevent falls and improve safety to prevent falls and injury, enhancing mental and physical injury, enhancing mental and physical activities that can keep frail elders at activities that can keep frail elders at home longer.home longer.

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SH for frail elderly in the SH for frail elderly in the worldworld

• SH technology (X10) was introduced in early SH technology (X10) was introduced in early 1980’s from Scotland.1980’s from Scotland.

• In 2000, SmartBo In 2000, SmartBo used an intelligent building control system (European Installation Bus) that controlled all lighting, most electric power outlets, the motorized lock of the entrance door, and motorized blinds, curtains, and window openers.

• When a person leaves the bed at night, dimmed lamps lighted the way from bedroom to bathroom. If the person does not return to bed after a pre-set time, the caregivers would then be alerted.

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SH for Frail Elderly in SH for Frail Elderly in the USthe US

• Allegheny Hospital McKeesport Aging Project in Allegheny Hospital McKeesport Aging Project in Pennsylvania.Pennsylvania.

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Comprehensive Needs Comprehensive Needs Assessments for SHAssessments for SH

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Purpose of the StudyPurpose of the Study

• To conduct a two-year To conduct a two-year randomized controlled trial randomized controlled trial on sustainability of on sustainability of independent living at smart independent living at smart home among home-based home among home-based older adults with chronic older adults with chronic conditions.conditions.

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Model toward Optimal Management of Model toward Optimal Management of Independence through Technological Independence through Technological

AdoptionAdoption

Independence (Living

at Home)

PersonalFactors

Physical Activities

Cognitive Activities

Psychological State

TA&HE

Family and Friends

Social/Community Support

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Research QuestionsResearch Questions1. Would frail elders accept the SH, if it is 1. Would frail elders accept the SH, if it is

provided to them?provided to them?2. Do older adults using SH maintain 2. Do older adults using SH maintain

physical function better than the control physical function better than the control group? group?

3. Do the users of SH maintain cognitive 3. Do the users of SH maintain cognitive function better than the control group? function better than the control group?

4. Do the users of SH experience less 4. Do the users of SH experience less depression than the control group? depression than the control group?

5. What are subjective evaluations of SH by 5. What are subjective evaluations of SH by frail elders?frail elders?

6. Is the rate of remaining at home for SH 6. Is the rate of remaining at home for SH residents higher than the control group?residents higher than the control group?

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Method: DesignMethod: Design

• Randomized Controlled Design Randomized Controlled Design NotationNotation

InitialInitial 1 year1 year 2 years2 yearsR TR T O O X X O X O X O O

R CR C O O O O O O

Where R is randomization, T is treatment Where R is randomization, T is treatment group, C is control group, O is observation group, C is control group, O is observation (assessment), and X is intervention (SH)(assessment), and X is intervention (SH)

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Method: SamplingMethod: Sampling

• Older adults (60+) who live alone, have Older adults (60+) who live alone, have difficulty in IADL or ADL for 90 days, and difficulty in IADL or ADL for 90 days, and are cognitively intact (MMSE>23), and are cognitively intact (MMSE>23), and intend to remain living in their own intend to remain living in their own home.home.

• Sample size: 90 (Based on power Sample size: 90 (Based on power analysis)analysis)

• Initially 46 Treatment and 67 ControlInitially 46 Treatment and 67 Control• 2 years later 34 Treatment (26% attrition)2 years later 34 Treatment (26% attrition)

and 44 Control (34% attrition)and 44 Control (34% attrition)

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InstrumentsInstruments

• X-10 ActiveHome kit and other X-10 ActiveHome kit and other modulesmodules

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Active Home Kit Includes:Active Home Kit Includes:

Two-Way Transceiver Module

5-in-1 Remote Control

LampModule

Interface

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Computer Operated Automated Computer Operated Automated FunctionsFunctions

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Automated Lighting Automated Lighting SystemSystem

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Remote Control Remote Control

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Coffee Maker Connected Coffee Maker Connected to X 10to X 10

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Door and Window SensorsDoor and Window Sensors

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Motion Sensor for windows and Motion Sensor for windows and doors doors

for securityfor security

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Alarm System Chime and Alarm System Chime and LightingLighting

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Power flash to control Power flash to control lights and chimeslights and chimes

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X10 devices used in the X10 devices used in the StudyStudy

X10 signal through existing wiring

Outlet Outlet

Computer

ActiveHome Software

Remote Control

TransceiverModule Lamp Module

LampLighting

MotionSensor

Interface

RadioFrequency

WindowDoorSecurity

Flash Unit

ChimeModule

Appliance Module

CoffeeMaker

WallSwitch

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ProcedureProcedure• A computer and/or A computer and/or

Internet were Internet were provided, if not owned.provided, if not owned.

