This workshop brought together needed interdisciplinary expertise, assess the state of the science at the human, medical, and technology levels, and articulate a research vision for a systems engineering approach to the development of technologies and solutions to support the home management of persons with significant chronic diseases and their family care providers. Effective home management of such chronic diseases as dementia, heart failure, hypertension, chronic obstructive airway disease (COPD), and asthma would reduce hospitalizations and other healthcare costs and improve quality of life. Currently, there is a paucity of research in these aging in place technologies (AiPT) from a systems approach that includes the expertise of both health and computer science. This workshop discussed challenges and opportunities and provide a research agenda regarding the next steps needed in the development and application of technology to home management of chronic diseases.
Needs and Justifications:
An understanding of the current status and future directions for AiPTs for aging, community living and independence is needed in order to examine critical gaps in knowledge, standards, and infrastructure supports. This workshop was needed to identify key research questions, measurement challenges, and strategies including scale-up evaluations and deployment or technology transfer.
- One important challenge in this field is the creation and validation of algorithms that rely on sensed data for home healthcare uses. Technologies used in home-based healthcare might include continuous, real-time, non-invasive monitors for health status, medical conditions, and disability. Current deficits in automated analysis of the data include identifying individualized care patterns driven by long-term longitudinal data, iterative validation of data (for inclusion in electronic medical records), and methods for integrating physiological, behavioral and psychological data. In particular, remotely sensed data requires authentication of data that is inherently unsupervised and potentially will require innovation for validation and comparison to current “gold” standards based on acute care settings.
- While many medical related sensing and actuation technologies have been developed, there are still significant barriers to widespread use. Research challenges include having these smart home systems deal with the logistics of deployments for elderly, sick, non-expert users over long time periods, and having these systems evolve as a patient’s medical problems change. Maintenance of the systems and continuous validation that the systems are operating correctly are also challenges. The level of accuracy required for the sensing and actuation systems are generally unknown.
- Along with novel sensing and measurement technologies, we can imagine information technology tools for integrating data from multiple sources, creating meaningful presentations and visualizations of information, and for integrating information into a person’s health record. Current deficits in information presentation tools include the visualization of passive and activity monitoring of daily activity as well as tools that mediate communication and information sharing among healthcare providers, patients and caregivers. All of this is coupled with a need for systems that can interact and respond for just-in-time interventions when needed. This problem space requires more advanced inquiry into such areas as the attitudes and beliefs of users, and the usability and utility of systems for the diverse stakeholders that may use these technologies.
- Additionally there is a need to explore methodologies for in-field evaluation and evolution of technology, addressing how one co-evolves technology and its evaluation in a medical context. In other computing domains, companies release software into the wild, observe how it’s used and evolve it quickly to address issues/opportunities that they discover. This process is counter to traditional NIH-style research. Given the speed in which technology changes occur, a more agile process is needed.
The outcome of this activity was the preparation of a white paper describing a research agenda to inform new federal research on home health technologies for an aging population. that will lead to randomized trials to test the use of these technologies for extending the active and healthy living for seniors. This workshop focused on the use of technologies and systems for health care, services and monitoring provided in the home and community that targets disorders common to substantial proportions of the aging population and persons with chronic disabilities.
Director of Global Healthcare Policy, Intel
Professor, Psychiatry and Behavioral Sciences & Industrial Engineering, University of Miami
Professor of Neurology and Biomedical Engineering, OHSU
Director of the Oregon Center for Aging and Technology (ORCATECH)
Buhl University Professor of ECE and Computer Science, CMU
Director, Quality of Life Technology Center (NSF ERC), CMU
BP America Professor of CS and Co-Director of the Wireless Health Center
Professor, Computer Science, University of Virginia
Professor of Interactive Computing, Georgia Tech, CCC Liaison
National Institutes of Health, National Heart, Lung and Blood Institute
National Institutes of Health, Office of the Director
Director, Computing Community Consortium
September 9, 2014 (Tuesday)
|06:30 PM||CCC Informal Networking Event | Embassy / Patuxent Room|
September 10, 2014 (Wednesday)
|08:30 AM||Opening Remarks
| NIH Building 31/6C, Room 6
Marie Bernard, M.D.