• An OT or a nurse An OT or a nurse visited a participants visited a participants home for a 2.5 hour home for a 2.5 hour assessment.assessment.

• The initial The initial installation, done by installation, done by Jim, took three to nine Jim, took three to nine hours depending on hours depending on the size of the home. the size of the home.

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Training of Computer UseA computer should be running 24/7 for the automatic lighting features but the monitor can be turned off when it is not in use.Kathy visited participants an average of 5 times for training.

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Devices That Help Computer Access

Keyboard Enlargement Tabs

Trackball

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Instruments for Outcome Instruments for Outcome MeasurementMeasurement

• Functional StatusFunctional Status– FIM for ADL, OAR’s IADL, FIM for ADL, OAR’s IADL,

CHART mobilityCHART mobility

• Cognitive StatusCognitive Status– MMSEMMSE

(Center for Functional Assessment (Center for Functional Assessment Research,1990; Fillenbaum, 1988; Research,1990; Fillenbaum, 1988; Gilson, et al. 1975; Wolinsky, Callahan, Gilson, et al. 1975; Wolinsky, Callahan, Fitzgerald, & Johnson, 1993 Folstein, Fitzgerald, & Johnson, 1993 Folstein, Folstein & McHugh, 1988)Folstein & McHugh, 1988)

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Results: Initial Demographics and Results: Initial Demographics and Health Data of Participants who Health Data of Participants who

Survived for 2 YearsSurvived for 2 Years T (n=34)T (n=34) C (n=44)C (n=44)

• Age Age 72.072.0 75.6* 75.6*• Gender (F) Gender (F) 30 (88.2%)30 (88.2%) 39 (88.6%) 39 (88.6%)• Race (Minority) Race (Minority) 10 (29.4%)10 (29.4%) 8 8

(18.2%)(18.2%)• Housing (Own) Housing (Own) 19 (55.9%)19 (55.9%) 24 (54.5%) 24 (54.5%)• Education (≤HS) Education (≤HS) 11 (29.4%)11 (29.4%) 26 26

(59.1%)(59.1%)• Diabetes Diabetes 4 (11.8%) 4 (11.8%) 14 (31.8%)* 14 (31.8%)*• Urinary tract d.Urinary tract d. 1 (2.9%) 1 (2.9%) 9 9

(20.5%)*(20.5%)*

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Results: RQ 1 - Would frail elders Results: RQ 1 - Would frail elders accept theaccept the

SH, if it is provided to them? SH, if it is provided to them?

• 100% 100% ComputerComputer• 65%65% Active Home softwareActive Home software• 68%68% Remote control and chimesRemote control and chimes• 67%67% Wall switchWall switch• 62%62% Power flash for window/door Power flash for window/door

securitysecurity• 62%62% LightingLighting• 53%53% Motion detectorMotion detector• 52%52% CoffeemakerCoffeemaker

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Results: RQ 2 - Do older adults using Results: RQ 2 - Do older adults using SH maintain physical SH maintain physical

function better than the function better than the control group?control group?

Physical Dysfunction Level (<.001)Physical Dysfunction Level (<.001)

60

70

80

90

100

110

120

130

Initail 1st F 2nd F

T

C

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Results: RQ 2 - Do older adults using Results: RQ 2 - Do older adults using SH maintain physical SH maintain physical

function better than the function better than the control group?control group?

CHART Mobility (P<.001)CHART Mobility (P<.001)

70

75

80

85

90

Initail 1st F 2nd F

T

C

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Results: RQ3 - Do the users of SH Results: RQ3 - Do the users of SH maintain cognitive function better maintain cognitive function better

than the control group?than the control group?FIM Cognition (p<.001)FIM Cognition (p<.001)

20

25

30

35

40

Initail 1st F 2nd F

T

C

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Results: RQ5 - What are subjective Results: RQ5 - What are subjective evaluationsevaluations

of SH by frail elders? of SH by frail elders? • Importance of PC (Very Important): Importance of PC (Very Important):

26.5% (126.5% (1stst F. ) 82.4% (2 F. ) 82.4% (2ndnd F.) F.)

84.6%84.6% Knowledge gainKnowledge gain

71.8%71.8% More mental stimulusMore mental stimulus

59.0%59.0% Increased socializationIncreased socialization

43.6%43.6% Better health and wellnessBetter health and wellness

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Results: RQ5 - What are subjective Results: RQ5 - What are subjective evaluationsevaluations

of SH by frail elders? of SH by frail elders?NotNot SomeSome A Great A Great

DealDeal• Benefited from SH: Benefited from SH: 00 21% 21%

77%77%• Improved daily life: 30% Improved daily life: 30% 20% 20%

50%50%• Gained confidenceGained confidence12%12% 35% 35% 53%53%

• Recommend to Recommend to NoNo YesYes

older adultsolder adults 6%6% 91%91%

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Results: RQ5 - What are subjective Results: RQ5 - What are subjective evaluationsevaluations

of SH by frail elders? of SH by frail elders?Reasons for recommend or not Reasons for recommend or not

recommendrecommend

Recommend (n=31, 28 answered)Recommend (n=31, 28 answered)

50% Security,50% Security, 28.6% Safety, 28.6% Safety,

14.3% Easy access to lights, 2% 14.3% Easy access to lights, 2% comfortcomfort

Not Recommend (n=8)Not Recommend (n=8)

Bad experience, Erratic, The system is Bad experience, Erratic, The system is not working, Not very reliablenot working, Not very reliable

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Results: RQ6 - Is the rate of remaining Results: RQ6 - Is the rate of remaining at home for SH residents higher than at home for SH residents higher than

the control group?the control group? TreatmentTreatment ControlControl

Initial Initial 46 46 67672 years later2 years laterStill in the studyStill in the study 34 (73.9%) 34 (73.9%) 44 44 (65.7%)(65.7%)

DiedDied 6 (13.0%) 6 (13.0%) 6 (9.0%) 6 (9.0%)InstitutionalizedInstitutionalized 1 ( 2.2%) 1 ( 2.2%) 3 3 (4.5%)(4.5%)

Quit due to illness 3 ( 6.5%)Quit due to illness 3 ( 6.5%) 3 (4.5%) 3 (4.5%)Phone Disconnected 0 Phone Disconnected 0 10 (14.9%)10 (14.9%)P<.05P<.05

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DiscussionDiscussion• It is possible to create a SH for under $300, It is possible to create a SH for under $300,

excluding the computer and labor.excluding the computer and labor.• The major problem was lighting, but if a The major problem was lighting, but if a

person learns how to reset the timer on the person learns how to reset the timer on the computer, this became the most preferred computer, this became the most preferred feature for safety reasons and the reason for feature for safety reasons and the reason for continuity of living at home.continuity of living at home.

• SH/computer users maintained physical and SH/computer users maintained physical and cognitive functions over two years in contrast cognitive functions over two years in contrast to a significant decline among nonusers. to a significant decline among nonusers. Although increased comorbidity usually Although increased comorbidity usually translates to declines in motor function, for translates to declines in motor function, for the treatment group, SH systems could have the treatment group, SH systems could have prevented falls and injuries, and allowed more prevented falls and injuries, and allowed more independent daily activities. It is difficult to independent daily activities. It is difficult to measure what was prevented by use of SH. measure what was prevented by use of SH.

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DiscussionDiscussion• Finally, SH users continued living in their Finally, SH users continued living in their

own home significantly more than nonusers own home significantly more than nonusers (80% vs. 66%). SH may have prevented an (80% vs. 66%). SH may have prevented an injury and promoted an active life style. injury and promoted an active life style. Psychologically, feeling secure also may have Psychologically, feeling secure also may have encouraged frail elders to continue living at encouraged frail elders to continue living at home. Creating a SH needs skill, and living home. Creating a SH needs skill, and living in a SH requires patience in learning how to in a SH requires patience in learning how to operate SH technologies. Nevertheless, we operate SH technologies. Nevertheless, we conclude that retrofitting an older home with conclude that retrofitting an older home with smart home technology can be an effective smart home technology can be an effective coping strategy for remaining in one’s own coping strategy for remaining in one’s own home, increasing quality of life for older home, increasing quality of life for older adults with chronic conditions. adults with chronic conditions.

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AppendixAppendix

• Detailed statements of installation, Detailed statements of installation, problems and solutions can be found problems and solutions can be found in in www.agingresearch.buffalo.eduwww.agingresearch.buffalo.edu

• An example of SH technology was An example of SH technology was recreated in the basement of the recreated in the basement of the Independent Living Center on Main Independent Living Center on Main Street in Western New York, near Street in Western New York, near the South Campus of the University the South Campus of the University at Buffalo. at Buffalo.

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““I like Smart House and only I like Smart House and only wish this place were larger so wish this place were larger so

that I could take more that I could take more advantage of it.”advantage of it.”

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Crews for the studyCrews for the study

• Machiko R. TomitaMachiko R. Tomita• Kathy StantonKathy Stanton• William MannWilliam Mann• Jim PeronJim Peron• Vidya SundarVidya Sundar• Akihiko D. TomitaAkihiko D. Tomita• Mary BeckerMary Becker• Maria CastiloneMaria Castilone• Patty JahnPatty Jahn RERC-Technology for Successful RERC-Technology for Successful

AgingAgingThis project was funded by This project was funded by NIDRR, USDENIDRR, USDE