William Heetderks, M.D. Ph.D
|09:00 AM||Overview of the workshop
| NIH Building 31/6C, Room 6
Elizabeth Mynatt, Ph.D., Georgia Tech
|09:30 AM||Participant Introductions | NIH Building 31/6C, Room 6|
|11:00 AM||Insights and Realities of Designing for Older Adults and Their Caregivers
In this panel, we discuss the complex challenges of designing useful and usable services and technologies for older adults and their caregivers. We discuss the challenge of designing technologies that are useful as older adults healthcare needs evolve. We discuss how older adults view health and how health is integral in the activities of daily life. We discuss how general tools and services must be adapted for specific contexts.
In this panel we discuss the evolving landscape of technologies in the home and their potential to support aging in place. We address the complexities of relying on home technologies for health and healthcare including issues of reliability, security and trustworthiness. The panel will identify the limits of current technology and new research required for devices and systems. We will also discuss the challenges of integrating multiple data streams and the role of data analytics for aging in place.
|03:30 PM||Health transition trajectories: Data to action
In this panel we present a health state/transitions framework to using technology to support independence providing examples of how and where in transitions trajectories opportunities are found for technology utilization. Thus discussion during this theme session will focus on lessons and opportunities from across the continuum of change including: independent healthy people (focused on primary prevention) who may for example take advantage of utilization of health and fitness/lifestyle technologies, at risk populations (focused often on secondary prevention) who may benefit from technologies that identify subtle cognitive impairment or functional decline, and more dependent people (where tertiary prevention is a focus) who may be managed by tele-care approaches to mitigate excess morbidity.
|05:00 PM||Interim Remarks and Homework|
|06:00 PM||CCC Aging in Place Reception | Bethesda Hyatt Hotel, Concours Terrace|
September 11, 2014 (Thursday)
|08:30 AM||Open Discussion | NIH Building 35A, room 620/630 (middle room only)|
|09:00 AM||How to integrate Aging in Place in a Learning Healthcare System
| NIH Building 35A, room 620/630 (middle room only)
In this panel we discuss the challenges in moving from individual approaches for specific disease conditions to supporting an overarching system for healthy aging in place. Currently, much of the work on aging in place focuses on creating home healthcare system. Alternative approaches would bring health into all aspects of a person’s life. This panel will explore systems approaches to aging in place that target the internet of things, communities and a rethinking of a traditional health services focus.
|11:00 AM||Shaping the future of Aging in Place
Panelists: Mary Weick-Brady, MSN, RN, The Food and Drug Administration, Susan Miller, M.D., Centers for Medicare and Medicaid Services, Shari Ling, M.D., Centers for Medicare and Medicaid Services, and Melinda Buntin, Ph.D., Vanderbilt University
An understanding of factors that allow people to remain in their private homes or community are needed that show improved outcomes and cost-savings to providers in all demographic populations for people with disabilities and for people who are aging. The panelist will address the type of research needed to confirm costs and benefits in order to inform regulatory agencies and funding agencies.
|Lunch and Summary Panel
Panelists: Sara Czaja, Ph.D., University of Miami, Jeff Kaye, Ph.D., Oregon Health & Science University, John Stankovic, Ph.D., University of Virginia, Beth Mynatt, Ph.D., Georgia Tech, and Dan Siewiorek, Ph.D., Carnegie Mellon University
Click here for the Aging in Place Speaker Bios
Quality of Life Technologies in Supporting Family Caregivers by Czaja et al.
Wireless Sensor Networks for Healthcare by Ko et al.
Sensor Technology to support Aging in Place by Rantz et al.
Generation Smart-phone by Dan Siewiorek